THE PROGNOSIS

How many people around the world will ultimately be sickened or die of the swiftly spreading coronavirus? That depends partly on a calculation known as the “basic reproductive number.”

This number — which is a calculation of how many people one victim can infect — has a lot to do with how rapidly a virus is able to spread. If the number is 2.0, it means each victim will spread the virus to two others on average. The same for 3, 4, 5 and so on. If the number is less than 1.0, it means the pathogen will eventually die out. 

But for this new coronavirus, which has now infected 2,744 people and killed 80, scientists don't agree on precisely what the basic reproductive number is.

• The World Health Organization has given an estimate on the conservative end of the spectrum, placing it between 1.4 and 2.5. 

• But researchers at Great Britain’s Lancaster University estimate the virus’s reproductive number is somewhat higher, around 3.8.

• And a preliminary estimate from Harvard researchers Maimuna Majumder and Kenneth Mandl puts the figure between 2.0 and 3.3.

At first glance, those estimates may not appear so terrible. They are certainly lower than the transmission rates for many other illnesses including the 2003 SARS outbreak in China, which had a reproductive number of 4, and the highