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Case Fatality Rate is falling dramatically and currently 0.7% - from WHO

The CFR is hugely important and the media seems to have overlooked this critical stat - on the page it is currently listed as 3.4% - but Case Fatality Rates at the very beginning of a data set are not reliable. At the minimum here on Wikipedia we should list both what the current prediction is - 0.7% - versus what the early numbers were.

https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

Page 12, Paragraph 5 and the graph on page 13 shows the progressive fall in CFR

I am happy to do any specific written content if it helps, or someone with more Wikipedia experience might be better to champion this through. Twrobins (talk) 14:57, 18 March 2020 (UTC)

That's a pretty old report... Unfortunately CFR is rising in some parts of the world. --Gtoffoletto (talk) 15:19, 18 March 2020 (UTC)
The CFR is very context dependent. Let's try to present what several sources say, and be clear about what context each number refers to. Bondegezou (talk) 15:33, 18 March 2020 (UTC)
OK, I will try to hunt down some additional sources - really hard to find though. Any suggestions appreciated! Please add here and I will work on it.
On the age of that report - yes, I would agree it is a bit old, but also (I believe) the most trusted source. It also appears that is the source where the 3.4% comes from - so it itself is a moving/old stat. Listing both with some clarification maybe is the most appropriate.
I'll prep an edit as well with the above in mind. Twrobins (talk) 16:13, 18 March 2020 (UTC)
This is where I'd start. Bondegezou (talk) 16:39, 18 March 2020 (UTC)

Some papers (better sources in bold):

  • doi:10.1016/S0140-6736(20)30183-5, 24 Jan: early paper, found 15% mortality among those admitted to hospital in China
  • doi:10.3390/jcm9020523, 14 Feb: used epidemiological modelling to get around the problem of under-reporting of cases giving an inflated CFR. Says, "The latest estimated values of the cCFR [confirmed case fatality risk] were 5.3% (95% CI: 3.5%, 7.5%) for Scenario 1 and 8.4% (95% CI: 5.3%, 12.3%) for Scenario 2." The two scenarios make different assumptions about the starting date of the epidemic.
  • doi:10.1093/ajcp/aqaa029, 13 Feb: editorial, says 2-3%
  • doi:10.21037/atm.2020.02.66, approx. 12 Feb: "We estimated that CFR during the first weeks of the epidemic ranges from 0.15% (95% CI: 0.12–0.18%) in mainland China excluding Hubei through 1.41% (95% CI: 1.38–1.45%) in Hubei province excluding the city of Wuhan to 5.25% (95% CI: 4.98–5.51%) in Wuhan."
  • doi:10.1016/S0140-6736(20)30374-3, 13 Feb: comment piece, says 1-2%
  • doi:10.1016/j.ijantimicag.2020.105924, 17 Feb: calculates 2.5%
  • doi:10.3760/cma.j.issn.0254-6450.2020.02.003, 17 Feb: this is the Chinese Center for Disease Control and Prevention Report based on >40,000 cases, which found a 2.3% rate <-- clearly the best source up until this time
  • BMJ news report, 18 Feb: reporting of the Chinese Center for Disease Control and Prevention Report
  • doi:10.1016/S2213-2600(20)30076-X, 18 Feb: quotes a 2% mortality, but I can't see where they get the number from - presumably the Chinese Center for Disease Control and Prevention Report
  • doi:10.1001/jama.2020.2648, 24 Feb: cites a 2.3% mortality figure from Chinese Center for Disease Control and Prevention Report
  • doi:10.1111/tmi.13383, date unclear: calculates 2.2% from global figures
  • doi:10.31646/gbio.56, 11 Mar: uses epidemiological modelling to go from raw mortality figures of 2-3% to time-adjusted figures of 4.4%-4.8%
  • doi:10.1016/S1473-3099(20)30195-X, 12 Mar: uses epidemiological modelling to go from raw mortality figures of 3.6% in China and 1.5% outside China into time-adjusted figures of 5.6% for China and 15.2% outside China
  • doi:10.1101/2020.03.07.20032573, 12 Mar: only a pre-print, but a systematic review. CFR is 3.7%, but 10.4% in Hubei vs. 0.6% in the rest of China
  • doi:10.3760/cma.j.cn112338-20200228-00209, approx. 14 Mar: detailed study of the outbreak in Guangzhou - finds a 0.29% mortality rate   edit by User:Bondegezou 19:10, 18 March 2020    DMBFFF (talk) 00:43, 19 March 2020 (UTC)

FWIW,
"Coronavirus Is Hiding in Plain Sight

For every known case of coronavirus, another five to 10 cases are out there undetected, a new study suggests."

https://www.nytimes.com/2020/03/16/health/coronavirus-statistics-undetected.html?utm_source=pocket-newtab
March 16, 2020
DMBFFF (talk) 00:43, 19 March 2020 (UTC)

The popular press is not a reliable source for medical content. WHO says this is not the case. Doc James (talk · contribs · email) 14:25, 21 March 2020 (UTC)
Got it, working on it in a sandbox and can share that back asap - Twrobins (talk) —Preceding undated comment added 05:06, 19 March 2020 (UTC)

I started making this over here - should I move that into somewhere better? https://en.wikipedia.org/wiki/User:Twrobins/cfrdraft/sandbox2 — Preceding unsigned comment added by Twrobins (talk • contribs) 06:02, 19 March 2020 (UTC)

For the CFR we should stick with sources per WP:MEDRS. We should not be using the popular press or primary sources. Doc James (talk · contribs · email) 14:18, 21 March 2020 (UTC)
Indeed. And we have sources aplenty. Let's use them. Some more:

Add the official CFR from Spain ( https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov-China/documentos/Actualizacion_52_COVID-19.pdf ) — Preceding unsigned comment added by 2003:C0:A740:4472:D0CC:902D:D02E:BA84 (talk) 13:16, 23 March 2020 (UTC)

New CFR Data from Spain (26.03.2020): https://www.mallorcadiario.com/adjuntos/550771/Actualizacion_56_COVID-19.pdf New CFR Data frim Italy (25.03.2020) : https://www.epicentro.iss.it/coronavirus/bollettino/Infografica_25marzo ENG.pdf — Preceding unsigned comment added by 2003:C0:A740:4422:580B:5263:7149:22FA (talk) 13:36, 26 March 2020 (UTC)

CFR Data from Nederland : https://www.rivm.nl/sites/default/files/2020-03/Epidemiologische situatie COVID-19 26 maart 2020.pdf — Preceding unsigned comment added by 2003:C0:A740:4422:580B:5263:7149:22FA (talk) 14:07, 26 March 2020 (UTC)

CFR Update from Spain 01.04.2020: https://www.mallorcadiario.com/adjuntos/551082/Actualizacion_62_COVID-19.pdf CFR Update from Italy 01.04.2020: https://www.epicentro.iss.it/coronavirus/bollettino/Infografica_1aprile ENG.pdf CFR Update from Nederland 31.03.2020: https://www.rivm.nl/sites/default/files/2020-03/COVID-19_WebSite_rapport_20200331_1145_2.pdf — Preceding unsigned comment added by 2003:C0:A71B:CF37:6DF5:792C:2910:32B3 (talk) 10:24, 2 April 2020 (UTC)

Research project

Hi. There seems to be a notable Canadian COVID-19 research initiative at the Montreal Heart Institute: https://www.cbc.ca/news/canada/montreal/montreal-heart-institute-study-colchicine-1.5506930 . I would think it belongs somewhere in the Research section of this article? Or is it not of global import? It seems to me to be a large double-blind study. I had added to the frwiki article on the pandemic in Canada, and then proposed it for the enwiki Canadian article but it didn't seem to fit there, given that it is not a gov't initiative. Regardless of what happens on that page, I thought I'd flag it here in case someone thinks it merits inclusion. There are other refs for it, in addition to the CBC News ref above. thank you, Shawn in Montreal (talk) 14:52, 29 March 2020 (UTC)

In the subarticle about research maybe? Doc James (talk · contribs · email) 21:18, 31 March 2020 (UTC)

HOW ABOUT TB vaccine (a.k.a BCG) ?

Australians trial TB vaccine to fight coronavirus https://www.france24.com/en/20200326-australians-trial-tb-vaccine-to-fight-coronavirus

Map displaying BCG vaccination policy by country. (in 2011) https://www.researchgate.net/figure/Map-displaying-BCG-vaccination-policy-by-country-A-The-country-currently-has-universal_fig2_50892386

In addtion, (1) BCG vaccination history of individuals and actual rates of vaccinated people may differs even in the same group of nations. (2) The BCG strain of vaccine differs in every each nations. (3) In Japan, the mortality rate of persons aged 69 or older (only those from Japan) who are suspicious of not having vaccinated a BCG is significantly higher. (4) In most nations, ones over 40 years old increases the severity rate with age (correlated with a decrease in antibody titer) --Kyuri1449 (talk) 04:19, 29 March 2020 (UTC)

--Kyuri1449 (talk) 04:48, 29 March 2020 (UTC)

Would belong in the article about research. Doc James (talk · contribs · email) 21:19, 31 March 2020 (UTC)

Tocilizumab

Watchers of this page might want to also watchlist Tocilizumab, some recent additions [1] there might not comply with MEDRS guidelines. Posting here for maximum exposure. Geogene (talk) 07:16, 30 March 2020 (UTC)

thank you for post--Ozzie10aaaa (talk) 00:41, 1 April 2020 (UTC)

Origination in bats from southeast asia

Hi Everyone,

According to Scientific America, the Coronavirus is believed to have originated in bats in Southeast Asia. It is believed to have jumped species at least once (to pigs or horses), and then jumped species again to humans (in market places). The research was performed by a team led by Wuhan-based virologist Shi Zhengli.

The genomic sequence of the virus—now officially called SARS-CoV-2 because it is related to the SARS pathogen—was 96 percent identical to that of a coronavirus the researchers had identified in horseshoe bats in Yunnan, they reported in a paper published last month in Nature. “It’s crystal clear that bats, once again, are the natural reservoir,” says Daszak, who was not involved in the study.

Also see How China’s “Bat Woman” Hunted Down Viruses from SARS to the New Coronavirus.

I believe the information would make a good addition to the article. What I am less sure about is, where to add the information.

Jeffrey Walton (talk) 05:09, 31 March 2020 (UTC)

According to Severe acute respiratory syndrome coronavirus 2, the intermediate species was pangolin, not pig or horse. Dutchy45 (talk) 16:00, 31 March 2020 (UTC)
The pangolin study has been criticised. We should acknowledge there are several theories as to the intermediate species. Bondegezou (talk) 10:20, 1 April 2020 (UTC)

Misleading translation

According to translation of ([183] to English, this sentence:

They also said that the high number of fatalities in Italy is caused by a high percentage of ACE inhibitors used to treat high blood pressure, and at the same time they warn to change medication as it may lead to heart attacks.[183]

should read

They also said that the high number of fatalities in Italy is caused by a high percentage of ACE inhibitors used to treat high blood pressure, and at the same time they warn not to change medication as it may lead to heart attack or stroke. Blacki999 (talk) 01:04, 1 April 2020 (UTC)

Done Veritycheck✔️ (talk) 19:02, 1 April 2020 (UTC)

Mortality/fatality numbers in intro

Following a discussion on the pandemic talk page, the Epidemiology section of this topic was updated to present a single global death-to-case ratio. However, the intro paragraph still contains some bad numbers:

As of 28 March 2020, the overall rate of deaths per number of diagnosed cases is 4.7 percent; ranging from 0.2 percent to 15 percent according to age group and other health problems.[14] In comparison, the mortality rate of the 1918 flu pandemic was approximately 3% to 5%.[15]

There are a few issues:

  • 4.7% is the death-to-case ratio, not the CFR, which the immediately adjacent linked text implies. It's a finer point but one that we try to make in the Epidemiology section.
  • The text attempts to compare COVID-19's death-to-case ratio to the Spanish flu's mortality rate. The two numbers are not apples to apples. The Spanish flu's death-to-case ratio would be some multiple of the mortality rate.
  • Lastly, the range .2% to 15% is attributed to age and health factors but omits other variables defined in Epidemiology.

I'd propose removing these two sentences for now and letting interested readers find their way to Epidemiology for the number. - Wikmoz (talk) 07:31, 1 April 2020 (UTC)

I support removal too. The comparison with Spanish flu is WP:SYNTH unless there's a WP:MEDRS-compliant citation clearly making that comparison. The CFR number quoted is definitely a poor estimate of the true mortality: we have oodles of reliable sources explaining the huge limitations of just dividing a number for deaths by a number for cases. What we can include are good estimates of the CFR from secondary/tertiary sources. Bondegezou (talk) 10:18, 1 April 2020 (UTC)
I also support the removal of deaths per number of diagnosed cases. Moreover, the ratio of deaths to those who have definitively recovered would provide a much more accurate picture of the mortality rate as a true CFR does. As of today and 236,439 closed cases, 190,907 (81%) recovered/discharged – while 45,532 (19%) resulted in death. Again, citing deaths as a percentage of total unresolved cases is misleading. N.B. In reality, a much larger percentage than 1-4% will die from the virus once total active cases have resolved. Let's not forget a CFR can only be considered final when all the cases have been resolved (either died or recovered). Veritycheck✔️ (talk) 18:45, 1 April 2020 (UTC)
@Verity the percentage may also go down given that severe cases are more likely to be diagnosed. That said, it looks like everyone agrees that the current version is misleading. I've replaced it with the analogous description from the pandemic article that reports the counts instead. Sunrise (talk) 20:09, 1 April 2020 (UTC)

Semi-protected edit request on 1 April 2020

The article lists "Inhaled Nitrous Oxide" as one of the therapeutic methods for ARDS. This is not the case. It is Nitric (not Nitrous) oxide. There is a big difference so please change it. Nitrous oxide (N2O) is laughing gas/an anaesthetic, Nitric Oxide (NO) is not. 2A02:C7D:500A:2600:E83A:7E4:6521:1086 (talk) 18:16, 1 April 2020 (UTC)

Done. Veritycheck✔️ (talk) 20:54, 1 April 2020 (UTC)
N.B. Did not find Nitric Oxide (NO) in the source provided either, so did not add it - just deleted Nitrous oxide (N2O). Veritycheck✔️ (talk) 20:58, 1 April 2020 (UTC)

citation (not) needed

At "7.1 Reinfection" there is a "citation needed" upperscript after "It is unclear if these cases are the result of reinfection, relapse, or testing error." These are the only 3 possibilities, therefore citation is not needed. I would have deleted myself, but this is 1 of the pages with a serious protection warning, so I thought it best to leave this here. --Dutchy45 (talk) 15:53, 31 March 2020 (UTC)

I wrote that sentence... apart from the fact that those are the only possibilities I thought the sources just before said exactly that. In any case I would also take it out. --Gtoffoletto (talk) 19:43, 31 March 2020 (UTC)
I think they could also be due to recording, transcription or bookkeeping errors.Kdammers (talk) 14:44, 1 April 2020 (UTC)
What's more, the claim that something "is unclear" is itself a statement that needs to be cited, and also has to be anchored in time - it could very well become untrue if new research comes out that finds an explanation for these cases. Regards, HaeB (talk) 11:30, 2 April 2020 (UTC)

"China's aggressive gift to the world"?

What does this sentence mean exactly?: "It also implies that the pandemic is China's aggressive gift to the world, when actually thousands of Chinese suffered and died from COVID-19, especially in Wuhan." It's strange English and the citations are Fox News and a Salon editorial rather than an authoritative source—not sure what it adds beyond the WHO recommendation to "avoid references to a specific geographical location", which is already mentioned in that section. —Nizolan (talk · c.) 11:23, 2 April 2020 (UTC)

Agree. I reworded for now pending further edits from other editors.MartinezMD (talk) 16:01, 2 April 2020 (UTC)

Case fatality rate

Why does our article say that the case fatality rate is 4.6% even though this doesn't appear anywhere in the cited source? The cited source says 3.4% or 3%. If we're simply dividing the number of cases by the number of deaths, the cited source says that's probably misleading: "It is tempting to estimate the case fatality rate by dividing the number of known deaths by the number of confirmed cases. The resulting number, however, does not represent the true case fatality rate and might be off by orders of magnitude... While an epidemic is still ongoing, as it is the case with the current novel coronavirus outbreak, this formula is, at the very least, 'naïve' and can be misleading if, at the time of analysis, the outcome is unknown for a non negligible proportion of patients." Since the number of cases is increasing exponentially and there is an average 2 week lag between infection and death, doesn't that mean that a large percentage of the total number of cases have an unknown outcome? It seems like it would be safer to stick to estimates by cited experts rather than doing our own research. Kaldari (talk) 03:20, 31 March 2020 (UTC)

Good points Kaldari. I think the estimates of the overall mortality rate are important. If you make an edit please ensure there is something that speaks to a mortality rate, even if it paints with a broad brush. I visited the Wikipedia article to find an early estimate.
To give you something to compare against, the 1918 Spanish Flu article provides a lot of details of the flu's mortality rate across age groups and broken down by country and wave experienced across the world.
Jeffrey Walton (talk) 05:17, 31 March 2020 (UTC)
Per WP:CALC 41494/846,156 = 4.7% Doc James (talk · contribs · email) 21:16, 31 March 2020 (UTC)
But we've agreed previously that WP:CALC does not apply, that reliable sources are clear on how poor that calculation is. We should not be doing that calculation ourselves. Bondegezou (talk) 10:21, 1 April 2020 (UTC)
The number has been removed from the intro and correctly presented as the death-to-case ration in the Epidemiology section. It is preceded by an explanation that the number is influenced by many variables. It's fair to argue how useful this particular ratio is (especially relative to infection fatality rate) but the calculation is accurate. - Wikmoz (talk) 21:29, 2 April 2020 (UTC)

Cytokine storm

> I suggest to insert this in the 'Anti-cytokine strom' chapter, after footnote 261 (the part about ’tocilizumab’):

Anakinra (an active agent of Kineret injection) has also been proved to be useful against cytokine storms footnote:https://www.uab.edu/reporter/know-more/publications/item/8909-here-s-a-playbook-for-stopping-deadly-cytokine-storm-syndrome Footnote:https://www.medicines.org.uk/emc/product/559/smpc

and is also officially tested in Italy as a possible medicine against cytokine strom syndrome. footnote: https://www.bresciaoggi.it/studio-sui-farmaci-parte-oggi-al-civile-e-in-altri-3-ospedali-1.8011673

https://en.wikipedia.org/wiki/Talk:Coronavirus_disease_2019#Semi-protected_edit_request_on_1_April_2020

Szíjúszún (talk) 20:18, 3 April 2020 (UTC)

Age, gender, and preexisting conditions -> mortality rate

I have found a lot of news stories with statistics on these, but I am not sure if that can be added without MEDRS compliant studies. It is an important detail that should be in the article. buidhe 01:34, 4 April 2020 (UTC)

Details are here Coronavirus_disease_2019#Prognosis Doc James (talk · contribs · email) 16:08, 4 April 2020 (UTC)

Orphaned references

In the current version of the article, nine footnotes throw a "invoked but never defined" error. It seems that for some reason AnomieBOT was not able to complete its usual task to restore the citations orphaned in Special:Diff/948553290. If someone has a moment to sort these out manually, that would be great.

Regards, HaeB (talk) 11:51, 2 April 2020 (UTC)

Spitfire8520 has now fixed this - thanks! Regards, HaeB (talk) 20:12, 4 April 2020 (UTC)

Death by COVID or with COVID ?

Hi, United states tested 0.1% of their population as positive. There could be 1% to 10% infected. At this critical mass we should start hearing about death WITH covid instead of FROM covid. For exemple car accidents. Is there anything about that in the sources yet ? Iluvalar (talk) 01:28, 4 April 2020 (UTC)

Not that I am aware of. Doc James (talk · contribs · email) 16:19, 4 April 2020 (UTC)
You're saying that once infection becomes more prevalent and treatment improves, we'll get to a point where it's necessary to distinguish that Person X had COVID but died from a car accident or heart attack? There's some limited talk of this given a hospital reimbursement scheme currently being considered in the US but I haven't seen it discussed outside of that context. - Wikmoz (talk) 18:20, 4 April 2020 (UTC)
@Wikmoz and Doc James: — WP:DONTFEEDTHETROLL Carl Fredrik talk 18:35, 4 April 2020 (UTC)
WP:FAITH ? nah ? not for you ? Yes Wikmoz, it seems inevitable that we'll have to account for that. We are heading to 9%-25% of all deaths in the world having COVID right now. But some of them will be asymptomatic or mild cases. It is bound to be discussed at some point. But I won't do WP:OR, i have someone who watch me for that. Iluvalar (talk) 20:54, 4 April 2020 (UTC)

COVID acronym?

I've read on various websites that COVID is an acronym for Chinese-Originated Viral Infectious Disease. Is this correct?

No, it's an acronym for COronaVIrus Disease. Jayab314 23:08, 4 April 2020 (UTC)
Thanks. Aaaaaabbbbb111 (talk) 23:10, 4 April 2020 (UTC)
You could just read the article here. It is very clear. Coronavirus_disease_2019#Terminology MartinezMD (talk) 23:24, 4 April 2020 (UTC)
There is a fair amount of people who want to blame the Chinese government. Turns out, not everyone like dictatorships. I heard that acronym before. Seems like just fake news. Iluvalar (talk) 01:47, 5 April 2020 (UTC)

Research; Povidone-I

Regarding; Povidone-I, based on SARS of 2002/3[2]. Any opinion on nasal inhalation and oropharyngeal wash of PVP-I should be used in the current COVID-19 pandemic to limit the spread of SARS-CoV-2 from patients to healthcare workers (and vice versa) and thus reduce the incidence of COVID-19.[3]... in reseach section maybe. Whispyhistory (talk) 13:29, 2 April 2020 (UTC)

That's an old study on SARS. We can only talk about this drug in the context of SARS-CoV-2 if a MEDRS-compliant source makes the link. Bondegezou (talk) 13:34, 2 April 2020 (UTC)
@Bondegezou: The second link...published this week.. [4]. Whispyhistory (talk) 14:55, 2 April 2020 (UTC)
That's better, but it's still only a proposal. There's no data in that second paper. That's not much to go on, as per WP:MEDRS. Wikipedia is not a science journal for breaking ideas. It's an encyclopaedia. Bondegezou (talk) 17:15, 2 April 2020 (UTC)
I guess the question is, is it sufficient to add to the research section as something being looked at? Doc James (talk · contribs · email) 16:51, 4 April 2020 (UTC)
I think it's premature at this point. They're throwing the kitchen sink at this problem so there can be hundreds of investigations. I'd wait for inclusion of any until we see good trials or widespread implementation. MartinezMD (talk) 17:44, 4 April 2020 (UTC)
Thanks...It's being looked at or according to this, maybe overlooked. Will keep a watch on it. May have more information in coming days. Whispyhistory (talk) 06:37, 5 April 2020 (UTC)

Strong possibility virus escaped Wuhan lab

Why isn't this in the article? There are numerous sources reporting this. For example:

https://www.news.com.au/lifestyle/health/health-problems/researchers-pinpoint-facility-near-wuhan-seafood-market-as-possible-ground-zero/news-story/d51925ef5b00711e29e194ac73be7951
https://metro.co.uk/2020/02/17/coronavirus-start-chinese-lab-bats-attacked-scientists-peed-12252873/
https://nytimespost.com/coronavirus-bombshell-real-cause-of-outbreak-claim-chinese-scientists-break-cover/
https://www.express.co.uk/news/weird/1251719/coronavirus-china-bioweapon-experiment-lab-leak-wuhan-seafood-market-spt
http://newshourfirst.com/2020/02/17/experts-confirm-killer-virus-leaked-from-lab/
https://legalinsurrection.com/2020/04/msm-can-no-longer-ignore-theory-that-wuhan-coronavirus-spread-from-a-chinese-lab-accident/

Here's a link to the original article: https://gofile.io/?c=D4zfxD — Preceding unsigned comment added by Rhejhect (talk • contribs) 16:26, 3 April 2020 (UTC)

It doesn't belong in the article because it's purely tabloid speculation. HiLo48 (talk) 16:42, 3 April 2020 (UTC)
Because the "Theory that Coronavirus Escaped from a Lab Lacks Evidence"[1][2] MartinezMD (talk) 16:49, 3 April 2020 (UTC)
A perfect example of why WP:MEDRS is so important. Doc James (talk · contribs · email) 16:20, 4 April 2020 (UTC)

References

  1. ^ "Theory that Coronavirus Escaped from a Lab Lacks Evidence". The Scientist Magazine. 2020-03-05. Retrieved 2020-04-03.
  2. ^ "The proximal origin of SARS-CoV-2". Nature Medicine. Retrieved 2020-04-03.
Actually WP:MEDRS doesn't apply here because it's not a medical issue. There's credible speculation that it escaped the lab and that this is China's Chernobyl. Rhejhect (talk) 09:46, 5 April 2020 (UTC)
I find "credible speculation" an interesting concept, and not at all convincing. HiLo48 (talk) 10:16, 5 April 2020 (UTC)
WP:SPECULATION - this subject is not suitable for the article. MartinezMD (talk) 17:45, 5 April 2020 (UTC)

Semi-protected edit request on 5 April 2020

Chrisroby2000 (talk) 23:00, 5 April 2020 (UTC)

COVID19 was originated from. Wuhan China

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. Yes, we know that EvergreenFir (talk) 23:58, 5 April 2020 (UTC)
Chrisroby2000 lead mention >> "The disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province". Is that meet your request ? Prodigyhk (talk) 06:18, 6 April 2020 (UTC)

Disinfecting solutions

Could somebody clarify this statement: Surfaces may be decontaminated with a number of solutions (within one minute of exposure to the disinfectant for a stainless steel surface), including 62–71% ethanol (alcohol used in spirits), 50–100% isopropanol (isopropyl alcohol), 0.1% sodium hypochlorite (bleach), 0.5% hydrogen peroxide and 0.2–7.5% povidone-iodine. I'm pretty sure that's meant to be a list of five different solutions, but if you read it quickly, it sounds like a solution made of those five different things, all mixed together. -- RoySmith (talk) 16:56, 6 April 2020 (UTC)

Replace "and" with "or"? HiLo48 (talk) 22:24, 6 April 2020 (UTC)
Good catch. I've changed to or and added an Oxford comma. - Wikmoz (talk) 23:39, 6 April 2020 (UTC)

????

Who was this written by? Could you give me a name, along with there talk page? Thx.
Shadowblade08 (talk) 14:24, 6 April 2020 (UTC)
Shadowblade08, Wikipedia pages are written by lots of different people. If you click on the 'View history' tab, you can see who wrote what. Bondegezou (talk) 14:49, 6 April 2020 (UTC)
Thanks.
Shadowblade08 (talk) 14:08, 7 April 2020 (UTC)

Semi-protected edit request on 1 April 2020

I suggest to insert this in the 'Anti-cytokine strom' chapter, agter footnote 253: Anakinra (an active agent of Kineret injection) has also been proved to be useful against cytokine storms footnote:https://www.uab.edu/reporter/know-more/publications/item/8909-here-s-a-playbook-for-stopping-deadly-cytokine-storm-syndrome Footnote:https://www.medicines.org.uk/emc/product/559/smpc

and is also officially tested in Italy as a possible medicine against cytokine strom syndrome. footnote: https://www.bresciaoggi.it/studio-sui-farmaci-parte-oggi-al-civile-e-in-altri-3-ospedali-1.8011673 Szíjúszún (talk) 00:31, 1 April 2020 (UTC)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. Alucard 16❯❯❯ chat? 03:59, 8 April 2020 (UTC)

Disease X for other name of COVID 19

I was thinking added a name for COVID-19 Disease X. I had added news link from Bloomberg. The only problem is when I put it in the infobox it has some problems with it can someone fix it please Thanks. — Preceding unsigned comment added by CrusaderToonamiUK (talk • contribs) 11:53, 8 April 2020 (UTC)

Disease X is a separate topic, already linked in the See also from this topic. It isn't a synonym for this topic, so I removed it (fixing the markup breakage, and fixing the removal of the "Early names:" label). Widefox; talk 12:04, 8 April 2020 (UTC)
@CrusaderToonamiUK: I reverted you re-adding it with different links - I agree with Widefox, COVID-19 is (or may be) Disease X, but other diseases may fit its definition as well, so is not its synonym. – attomir (talk | contribs) 15:27, 8 April 2020 (UTC)
Yes. User:CrusaderToonamiUK please note the DS notice on your talk. You should not redo your edit after it is undone, but first discuss here to reach WP:CONSENSUS in future. Failure to take notice of this best practice may result in being blocked without notice, being as you've disruptively edited this article, and started to edit war over it. Widefox; talk 15:42, 8 April 2020 (UTC)

We need a page about Post COVID-19 Syndrome

They are some report that some patients had reduced lung function and may lead to pulmonary fibrosis. So i got a idea. I know you may not agreed but we need page about this

Here is the link about it from Hong Kong: South Morning News Report — Preceding unsigned comment added by CrusaderToonamiUK (talk • contribs) 14:33, 8 April 2020 (UTC)

We have a section here on prognosis which could be imporved. Coronavirus_disease_2019#Prognosis Doc James (talk · contribs · email) 17:05, 8 April 2020 (UTC)

Semi-protected edit request on 8 April 2020

Why did you get rid of the global/country cases/death/recover table? 67.246.226.134 (talk) 12:14, 8 April 2020 (UTC)

Fixed.[5] Doc James (talk · contribs · email) 17:07, 8 April 2020 (UTC)

Blood type

There is a study done investigating the correlation between rates of infection and blood type (https://www.medrxiv.org/content/10.1101/2020.03.11.20031096v2). The study's results have not be peer-reviewed, but they have drawn comments in the media and on fact-checkers (e.g., http://theconversation.com/coronavirus-are-people-with-blood-group-a-really-at-higher-risk-of-catching-covid-19-134181, https://www.usatoday.com/story/news/factcheck/2020/04/01/fact-check-coronavirus-blood-type-a-more-susceptible/2922465001/, https://www.healthline.com/health-news/does-your-blood-type-increase-your-risk-for-coronavirus#Things-to-keep-in-mind, https://www.sciencealert.com/paper-suggests-certain-blood-types-might-be-slightly-more-susceptible-to-covid-19, https://www.coronavirustoday.com/blood-type-people-might-need-strengthen-personal-protections-sars-cov-2) which mostly caution on promulgating the conclusions. Strangely, I have found no other reports testing for a blood-type/ infection correlation (which would be easy enough to conduct). We should watch the results of peer reviewing of the original study and look for other studies to see if this should be included in our article in one way or another. Kdammers (talk) 02:18, 6 April 2020 (UTC)

A statement that a link exists between blood type and rate of infection would be a biomedical claim subject to WP:MEDRS. We would need to wait for these sort of studies to be reviewed in a good secondary source. --RexxS (talk) 03:15, 6 April 2020 (UTC)
we can include it with a suitable disclaimer that the information is not peer reviewed. This is a decision we as editors can come to a consensus and proceed on a case-t-case basis. Prodigyhk (talk) 06:34, 6 April 2020 (UTC)
@Prodigyhk: We cannot include it without a reliable secondary source. Please read WP:MEDRS and try to understand the difference between "peer-reviewed" and "secondary". This isn't a matter for local consensus, it's a project-wide guideline, and breaching it is disruptive editing. --RexxS (talk) 17:41, 6 April 2020 (UTC)
@RexxS: did notice the fences our admins have put around these articles. hence, providing my comments here in talk page. Is there a page where the guidelines are being discussed for this topic ? Prodigyhk (talk) 03:27, 7 April 2020 (UTC)
@Prodigyhk: Articles on medical topics can potentially draw on a huge number of published peer-reviewed articles, but they often suffer from the problem that their conclusions are not reproducible. If you're interested in the problem, I can recommend "Challenges in irreproducible research" from Nature as a good starting point. The problem has resulted in the project-wide agreement that all biomedical claims must be sourced to reliable published secondary sources, as explained in WP:MEDRS. The situation here, of course, is that on-going research is proceeding very rapidly and so there are many articles related to to Covid-19 being published all of the time. The goal of the admins (and other experienced editors) is to try to keep our coverage as accurate and encyclopedic as possible. We are not a news site, and tempting as it may be to report every potential breakthrough in research, that isn't the job of an encyclopedia, which is to summarise the accepted published mainstream knowledge on a topic, and it takes time for secondary sources to sift through the myriad of sometimes conflicting primary sources and produce conclusions that we can report with some degree of confidence. I understand your enthusiasm, but please, temper it with a little patience; if a relationship between blood type and rate of infection does exist, it will be analysed in reliable secondary sources in good time, and that is when we can convincingly report on it in Wikipedia. Cheers --RexxS (talk) 13:05, 7 April 2020 (UTC)
support inclusion with suitable disclaimer the claim is not peer reviewed Prodigyhk (talk) 06:34, 6 April 2020 (UTC)
oppose inclusion until we have some better sourcing. Bondegezou (talk) 14:50, 6 April 2020 (UTC)

Antibodies Test Being Developed at University of Montreal

In Quebec, Canada, University of Montreal chemistry professor Jean-François Masson is currently working on a portable antibody test to determine who has been infected with Covid-19. The test detects antibodies that are produced in response to the virus when the body is fighting it. The test is important for prevention of the virus because it can illuminate many factors, including what fraction of the population (i) will be or is currently immunized, (ii) do or do not develop symptoms, and (iii) will or will not be among the first to receive the eventual vaccine.[1] --TheoryNeutral (talk) 18:38, 5 April 2020 (UTC)

There must be hundreds if not thousands of people developing or who claim to have developed antibody tests. Some of these are even sold commercially. We already mention "As of 19 March 2020, antibody tests (which may detect active infections and whether a person had been infected in the past) were in development." This could maybe do with an update or we could mention approvals e.g. FDA and of course if any test begins to be used in more widespread. But I don't see any real reason to single out any particular test under development. Nil Einne (talk) 20:24, 5 April 2020 (UTC)
Agree with Nil Einne: we don't need to list every news report of work on tests or (vaccines or antivirals), as per WP:NOT. We should focus on doing the broad view well. Bondegezou (talk) 15:01, 6 April 2020 (UTC)
Antibody tests are being developed all over the world... What will be interesting is when we have evidence on how useful these tests are when 1) they are actually clinically avaliable 2) we have guidelines around their use. Doc James (talk · contribs · email) 17:38, 8 April 2020 (UTC)

References

  1. ^ Gobeil, Mathieu. "Développer des tests sérologiques fiables, la clé pour les prochains mois". Radio Canada. Société Radio‑Canada. Retrieved 5 April 2020.

No mention of Chinese government cover-up?

Presently, this may be the most disgraceful article on Wikipedia. It's not racist to mention the active measures taken by the Chinese government to suppress early reports of this disease, and punish those who reported cases. I see Wikipedia is allowing itself to be cowed by sock-puppet editors/propagandists from the CPC. The Chinese people are not at fault, and no reasonable people are saying they are. Their leadership is. For those of us who actually care about facts, this is a desecration. Omitting it is two steps removed from "Oceania had always been at war with Eastasia".

2601:18F:4101:4830:D142:D6F7:5353:6DB6 (talk) 22:08, 5 April 2020 (UTC)

Reliable sources are required for such claims. Also, stop with the polemics. EvergreenFir (talk) 22:10, 5 April 2020 (UTC)
Early information suppression by China is appropriately discussed in a number of Wikipedia topics on the pandemic. This is a medical topic that deals with the specifics of the disease, not the outbreak. If you're interested in information on government responses, visit the many topics covering the pandemic. - Wikmoz (talk) 01:17, 6 April 2020 (UTC)
The numbers reported from many countries must be subject to doubt, for many reasons, including government suppression in probably quite a few cases. Hating on China alone says more about the OP than anything else. HiLo48 (talk) 01:26, 6 April 2020 (UTC)

I specifically said that this is not the fault of the Chinese people, just the government. The Chinese government is uniquely responsible and therefore deserving of criticism in this case for the obvious reason that this began in China, and the government's knowing concealment resulted in an unprecedented spreading of the virus. No one is "hating". If you want to make unsubstantiated reactive generalizations, than let me ask you, when did you stop beating your wife? 2601:18F:4101:4830:D142:D6F7:5353:6DB6 (talk) 01:49, 6 April 2020 (UTC) 2601:18F:4101:4830:D142:D6F7:5353:6DB6 (talk) 01:43, 6 April 2020 (UTC)


Here are a few reliable sources for my "claim", that the Chinese government covered up the outbreak of this virus, and punished those who reported it. If you'd like more, I can provide you with several dozen more. In other breaking news, the moon is not made of cheese.


https://www.bbc.com/news/world-asia-china-51409801

https://www.wsj.com/articles/china-rescinds-penalty-for-late-doctor-who-warned-about-coronavirus-11584637545

https://www.theguardian.com/world/2020/mar/20/chinese-inquiry-exonerates-coronavirus-whistleblower-doctor-li-wenliang

https://www.nytimes.com/2020/04/03/world/asia/coronavirus-china-grief-deaths.html

https://www.wsj.com/articles/world-health-coronavirus-disinformation-11586122093

https://www.bloomberg.com/news/articles/2020-04-01/china-concealed-extent-of-virus-outbreak-u-s-intelligence-says

https://www.ft.com/content/efdec278-6d01-11ea-9bca-bf503995cd6f

https://nymag.com/intelligencer/2020/04/u-s-intel-china-covered-up-extent-of-coronavirus-outbreak.html

https://www.washingtonpost.com/politics/2020/03/10/wuhan-officials-tried-cover-up-covid-19-sent-it-careening-outward/ 2601:18F:4101:4830:D142:D6F7:5353:6DB6 (talk) 01:51, 6 April 2020 (UTC)

I could play silly games, like asking you to name a government that has never covered anything up, but I see it would be pointless. HiLo48 (talk) 01:51, 6 April 2020 (UTC)
What other governments have done in other situations is not relevant here. The fact is that there have been allegations in various reputable sources of significant coering up by the Chinese government (and China is relevant here because it is apparently where the disease first occurred and one of the five or so countries with the highest incidence) . There is already a small section on misinformation, which is a link to another article. But that article does not address the issue of governments' misinformation in numbers of infected etc. Kdammers (talk) 02:01, 6 April 2020 (UTC)
To be fair, the claims in the first days were a death rate of over 25% if I remember. I don't think there is many sources now that set it over 1%. The Dr. had enough experience to see something was wrong, i'm sure, but his data was just a huge statistical anomaly (1 in a million that it was the first cases). It's normal IMO to get a fair bit of resistance from the authority. They didn't have the information to suppose the virus was already spreading in the population at an entirely other mortality rate. Why would they ? Iluvalar (talk) 03:20, 6 April 2020 (UTC)
Again, suppression by China is discussed at length in a number of Wikipedia topics on the pandemic. This is a medical topic that deals with the specifics of the disease, not the outbreak or government actions. If you're interested in information on government responses, visit the many topics covering the pandemic and government actions. - Wikmoz (talk) 04:01, 6 April 2020 (UTC)
The link you've listed, now twice, doesn't lead to any articles. There are no articles dedicated to the Chinese government's attempts to cover-up this virus. Nor should there be, that wouldn't belong in an encyclopedia at this point. The factors which led to and exacerbated the initial spread of the virus however, are very relevant to a medical article. On wikipedia, we generally try not to exclude pertinent information from articles simply because some people may find it uncomfortable. 2601:18F:4101:4830:D142:D6F7:5353:6DB6 (talk) 06:00, 6 April 2020 (UTC)
While the US President is busily fomenting racial hatred by insisting on calling this the Chinese Virus, it's not our job to make things worse. HiLo48 (talk) 06:13, 6 April 2020 (UTC)
the early cover up by WHO and chinese communist party was the primary reason for this crisis. This claim of being offended if the virus called "wuhan virus" or "chinese virus" is just propaganda of the communist party of china and foolishly supported by the Democratic party of USA. But, at this point in time, we will loss valuable energy trying to have this included in the article space, arguing with supporters of both communist party of China and the Democratic party of USA. So, best not to waste time. Let us focus on update information on medical treatment and useful information for immediate help to public.Prodigyhk (talk) 06:28, 6 April 2020 (UTC)
Attributing political motives to those you disagree with is not helpful, and a breach of WP:NOPERSONALATTACKS. HiLo48 (talk) 06:51, 6 April 2020 (UTC)
Sorry about that. The link directs to a tempate page that's not easily viewed on mobile web. I've directly linked to a few relevant topics below...
I hope that this is helpful. - Wikmoz (talk) 10:02, 6 April 2020 (UTC)

User HiLo48 , please read your own posts before chiding others for WP:NOPERSONALATTACKS . You literally entered this discussion by implying I was racist for stating something thoroughly sourced. No one outside of the CPC disputes this info. When other editors pointed out your mistake, you declared that by even discussing the topic they are somehow "making things worse", and proceeded to lump them in with the US President. Who exactly is attributing motive here?

We deal in facts on Wikipedia. If the content put forth is both factual, and pertinent to the article, it is appropriate to include. You taking offense to the facts is entirely irrelevant. If you have source material that disputes the accuracy, provide it. Otherwise please refrain from labeling other editors.

2601:18F:4101:4830:D142:D6F7:5353:6DB6 (talk) 22:34, 6 April 2020 (UTC)

I'm not offended at all. I just sick of bigots trying to use an article about a disease to attack a government they don't like. HiLo48 (talk) 00:57, 7 April 2020 (UTC)

Your right. The New York Times, Wall Street Journal, The Guardian, BBC, Bloomberg, Washington Post, La Times, Boston Globe, and Times of London are all staffed by bigots. Please stop with the strawman. 2601:18F:4101:4830:D142:D6F7:5353:6DB6 (talk) 02:13, 7 April 2020 (UTC)

Those papers weren't the bigots I meant. And again, this is an article about a disease, not the place to play politics. HiLo48 (talk) 03:47, 7 April 2020 (UTC)
Agree with User:HiLo48 Doc James (talk · contribs · email) 19:21, 8 April 2020 (UTC)

Flattening the curve doesn't really seem to work.

Fascinating, but this is not a forum to discuss the efficacy of "flattening the curve" EvergreenFir (talk) 21:45, 8 April 2020 (UTC)

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

To go to Castiglione d'Adda levels of death immunity, there is a problem. 1.8% death means that about 1.3% will be admitted to the icu for 20 days (e.g. Dutch numbers). With 0.01% of an icu bed per person (Dutch numbers). This means flattening to 1.3%/0.01%*20 days = 2600 days, i.e. forever. Jmv2009 (talk) 16:52, 8 April 2020 (UTC)

No you do this until a vaccine or effective treatment is developed. Not forever. Doc James (talk · contribs · email) 17:02, 8 April 2020 (UTC)
Right, that is a completely different picture. Also the way you go about the epidemic is different, namely it implies stronger and earlier suppression. Jmv2009 (talk) 17:13, 8 April 2020 (UTC)
There's no point in speculating about future death rates or rates of infection when we simply don't know how many people are or have been infected, and confirmed cases is a very poor proxy for that. For example, if massively more infections occur than are reported and immunity results, it could eventually push R below 1 even without a vaccine or effective treatment. We don't have good evidence for any speculations like that though. --RexxS (talk) 18:23, 8 April 2020 (UTC)
Not using confirmed cases. See above. Jmv2009 (talk) 19:38, 8 April 2020 (UTC)
I don't understand where you got that 1.3% from. You must be confusing numbers. Last USA press conference talked about a maximum of 200,000 deaths in a 265 million population. That's under 0.1%. Also, I might be a little early to announce it, but it seems like COVID-19 have took a fraction of this seasonal death toll. I suspect a lot of elderly people receive treatment at home or from special care centers from nurses and doctors. At least that's how it typically work here in Quebec. So it's not only the ICU number. Finally, Yes there will be a trade off between deaths and economic that governments will have to take even putting a price on life is a tough one. To save EVERY life possible, we'd have to stay home till 2023 yes. Iluvalar (talk) 21:09, 8 April 2020 (UTC)
The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

In animals

https://www.nationalgeographic.com/animals/2020/04/tiger-coronavirus-covid19-positive-test-bronx-zoo/ SandyGeorgia (Talk) 07:45, 6 April 2020 (UTC)

The original press release is here. I think we should mention somewhere that animals are generally thought not to be transmission vectors, but there are examples of animals being infected. I leave it to the SMEs to figure out how that should be phrased and cited. -- RoySmith (talk) 16:59, 6 April 2020 (UTC)
And another article in the NY Times -- RoySmith (talk) 17:28, 6 April 2020 (UTC)
Another article that may be useful, including the idea that pet fur may carry virus particles as a risk as opposed to the animal actually becoming infected. Bondegezou (talk) 10:21, 8 April 2020 (UTC)
A study just came out about viral replication in animals. It appears that cats and ferrets "highly susceptible" to the disease. Dogs also appear to be at least somewhat susceptible, but not as much as cats. Pigs, ducks, and chickens did not seem to be able to get the virus. Titanium Dragon (talk) 09:18, 9 April 2020 (UTC)

"COVID-20" listed at Redirects for discussion

An editor has asked for a discussion to address the redirect COVID-20. Please participate in the redirect discussion if you wish to do so. -- /Alex/21 14:52, 9 April 2020 (UTC)

Hi, Just a quick question

Hi, this is Shadowblade08 again, I just had a quick question. Would it be helpful to combine all the different COVID-19 articles into one article, and just have them labeled under different topics? Thanks

Shadowblade08 (talk) 13:51, 9 April 2020 (UTC)

No, that would result in a massive and unreadable article. Please read Wikipedia:Splitting for the reason we structure articles this way. Cullen328 Let's discuss it 01:51, 10 April 2020 (UTC)

VITAMIN D SUPLEMENTATION IN PREVENTION OF CORONAVIRUS (EDIT REQUEST)

There seems to be no research into the benefits of large doses of vitamin c to assist with the growth and repair benefits can be found in people with the covid 19 and the benefits of repair upon the lungs — Preceding unsigned comment added by 49.195.78.43 (talk) 03:49, 10 April 2020 (UTC)

Recently, a new hypothesis has been put forward according to which vitamin D can help prevent coronavirus disease (Grant, W.B.; Lahore, H.; McDonnell, S.L.; Baggerly, C.A.; French, C.B.; Aliano, J.L.; Bhattoa, H.P. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients 2020, 12, 988.) - "Results of a community field trial reported herein indicated that 25(OH)D concentrations above 50 ng/ml (125 nmol/l) vs. <20 ng/ml were associated with a 27% reduction in influenza-like illnesses. From the available evidence, we can hypothesize that raising serum 25(OH)D concentrations through vitamin D supplementation could reduce the incidence, severity, and risk of death from influenza, pneumonia, and the current COVID-19 epidemic." (//citation to be excluded if not allowed//)


This is critically important since most of the northern regions (USA, China, Europe) suffer from from chronic vitamin D defficiency. Deficiency in USA may cover even 77% of population ( https://en.wikipedia.org/wiki/Vitamin_D_deficiency#Epidemiology)

Vitamin D defficiency weakens people's immune system[2][4] which can result in greater susceptibility to acquiring coronavirus and can be associated with worse prognosis in the course of coronavirus and other viral infections.[1][3][5]

Since this article is now semi-protected, can anyone with the appropriate rights edit this article to include this data? Humanity would be grateful.

[1] Grant, W.B.; Lahore, H.; McDonnell, S.L.; Baggerly, C.A.; French, C.B.; Aliano, J.L.; Bhattoa, H.P. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients 2020, 12, 988.

[2] Hewison, M. An update on vitamin D and human immunity. Clin Endocrinol (Oxf) 2012,76, 315-325, doi:10.1111/j.1365-2265.2011.04261.x.

[3] Lang, P.O.; Aspinall, R. Vitamin D Status and the Host Resistance to Infections: What It Is Currently (Not) Understood. Clin Ther 2017, 39, 930-945, doi:10.1016/j.clinthera.2017.04.004.

[4] Schwalfenberg, G.K. A review of the critical role of vitamin D in the functioning of the immune system and the clinical implications of vitamin D deficiency. Mol Nutr Food Res 2011, 55, 96-108, doi:10.1002/mnfr.201000174.

[5] Beard, J.A.; Bearden, A.; Striker, R. Vitamin D and the anti-viral state. J Clin Virol 2011, 50, 194-200, doi:10.1016/j.jcv.2010.12.006.

MDPI is probably predatory and thus not a suitable source. Doc James (talk · contribs · email) 17:35, 8 April 2020 (UTC)

Cover the mouth for all humans

After looking at the Covid 19 page here's my question to all. Why are all humans not being asked to cover there face when in public or have another person in there space? There appears to be a huge issue with the facts being released in regards to the distance of a breath and. Contamination of others The sneezing and coughing can contaminate so personal protective equipment is required and not being worn by official groups The police in rural nsw have snot been sighted wearing any items bat gloves a poor effort by our pep designed officials — Preceding unsigned comment added by 49.195.78.43 (talk) 03:44, 10 April 2020 (UTC)

Are you suggesting an edit to the article? Because otherwise this is not a forum. MartinezMD (talk) 05:43, 10 April 2020 (UTC)
The File:20200403_Flatten_the_curve_animated_GIF.gif has been updated and all who have weight in are happy with it now. Doc James (talk · contribs · email) 17:00, 8 April 2020 (UTC)

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

An illustration of the effect of spreading out infections over a long period of time on healthcare capacity managing patient volumes, known as flattening the curve[1][better source needed]
  1. ^ Wiles, Siouxsie (9 March 2020). "The three phases of Covid-19 – and how we can make it manageable". The Spinoff. Retrieved 9 March 2020.

@Diannaa:, can we have your wisdom on this? The illustration is a property of the nz magazine, as I get it. Cinadon36 17:46, 10 March 2020 (UTC)

In either event, it's either meta or instructional, which is not really what we should be going for here. Dekimasuよ! 17:54, 10 March 2020 (UTC)
@Dekimasu: totally agree. Cinadon36 17:56, 10 March 2020 (UTC)
Agree that it's not appropriate for the article, but on copyright it looks fine. The creators released it on a CC-BY-SA licence.  — Amakuru (talk) 18:01, 10 March 2020 (UTC)
@Amakuru: Are you sure? I can not find the original creator. Is it Drew Harris? https://twitter.com/drewaharris/status/1233267475036372992 Maybe @splette https://twitter.com/splette/status/1236345661962039297. But the illustration on WP article, is created by thespinoff.co.nz. And there is no mention of the licence. Cinadon36 18:09, 10 March 2020 (UTC)
A reviewer at the Commons has checked and states that the license is okay. — Diannaa (talk) 20:11, 10 March 2020 (UTC)
@Diannaa: Great, thanks! Cinadon36 20:21, 10 March 2020 (UTC)
And you're happy to believe them when you didn't believe me? Why don't you ask that person if they're wrong as well?  — Amakuru (talk) 20:48, 10 March 2020 (UTC)
Well, I understand why you feel offended dear Amakuru, but see it from my perspective. I was told by one other user that is ok- I wasn't convinced. Then another editor had the same opinion as the first user. Why should I continue talking about it? I haven't really understand why I am wrong on it, but I am probably wrong since 2 users have an opposite opinion and I am not really familiar with copyright infringements. Thank you for your replies. Cinadon36 21:16, 10 March 2020 (UTC)
@Cinadon36: apologies for being snarky here earlier... you caught me at a bad time! To be honest, it's been tricky to trace the true origin of this graph, although everyone has attributed it along the way! The earliest version seems to be from the CDC in 2007, which they then reused again in 2017. Neither of those versions appear to release the copyright. Drew Harris then adapted his own version, as did Ros Pearce. CT Bergstrom made a version from all three of the above sources and Thomas Splettstößer adapted that still further, with the line "Feel free to use and share" but again no explicit licence. The Spin Off's version mentions Harris, Splettstößer and the CDC, and for the first time is released with a CC-BY-SA tag marked on the graphic, with the handles of the authors of this work. Is it a derivative work? If so, their CC-BY-SA might actually not be valid and we should delete it. But if the graph itself is just a generic un-copyrightable concept, with only the specific design deemed to be original, then our reuse of the Spin Off's work, maintaining their licence is acceptable. I don't know if the Commons user considered this and made a decision or not!  — Amakuru (talk) 23:11, 10 March 2020 (UTC)
Copyright is ok, but "flattening the curve" is probably just a layman's term instead of an established medical jargon, because the phrase was not mentioned in any of the scientific papers but first by an Economist article (see the probable genesis I listed on c:File:Covid-19-curves-graphic-social-v3.gif).--Roy17 (talk) 00:04, 11 March 2020 (UTC)
Or you could have asked the person who uploaded the image itself. This image is complete appropriate when it comes to a pandemic disease.Doc James (talk · contribs · email) 00:13, 11 March 2020 (UTC)
Here is a Lancet paper on the topic https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30567-5/fulltext
Technically it is known as "flattening the epidemic curve" but is often shortened to "flattening the curve"
Seriously this is basic epidemiology which I took 20 years ago in medical school.
These are basic scientific facts. This is like arguing that someone can "own" / "copyright" the bell curse. Doc James (talk · contribs · email) 00:25, 11 March 2020 (UTC)
yes, agree.Doc James is making a logical point, I don't see what the problem is--Ozzie10aaaa (talk) 01:33, 11 March 2020 (UTC)
Doc James, that is a valid point. It is obvious that there is a strong consensus that the illustration is ok regarding copyright. My concern was on the illustration, how the one curve move into the other curve- I thought that was a creative element. Also there are two young persons talking- also a creative element. When I saw the graph on the Spin Off magazine, I was alarmed. Sorry for any inconvenience. Now it 's time to get busy with more interesting staff on CoVID-19. Cinadon36 07:22, 11 March 2020 (UTC)
Cinadon36 agree it's time to move on, but just as a final question, are you aware that the graphic itself has a "CC-BY-SA" label printed in the bottom right corner? Which should cover all original elements in the graphic itself. Or is your concern that although they labelled it, they maybe didn't follow all the steps required for an official CC licence? Either way it looks like the intent was to release it that way...  — Amakuru (talk) 07:30, 11 March 2020 (UTC)
@Amakuru:, I had noticed the CC-BY-SA label, but since there is no number next to it (ie CC-BY-SA 2.0, 3.0 etc), my though was it might not be valid. Also, I noticed that their cited refs (which weren't pretty clear) did not use a CC-BY-SA label. Thanks for asking. Cinadon36 07:52, 11 March 2020 (UTC)
You do realize it was created by an expert in the subject in question? Also we are working with them. They will add the number if we want. Ie they are experts in infectious disease outbreaks not CC licensing. If you can provide evidence that they got this wrong (which I do not think they have) than they will adjust it. Doc James (talk · contribs · email) 15:33, 11 March 2020 (UTC)

Now to the important stuff. Prevention happens at two levels individual and population. We need to address both and this graph is about population level measures, which are harder for many people to understand by the way. Doc James (talk · contribs · email) 15:36, 11 March 2020 (UTC)

Doc James I didnt realized that it was created by an expert, I thought it was regular artwork created by a magazine employee. But what do you mean with " we are working with them"? Who are "we"? No need to add a number at the licence, since everybody thinks it is ok. I was also convinced it is ok regarding copyrights, it is obvious that the case is closed. We can re-add this material if there is no objection. (there is no objection by me, I am rather neutral) Cinadon36 16:39, 11 March 2020 (UTC)

I asked them to release it under an open license and they did. This is the author Siouxsie Wiles. Doc James (talk · contribs · email) 16:44, 11 March 2020 (UTC)
I have reviewed this image and the original source (and related copyright permissions). The evidence meets our criteria and we should add in. Thanks for all your efforts to get permission for use JenOttawa (talk) 18:46, 12 March 2020 (UTC)

An additional point: this image is representative of a viral communication process in this pandemic, which is crucial from the perspective of history, which this will thankfully one day be. As such, ultimately a section on this image itself will be needed, capturing the provenance that's discussed here, and including a copy of the CDC one (which would be usable given its the product of US government employees in their work). Hildabast (talk) 21:31, 17 March 2020 (UTC)

It appears effective in encouraging people to perform all the social distancing methods at moment, a concept not easy to understand for a lot of people. Whispyhistory (talk) 04:50, 18 March 2020 (UTC)

Misleading figure that should not be used

The figure from Spinoff is misleading and simply does not follow the CDC source it is purported to be based on. In no other reliable scientific sources have I seen a flattened curve that doesn't also show reduced total number of deaths (represented by area under curve). There is no suggestion that intervention must result in cases not exceeding the health care capacity, and it is clearly not possible in a large-scale outbreak (the best you can do is reduce the load). It should not be used. Hzh (talk) 12:24, 20 March 2020 (UTC)

Also the second graph seems to be about more effective measures to contain the outbreak, and it is not an alternative to flattening the curve, see [6] (first part of the blue curve that shows more effective intervention, and what happens if control is relaxed too soon). Hzh (talk) 12:44, 20 March 2020 (UTC)
I agree. It does not belong here. Graham Beards (talk) 12:48, 20 March 2020 (UTC)
No, it is wrong to say that it is about one aspect, given that various sources mention reducing number of cases. The source for the second diagram also clearly stated that one is a simulation with social distancing in place throughout the epidemic, flattening the curve (green), and the other a simulation with more effective social distancing in place for a limited period only (blue). The green curve is basically the same as the CDC one with intervention. Both the green and blue curves are the same about social distancing, except that one is more effective (hence sharper fall of cases) but applied only for a limited period (hence increasing later). It is not an alternative, just showing what happens depending on how the intervention is applied. The Spinoff clearly is misinterpreting the sources for both. Hzh (talk) 17:17, 20 March 2020 (UTC)
Yes there are two aspects. One is spread out the cases. The second is lowering the number of cases. Both help. Doc James (talk · contribs · email) 17:46, 20 March 2020 (UTC)
The sources clearly indicate that the first curve also decrease the numbers. Trying to extract one aspect while claiming that it is based on the source is OR. The second is about more effective intervention, decreasing much greater number of cases. It is strange to think that you can have intervention but doesn't change the number of cases since the point of intervention is about decreasing the number of cases. Simulation indicates that it does reduce the number of cases. Hzh (talk) 17:52, 20 March 2020 (UTC)
Hzh Would you be so kind as to indicate where you find this simulation, and where it specifically references this outbreak. The accuracy of a simulation for one disease varies tremendously depending on a range of factors — and we can't simply lift an older graph from a textbook and apply it here. The first graph referencing in response to COVID is from a paper by Dalton et. al, and makes no reference to decreasing total case load — and I have seen no instance of flattening the curve being referred to as meaning to decrease the number of cases. Carl Fredrik talk 21:17, 21 March 2020 (UTC)
The simulations of a transmission model of COVID-19 is from the Lancet article [7]. The SSRN one appears to be based on this [8], which is in turn based on one at European CDC. This is the only one I can find at ECDC so far, [9], and that is similar to the CDC one showing a decrease. Hzh (talk) 00:34, 22 March 2020 (UTC)

Not misleading, very clear, and should be used

  • Nonsense. There is nothing wrong with that image — and that the primary goal of "flattening the curve" should be fewer cases — is simply wrong. The goal of the efforts are fewer deaths, which are plotted on a different curve. Carl Fredrik talk 20:28, 20 March 2020 (UTC)
Did you even see the curve in the sources that the Spinoff curves are supposedly based on? Flattening the curve must means that you are reducing the number of infections at any point compared to the curve without intervention except towards the end of that curve. It also has the effect of shifting the peak of the curve. The idea that you might have the same number of people infected with no drop in the total number just plainly doesn't make sense, since the intervention has the effect of reducing number of cases. Why not just double the number of cases if you think it is not going to reduce the number of cases? What exactly do you think is the mechanism that would give you the same number of cases? Are you suggesting that anyone who can get infected must get infected whatever the intervention? That means it's only a matter of time that you will get infected whatever you do, which is a bizarre suggestion. The reduction is clearly shown by the CDC curves as well as the one in Lancet. The curve given here simply misrepresents the curves given in the CDC and Lancet sources.
I have no idea what you mean by number of deaths, do you mean this one on the right? This is the same one just showing the effect of a more effective intervention, but ended too soon allowing cases to increase. I have no idea why Doc James restored the description, since it is clearly not an alternative to flattening the curve or any way to stop the spread, it simply shows different scenarios with intervention (allowing the cases to increase is not the alternative). Note that this curve is also flattening the curve (it is simply a differently-shaped curve), per the source The greater the reduction in transmission, the longer and flatter the epidemic curve, hence the risk of increase in cases later when intervention is stopped too soon. Spinoff simply misrepresented the sources to make the diagrams. Hzh (talk) 23:21, 20 March 2020 (UTC)
An interesting work - [10] it called the second diagram the "suppression" strategy. All the mitigation curves given in the article however showed a decrease in the total number of cases. Hzh (talk) 02:12, 21 March 2020 (UTC)
I will ask an infectious disease expert. Lots of organizations however are using similar diagrams such as Michigan Health[11] and John Hopkins[12] Doc James (talk · contribs · email) 05:12, 21 March 2020 (UTC)
Just a note, Hzh when you said "I have no idea what you mean by number of deaths", CFCF was most likely referring to your statement "...show reduced total number of deaths (represented by area under curve)" in your original post in this section. EvergreenFir (talk) 21:36, 21 March 2020 (UTC)
Then that is my mistake which I didn't notice. I meant number of cases. Hzh (talk) 00:14, 22 March 2020 (UTC)
Hzh — Still nonsense, there is nothing wrong with the image, and as for:

What exactly do you think is the mechanism that would give you the same number of cases?

It's basically herd immunity, although that's beside the point, because that isn't the issue.
As James points out, many orgs are using the graphs, and among the first (far before the ones you mention) did not make mention of fewer cases, which is basically wishful thinking.
You being one to argue beyond the source material: By what mechanism would suppression give rise to fewer cases, apart from herd immunity which only arrises very late?
And last, no one in their right mind is going to measure the area under the curve of this type of schematic diagram. (You might want to calculate (rather than measure) it in a real world example, such as here [13], but that is not the same thing as taking out a ruler on a Wikipedia-article.) Some original curves produced by the CDC actually show a greater area under the curve with supression [14] (which is likely erroneous). The major point is lower case load at any one point below the breaking point of the health system, not lowering number of cases — and the diagram illustrates this perfectly. Carl Fredrik talk 05:33, 21 March 2020 (UTC)
Whether other people use it is entirely irrelevant. We are here to present accurately what the sources say, and if the original source say one thing, but other sources based on the original source say another, then we use the original source. The fact that the media don't understand the meaning of curve is their fault, we should not follow them blindly. Look at what they are saying - the two Doc James given clearly stated that they based them on the CDC one [15][16] (ditto the Spinoff), but the diagrams they gave aren't the same as the CDC one (shown on right). CDC also did not say the curve will go below healthcare capacity. People are making things up to without understanding what the original sources say, and we should not misrepresent what the original source says. Note also that you are also doing OR to suggest herd immunity, the academic sources with those diagram say no such thing, the Imperial one for example mentions building up herd immunity, and the diagrams they presented are nothing like the one given here, but similar to the CDC one. Why use a substandard derivative when the correct original is available? We have an obligation to present facts and figures as accurately as we can. Hzh (talk) 09:40, 21 March 2020 (UTC)
The comments by Hzh are sound and to dismiss offhandedly as "nonsense" is rude and unhelpful. I too have serious doubts about the value if these figures.Graham Beards (talk) 13:20, 21 March 2020 (UTC)
  • I am an academic Infectious Diseases physician (cf my user page if curious) caring for inpatients now (came here after being asked to take a look) and must admit that I'm puzzled by the drama here - perhaps I'm missing something (there's a lot of words above, perhaps I missed a few). The New York Times image is similar to the one current used on this page; sure, it doesn't show reduction in overall number of cases but the NPOV concept that I think the current image, the NYT image, and the Economist article convey is that - even if the total number of cases were not reduced - delaying & lowering the peak could have major impacts on survival (note this quote from the Economist: "the aim of public-health policy, whether at the city, national or global scale, is to flatten the curve, spreading the infections out over time."). It's completely obvious that reducing overall deaths will help; it's less obvious to many that simply delaying could also have major benefits. Perfect: No. Neutral & informative: Yes. Again, I might be missing something to justify all the drama? — soupvector (talk) 20:11, 21 March 2020 (UTC)
Thank you for your comments, soupvector. I think this might be a case of talking past eachother, and where I was overly dismissive initially, and some more valid comments have been added later on. The point nonetheless is just as you say, that the end goal is spacing out cases, with any impact on the total number of cases only being an added bonus — and I think not central to any illustration. Given that we should go for the one that looks best, which in my mind is the animated cartoon one. The CDC-gif linked above by Hzh was surfaced later, and the image I linked with the "healthcare system capacity"-line has been circulating longer. That line is also not something made up by either Wikipedia or the creators of the first image, but has been pushed by a number of very reputable organizations, such as the Australian Government Department of Health, The Swedish Public Health Agency (adapted image from a television broadcast). I can't find all the references now, but to Hzh and Graham Beards: be aware it isn't WP:OR, and is well sourced. Carl Fredrik talk 21:06, 21 March 2020 (UTC)
@ soupvector Both New York Times and the Economist's diagrams referenced CDC, so CDC should be the original source. Since they failed to represent what the figures given by CDC correctly, then their diagrams are incorrect. You actually misrepresented what the Economist says, which says in the following paragraph that the total number of infections throughout the course of the epidemic can be lower. Bizarrely, their diagram actually shows the total number infections increased, yet still referenced to CDC. I have no idea which CDC figure they refer to, but it certainly isn't the one shown here which show a decrease. All in all, it would seem that those media sources are unreliable and cannot be considered WP:MEDRS, and they are certainly careless in how they draw the diagrams. Hzh (talk) 23:31, 21 March 2020 (UTC)
Hzh: (1) Please point me in the direction of the policy that says that secondary sources must exactly copy, in detail, what's presented in a primary source; (2) I misrepresented nothing - saying "can be lower" doesn't say "must be lower." I think you're inventing a set of requirements. I see many experts repeating the point in a manner similar to the NYT (and Spinoff) diagrams. I think the horse you're flogging has been dead for some time. — soupvector (talk) 23:58, 21 March 2020 (UTC)
They certainly don't have to exact, but when you have a source that says its diagram is based on the CDC one, yet shows increase number of cases (which is not reflected in the text) when we have a CDC source that say decrease, then you can see a problem there. In the end, the point is still that these media sources don't represent the original sources correctly, so why use them instead of the original? Hzh (talk) 00:12, 22 March 2020 (UTC)
@ CFCF I don't know if you look carefully, but the Australian diagram say it is based on European Center for Disease Prevention and Control Technical Report. Check then what is given in ECDC website - [17] the diagram there is very similar to the CDC one, which shows a decrease. The Australian one also shows the cases exceeding healthcare system capacity, so I doubt you can use it to support your case. The Swedish one shows it touching the line, again not the same as Spinoff. The curve for the Swedish one is also more similar to the CDC one. I don't think you have shown the Spinoff is not OR. So now we have a the curve going above the line, touching the line, and below the line. Seems like these diagrams randomly put a line there. Hzh (talk) 23:39, 21 March 2020 (UTC)
Hzh — So you just found an extremely similar image from the ECDC, with a line and you're stating that it doesn't prove it isn't WP:OR. I don't follow or see how that is logical. The line isn't set arbitratily, but in each case illustrates a different hypothetical situation — all of which are plausible and worth discussing. I am still going to in the stongest way possible contedt that there is nothing wrong with the Spinoff image — to the point where you have proven that it isn't WP:OR and even linked the ECDC image yourself. Carl Fredrik talk 08:21, 22 March 2020 (UTC)
The point isn't that CDC and ECDC ones were very similar, but that they appear to be the original. The Spinoff one differs from them on at least three points (length of delay, total cases, length of outbreak) while claimed that it is based on the CDC one. The differences suggest OR and a failure to understand the original curve and is therefore substandard, and should not be used. Hzh (talk) 09:42, 22 March 2020 (UTC)
It doesn't matter if the Spinoff-team understands the concept, but rather that the illustration is accurate when assessed in accordance to the relevant literature — which it is.
Monkeys can write Shakespeare — that doesn't make it less worth reading. Carl Fredrik talk 10:38, 22 March 2020 (UTC)
I see assertions but no real sources to back it up that Spinoff fits with any relevant literature. For example, where is your source that say the curve will go under healthcare capacity? Infinite monkey can also make infinite number of nonsensical works, which you have to plough through to get one that's worth reading. I hadn't realised that infinite random nonsense is acceptable in Wikipedia just because one might actually make some sense. Hzh (talk) 12:14, 22 March 2020 (UTC)
WP:ICANTHEARYOU Carl Fredrik talk 12:44, 22 March 2020 (UTC)
  • Comment - I don't know much about infectious disease control, but I do know enough about statistics and graphics representing quantitative data. The Spinoff graphic appears to show a distribution of cases (not deaths) as a function of time. It seems that the main concerns raised by Hzh is that the graphic from Spinoff shows "flattening the curve" as a decrease in infection rate but not total cases. That is to say, the distribution curve is more leptokurtic in appearance, with a smaller standard deviation from the mean infection date and thus is just a transformation of the original distribution curve. The case total (area under the curve) remains the same. I agree with Hzh that that is approximately what is being shown.
The Lancet article has a figure that appears to show a green "flattened" curve which has an area under the curve less than the red "no intervention" curve. Appendix 3 from that article ([18]) describes the figure as:

For the simulations in the main text, the initial conditions are 625 infections, in a population of 60 million, of which 61 reported. Red line: epidemic with case isolation only; green line: same but with social distancing in place indefinitely (25% lower contact rate after 70 days); blue line: same but with stronger social distancing in place for only four months (50% lower contact rate after 80 days). Parameter values as above,with p = 50% symptomatic, 1/a = 2 days to isolation.

In the article, ¶10 describes the possible goals, ¶11 explains the unlikelihood of a vaccine in time to effectively reduce morbidity & associated mortality, and ¶12 & 13 discuss social distancing with the goal of: "

[preventing] transmission from symptomatic and non-symptomatic cases, hence flattening the epidemic and pushing the peak further into the future... The greater the reduction in transmission, the longer and flatter the epidemic curve

" The rest of the Lancet article doesn't really indicate if they believe that social distancing will decrease the number of cases, or just the rate of transmission (though the only explicitly talk about the latter).
The SSRN article says

Early interventions to reduce the average frequency and intensity of exposure to the virus might reduce infection risk, reduce the average viral infectious dose of those exposed, and result in less severe cases who are less infectious.

But this doesn't necessarily suggest a decrease in total cases over time. Later, the article says:

The purpose of pre-emptive interventions is to slow the transmission of disease and limit the impact on health services, particularly hospitals and intensive care units,to ensure access to high level care when needed... Reducing the force of infection, particularly early, will delay the epidemic peak, blunt the epidemic peak, spread cases over a longer time, and help to limit the potential for critical care services to be overwhelmed, which may be lifesaving

.
I got to go, but in sum I think the Spinoff graphic is okay and accurately represents the goals of social distancing as primarily being about avoiding overloading health care infrastructure. EvergreenFir (talk) 22:26, 21 March 2020 (UTC)
The point is that the Spinoff diagram claims to be based on the CDC one as well as a couple of tweets (which also referenced CDC). Therefore to say that it is accurate, you'd have to compare it with the CDC one. Even if you use the SSRN reference, you will see that it shows the curve going above healthcare capacity, while in the Spinoff one, it shows the curve going below healthcare capacity. The SSRN one ultimately is based on one at the ECDC, and the only one I can find there is similar the CDC one [19] (in this case, this show the peak is met exactly by the capacity). The Spinoff diagram is supported neither by the CDC nor the SSRN one since it resembles neither of them. It seems that someone just randomly drew a curve and a line. I will ask the same thing again, why use it when the CDC original is available? Hzh (talk) 01:30, 22 March 2020 (UTC)
A pretty ugly schematic showing increased healthcare capacity (for COVID-symptom management and isolation) as a result of delaying cases. If we have sources that support this take, we can use this illustration, in spite of being a Wikipedian-creation. Carl Fredrik talk 09:24, 22 March 2020 (UTC)
Another schematic showing difference in number of cases receiving sub-optimal care by delaying the peak and allowing health systems to respond. Images similar to this are also circulating from reliable sources.
You're jumping to a few conclusions on an invalid (or at the very least irrelevant) point — which aren't merited by the facts of the situation or by policy/Wikipedia guidelines. Frankly it doesn't matter what the Spinoff image says it is based off, because we can adapt their image to correspond to our intents. And if I were to do that — I woulnd't really make any changes, and would base our inclusion in this article on a range of sources, including the ECDC source you link above. Whether the peak of the supressed curve touches, comes just below, or just passes the health system capacity line is quite arbitrary (with all scenarios supported by major WP:MEDRS-compliant sources by now), as the intent is to communicate the same thing. The goal must be to push it below, and especially the animated Spinoff does a good job illustrating that the curve doesn't just snap between the two — but that it is possible to supress more or less well (and that we honestly don't know how much supression we need, or whether the "health system capacity" line shifts as our health-systems rearrange with field hospitals and produce more ventilators and ventilator-trained staff — I could make you an image to show this, and will promise you that it will arrise in the professional literature soon).
You're getting stuck on several technicalities, whether the "health system capacity"-line is in the source they site — or whether it is in other WP:MEDRS-compliant sources. The purple CDC image is excellent for a general overview of strategy for an article such as Social distancing, but as we have so far not seen any WP:MEDRS-sources stating that flattening the curve will lead to fewer cases in COVID (apart from your WP:OR interpretation of the area under the curve of schematic diagrams), which is in part because there is no population immunity so far. Carl Fredrik talk 08:31, 22 March 2020 (UTC)
There must be something wrong when a suggestion to use the original CDC diagram is argued to be OR. It is exasperating that you claimed that there is no sources that say it will reduced the total cases when that is exactly what CDC diagram says. If you want one that deals specifically with COVID-19, then the simulated one from Lancet one is very similar to the CDC. Why invent this The goal must be to push it below? You are arguing for using random curves and lines to suit whatever purposes you want, that is surely the definition of OR, and saying that some random curves you drew will appear in literature is WP:CRYSTAL. The point that you are refusing to answer is still why use them when the original is available? Hzh (talk) 10:09, 22 March 2020 (UTC)
What is wrong is that you assume a general graphic of pandemic response measures from a 2017 textbook is relevant in all situations — despite the fact that all current major (WP:MEDRS-compliant) sources discussing COVID-19 completely ignore the very aspect you are so zealously pushing, namely that efforts that flatten the curve will lead to "fewer cases".
Neither are any of the policies you link relevant. I made an observation for sake of argument on the talk-page, that these types of images would surface, which is is a qualified guess that may or may not be true, but since I'm not even suggesting to put this guess in an article it per definition can not be WP:CRYSTAL.
What is more, there is certainly nothing random about any of the concepts in the curves I drew. Both diagrams are based on potential scenarios which have been mentioned in the professional and WP:MEDRS-compliant literature, and there is no policy argument for not including them with proper sources. Since there is literature to support them, they are certainly not WP:OR nor do they break WP:NOTCRYSTAL.
I feel the need to point this out, despite not even suggesting we include them (mostly because they're ugly and poorly done — taking 5 minutes to make).
It is abundantly clear that you are grasping for straws here, since I have not refused to answer anything.
The curve you suggest we include is outdated, and most importantly: is not backed up by reliable sources (WP:MEDRS) in its relevance to COVID-19, and is too technical to be suited for an article which has many lay readers. I clearly did state that it was a good fit for a more technical, and general pandemic/epidemic response article such as social distancing (which is not COVID-19-specific). Carl Fredrik talk 10:23, 22 March 2020 (UTC)
External image
image icon https://i2.wp.com/flowingdata.com/wp-content/uploads/2020/03/flatten-the-curve-smaller.gif?fit=670,565&ssl=1] Animation from Twitter user @axlrdk. Schematic based on a number of different MEDRS-sourced concepts
(edit conflict) — P.S. I'd be willing to put more money on my guess of this concept being picked up in images from MEDRS-sources (it's already described in text), with this beautiful animation recently out: https://flowingdata.com/2020/03/09/flatten-the-coronavirus-curve/ .
Unfortunately it's copyrighted, unless anoyone would like to contact Alexander Radtke Twitter @alxrdk.
Carl Fredrik talk 11:04, 22 March 2020 (UTC)
I've already indicated that if you want one that deals specifically with COVID-19, you can use the Lancet simulation, and that is very similar to the CDC one. You are in fact arguing against yourself when you said the Spinoff one is fine, when it cannot deals specifically with COVID-19 since it is drawn at the beginning of the outbreak and before it finished. Whatever Spinoff is, it is not MEDRS. Trying to suggest that CDC is not MEDRS but Spinoff is fine is a very odd argument indeed. All the diagrams can only be based on current knowledge gained from experience in previous outbreaks (and the CDC one is therefore representative). Arguing against the CDC one is arguing against current knowledge. There is none now that can represent the COVID-19 outbreak, not even the Lancet one (since simulations must depend on what is already known from previous outbreak but adding assumptions). I expect there will be curves drawn on the current outbreak in the future, for example, from what is known in China, although that will not be representative since the draconian actions taken by the Chinese government cannot be replicated in other countries. Hzh (talk) 11:03, 22 March 2020 (UTC)
WP:DEADHORSE Carl Fredrik talk 11:08, 22 March 2020 (UTC)
  • Seems fine to me. Per Doc James and Carl Fredrik. This graph is illustrating one aspect of the principle of this type of intervention, in that it spreads cases out over time to reduce strain on healthcare at the peak.  — Amakuru (talk) 08:48, 22 March 2020 (UTC)
It illustrates more than one concept - delay, no decrease in total cases, peak cases will be brought under healthcare capacity, doubling of time of outbreak. Most of these are not supported by the sources. Hzh (talk) 14:42, 22 March 2020 (UTC)
The peak case at what it seem like 7x the hospital capacity troubles me a little. Also the healthcare capacity seemingly tripling it beds capacity in 1 month is, hmmm, dubious. We should also really stop just drawing the worst case scenario graph all the time where is the NPOV in that ? This being said, i think I stay neutral on this one. I don't mind a graph more then the other. Iluvalar (talk) 17:09, 22 March 2020 (UTC)

Using the 3 to 5% statistic for the Spanish flu death rate is absurd. You don't get to age adjust the death rate for COVID-19 and not age adjust the death rate for the flu. Absurd. I come here for facts. Not facts that are skewed in one direction. If the information for the age adjusted death rate of the Spanish Flu is not available it should not be on this page Sickboy254698 (talk) 22:50, 31 March 2020 (UTC)

What am I missing?

It seems obvious to me that this image ("flatten the curve") is wrong. It's simply not possible to "flatten the curve" sufficiently to remain below the healthcare system capacity of any country or the lockdown should be kept for 10 years or something. What am I missing? --RaphaelQS (talk) 16:26, 30 March 2020 (UTC)

What are you basing that on? TylerDurden8823 (talk) 20:55, 30 March 2020 (UTC)
List of countries by hospital beds vs the curve (total population). --RaphaelQS (talk) 22:28, 30 March 2020 (UTC)
We had a Wikipedian and infectious disease physician at Johns Hopkins User:Soupvector look at it and they said it was good. It was created by a medical microbiologist Siouxsie Wiles. It has been reviewed by 1,000s of people on various forums and deemed to be a good example of what it is trying to display (spreading cases overtime so that hospital capacity is less overwhelmed).
With respect to the long term goal, it is to develop a vaccine / treatment. One we have those in large numbers the lockdown can be ended. Doc James (talk · contribs · email) 22:46, 30 March 2020 (UTC)
Raphael, what you are missing is that flattening the curve is a goal, not necessarily one that will be attained. However, it is a notable concept that is highly publicized. MartinezMD (talk) 21:09, 1 April 2020 (UTC)

The "flatten the curve drive" is based on the idea of avoiding overwhelming hospital intensive care unit capacity. Also to allow time for a vaccine to be developed of course. THE hard question which I CANNOT FIND THE ANSWER TO is, "DOES ICU ADMISSION OF SEVERELY ILL COVID-19 PATIENTS IMPROVE THEIR SURVIVAL RATE?" If we knew it does not change outcomes then we would likely not stop/slow society only to allow more of us to endure a futile intervention. Please help look for that answer. Petlif (talk) 22:42, 1 April 2020 (UTC)

Yes ICU admission does improve survival of people with the disease. Doc James (talk · contribs · email) 16:13, 4 April 2020 (UTC)

So "ICU admission improves COVID-19 survival". Does ANYONE have a link to published evidence that ICU improves survival vs. fate just picking survivors regardless? Petlif (talk) 22:20, 4 April 2020 (UTC)

Have restored this again. Doc James (talk · contribs · email) 16:13, 4 April 2020 (UTC)
User:RCraig09 you could try a RfC. Doc James (talk · contribs · email) 19:06, 4 April 2020 (UTC)
@Doc James: I generated File:20200403 Flatten the curve animated GIF.gif in response to a request at the Commons:Graphic Lab/Illustration workshop (diff). I agree completely with the requestor's statement that the older GIF File:Covid-19-curves-graphic-social-v3.gif is "cartoonish", and, I strongly perceive, is completely inappropriate for an encyclopedia. The new graphic minimizes text and uses widely accepted non-cartoonish symbology for those who don't read English. Please let me know if you have substantive reasons for retaining the earlier graphic. —RCraig09 (talk) 19:29, 4 April 2020 (UTC)
The other one has been in the article a long time. Many people see no issue with it and actually thing it is very good. I am not seeing a consensus for the other version. Just because we are an encyclopedia does not mandate that we have less engaging images. Doc James (talk · contribs · email) 19:34, 4 April 2020 (UTC)
Why the stick figure of a man for number of cases? Doc James (talk · contribs · email) 19:38, 4 April 2020 (UTC)
The cartoon graphic wasn't even uploaded until March 9, so it could not have "been in the article for a long time" (which is not a substantive criterion for keeping it, anyway). It has been here as long as it has, simply because there had been no better alternatives for a while (and possibly because of the amount of hours needed to create a graphic from scratch). The cartoon graphic is clearly non-encyclopedic, much more distracting than it is "engaging", and borderline insulting .
To answer your question: the human figure by the vertical axis denotes a number of people, symbology that I included at Commons for non-English speakers.
The proper question is: which graphic is more appropriate? —RCraig09 (talk) 20:53, 4 April 2020 (UTC)
At Talk:Social distancing, I get 42 instances of the text string "cartoon", almost all of which is negative (except for your own comments there). There is a clear consensus against cartoonishness. —RCraig09 (talk) 21:02, 4 April 2020 (UTC)
Okay so you want me to start the RfC than? Doc James (talk · contribs · email) 21:28, 4 April 2020 (UTC)
It would be OK if you started an RfC, though they are time consuming. Talk pages of closely related articles should be notified.
A second question to be included, is whether to use an animated graphic at all (some people find them distracting but I think the verb flatten calls out for an animated graphic). —RCraig09 (talk) 21:58, 4 April 2020 (UTC)

RfC What image should we use

Option 1
Option 2
Option 3
Version revised April 7 with more explanatory legends and other formal changes suggested in this discussion.
Graphic 3.1 — for International use (probably not for English-language Wikipedia) is purposely devoid of text; explanations to be added in textual captions in respective languages. Incorporates changes suggested in this discussion.

What image should we use?

Option 1

  • Support as first choice. Does an excellent job of illustrating the concept. Doc James (talk · contribs · email) 00:59, 5 April 2020 (UTC)
  • Oppose This cartoon style doesn't belong to serious encyclopedia. —kallerna 10:49, 5 April 2020 (UTC)
  • Strong oppose. Cartoons are inappropriate, and borderline insulting, in this and related encyclopedia articles. This cartoon has endured here for a few weeks only because there had been no non-cartoonish free-use equivalent (see list below), but now Option 3 is available. —RCraig09 (talk) 16:12, 5 April 2020 (UTC)
  • Oppose. Can't read it at normal resolution and that's annoying. --RexxS (talk) 16:30, 5 April 2020 (UTC)
  • Oppose. Quoting myself from Talk:Social_distancing#Cartoonishness_of_graphics:

    I'm still not totally comfortable with the series of graphics that has taken over the article. They're accessible, yes, but we can be accessible without being cartoonish, and the extremely informal font in particular just doesn't feel appropriate for an encyclopedia, especially for a page on a serious medical topic. They also don't carry as much informational weight or medical authority — for instance, it's clear that for the "alternatives to social distancing" graphic, the artist just drew an arbitrary line saying "okay, if the response is strong but short-term, I'm going to draw cases going up this much". Compare that to something like the excellent (albeit not freely licensed) article the Washington Post put out about this, which uses some statistics and actual simulation to give the results more credence. I'm not going to say we should remove the graphics since I don't know of anything better currently available to replace them with (and yes, I recognize that criticism is cheap), but I do think we ought to recognize that they aren't the ideal, and if something better is created/found, we ought to be open to replacement.

    Since I made that comment, a better alternative, option 3, has become available, and is clearly preferable. {{u|Sdkb}} talk 16:29, 6 April 2020 (UTC)
  • Strong Support The only disadvantage may be the style. But I would easily fix this. Most importantly this image's curve suits showing the concept much better. 83.11.93.118 (talk) 07:36, 12 April 2020 (UTC)

Yes, they covered things up. But EVERY other country would have done it; of course by different means. An argument people don't consider, is that independent of the source of any outbreak, people in charge will always act carefully and try to contain it before alarming everybody. I'm not defending nor saying that what Chinese leaders did was the best they could have done. But is human nature to try and fix a problem before admitting we are unable to, in this case tell the world "hey, we couldn't handle this silent assassin... we have failed" when you are one of the world's biggest economies. Put yourself in the position of a President. If shit is happening, you maintain it a secret and try to fix it to not cause mass hysteria. When that fails, you'll have to swallow a bitter pill and then tell people about what is happening. 

Krakikoko (talk) 10:28, 13 April 2020 (UTC)

Option 2

Option 3

  • Support... Uploader's explanation: Option 3 avoids the nearly universal objection to having cartoons in an encyclopedia (see list below). Option 3 instead uses widely accepted symbols for the benefit of non-English speakers (more readily used directly outside en.wikipedia). —RCraig09 (talk) 16:04, 5 April 2020 (UTC)
  • Support Don't care about cartoons, but this graphic is clean and functional, and the symbols overcome my inability to read small text. --RexxS (talk) 16:33, 5 April 2020 (UTC)
  • Support per nom. I made some minor suggestions for improvement at the graphics lab, but overall this is a clear improvement. {{u|Sdkb}} talk 16:31, 6 April 2020 (UTC)
  • Support With the improvements to option 3 I am now happy with it. Doc James (talk · contribs · email) 16:54, 8 April 2020 (UTC)
  • Strong Oppose This curve does not suite showing the concept as it just shows plain vast reduction in cases rashly in half. So it shows "flattening the curve" as a side effect of any measures taken against a disease. It does not show that flattening the curve means the outbreak would lengthen in time. 83.11.93.118 (talk) 07:41, 12 April 2020 (UTC)

Discussion

- First, the symbol is a human figure, not a "male" figure. Second, I'm willing to spend time adjusting minor formal issues (shades of color) if there is a dominant consensus. —RCraig09 (talk) 16:15, 5 April 2020 (UTC)
The fact that the human figure is pretty much the figure used for male bathroom signs occurred to me too. Not sure quite how to change it to remedy that, but if a better symbol is found, I'd be very open to it being changed (so long as it remains sufficiently simplistic — I like that aspect). {{u|Sdkb}} talk 16:39, 6 April 2020 (UTC)
@Sdkb: I intend to use File:Bimetrical icon person black.svg, suggested by Rexxs below. —RCraig09 (talk) 16:48, 6 April 2020 (UTC)
  • Relevant prior comments re avoiding cartoonish graphics at Talk:Social distancing at 21:23, 4 April 2020 (at about the time this RfC was initiated):
  1. "The cartoon looks unprofessional and, well, cartoonish." Natureium (talk) 02:52, 17 March 2020
  2. "None of the cartoons work well for this topic..." Andrew🐉(talk) 11:07, 19 March 2020
  3. "This ridiculous cartoon does not add anything encyclopedic to the article. The lack of professionalism is overshadowed by the uselessness of it." Natureium (talk) 22:59, 17 March 2020 (UTC)
  4. "...we can be accessible without being cartoonish, and the extremely informal font in particular just doesn't feel appropriate for an encyclopedia, especially for a page on a serious medical topic." Sdkb (talk) 05:12, 24 March 2020
  5. "If there was the choice between formal and informal, we'd always want the more formal tone if possible." --Masem (t) 06:04, 24 March 2020
  6. "Fully agree with Masem. We have no good images that are both simple and non-cartoonish, and while it would be great if someone made simple conceptual images, ..." Carl Fredrik talk 11:24, 24 March 2020 . . . . Note: Option 3 answers this call.
  7. "i've seen the discussion about the cartoons in this article. problematic indeed." Maximilian (talk) 09:52, 26 March 2020
  8. "The images we're putting on this page are unprofessional and unencyclopedic. This isn't a blog. We can link to a blog if we think it is a valuable resource, but we should not be turning wikipedia into a cartoon repository. We are trying to provide information here, not grab attention with catchy animations." Natureium (talk) 16:11, 24 March 2020
  9. "Let's cut the cartoons off the bottom and keep the graphs." Natureium (talk) 19:19, 25 March 2020
One cannot deny the reasoned consensus. Arguments in favor are not based on Wikipedia policies, for example:
> "Cartoons are awesome. Most people like cartoons. Cartoons are common in outreach materials." Blue Rasberry (talk) 13:59, 1 April 2020
An encyclopedia is not for "outreach materials" even if they're "awesome". —RCraig09 (talk) 15:58, 5 April 2020 (UTC)
  • I don't care whether we have a photographic image, a silhouette, or a cartoon. There's no point in being precious about the medium if it helps to get information across. This is an online, multimedia encyclopedia and our readers can expect to see all sorts of visual presentations.
    Having said that, images are simply not going to be used at more than about the 330px width that the three here are displayed at, and I can't read the text in the first two. I know they are trying to tell me something important, but I can't get that information and it's frustrating. Yes, of course, I could click through to see a bigger image on the file description page – but I shouldn't have to, and I'm willing to bet that that the majority of readers (and 90% of mobile users) won't click through either.
    In general, graphics that rely on text to convey information are functionally inferior to those using universally recognised symbols, not just for translation purposes, but for reasons of accessibility. Please give a thought for us old folk. --RexxS (talk) 16:48, 5 April 2020 (UTC)
  • @RCraig09: I like your graphic' thank you very much for making it. James isn't keen on the male symbol to represent people, and I have some sympathy with that. Please see the caption for c:File:Person icon BLACK-01.svg - An icon of a person, usually meaning "Male", so we're not the only ones who make the association. If you wanted to overcome that objection, can I suggest that File:Bimetrical icon person black.svg is more gender neutral. James' dislike of "baby colours" is less of an issue for me, but should you consider redoing the graphic, my normal expectation for regions representing safe/unsafe would be green/red, that would become backgrounds of "pastel green"/"pastel red". Thanks again, and hope that helps. --RexxS (talk) 19:46, 5 April 2020 (UTC)
Thanks for the helpful suggestions, User:RexxS. Because re-doing 49 individual frames for a new version is fairly time-consuming, I'll wait for any additional suggestions that materialize before I upload a revised version. —RCraig09 (talk) 20:15, 5 April 2020 (UTC)
  • Not a fan of the cartoonish style but seeing Option #2, I realize that it's more the chartoon characters that are objectionable in an encyclopedia. I think Option #2 would be ideal with if there was a large label animated below the chart "WITH MITIGATION" and "WITHOUT MITIGATION" so we know what the two curves represent. If the author could also change to a standard font as well, that would be great. #3 also needs a bunch more labels to be useful. Without prior knowledge of the healthcare capacity line, the symbols are not meaningful. The lack of the gray line showing before/after states is another drawback. Overall, I'd still vote for the original purple CDC chart. - Wikmoz (talk) 20:19, 5 April 2020 (UTC)
Options 1 and 2 aren't made by Wikipedians as far as I know, but Option 3 is (by me). The minimal use of text in Option 3 is purposeful—for an international audience; "Dashed line shows healthcare capacity" (and other explanations) can be added to the textual caption in various languages in case people think the symbols "red cross" symbols near the right side aren't clear enough in addition to caption text. If there's a definite consensus here to add more text (at the expense of our international audience), I can do so but I definitely lean against it. —RCraig09 (talk) 20:36, 5 April 2020 (UTC)
Really nice job on the chart and thank you for investing the time to create an original option for Wikipedia! I understand the intent regarding symbol use. Perhaps this version can persist for non-English Wikipedia pages but I think for English Wikipedia articles, the labels are very helpful. My suggestion would be to add "HEALTHCARE CAPACITY" to the dotted line, remove the red and blue background color, add a static light gray line showing before and after curves, add a "WITH MITIGATION" and "WITHOUT MITIGATION" label (maybe one fades in when the other fades out as the line shifts), and remove the other icons. The red cross, mens bathroom guy, and calendar icon are clever but don't add much for readers IMO. - Wikmoz (talk) 21:52, 5 April 2020 (UTC)
User:Wikmoz, it's an excellent idea to make two graphics, one relying on symbols and one indulging in English text. Thanks for contributing thoughtfully. —RCraig09 (talk) 00:12, 6 April 2020 (UTC)
I'm not sure about removing the background colors entirely, but I do think it might be good for the area under the curve to have some filling, such as perhaps a darker version of the colors. {{u|Sdkb}} talk 16:45, 6 April 2020 (UTC)
To all: at this point, I'm thinking of making the background rectangles non-pastel red and green; and adding enduring light-gray silhouettes of the start and endpoints of the graph. I'm planning to not have "filling" under the graphs because the present "transparent fill" lets the red show through during most of the process. Thanks to all for suggesting improvements. Upgrading a 49-frame takes time, but I plan to upload a new version within a day or two, as the flow of suggestions peters out. —RCraig09 (talk) 16:59, 6 April 2020 (UTC)
I think I've responded to each and every issue and suggestion raised here, and the only opposing argument is that a cartoon "Does an excellent job of illustrating the concept"—which is true of the non-cartoon Version 3. —RCraig09 (talk) 15:49, 7 April 2020 (UTC)
@RCraig09: I'm not sure there's been quite enough participation here since you introduced your option for a WP:SNOW result, but we can certainly call your graphic the prevailing favorite right now. On that basis, I added it to the current consensus list (with the "prevailing" qualifier) and will add it to this and related articles where it's not yet present. {{u|Sdkb}} talk 06:56, 8 April 2020 (UTC)
As we all appear happy now that the changes have been made am closing. Anyone is free to reopen if they wish. Doc James (talk · contribs · email) 17:00, 8 April 2020 (UTC)
The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.
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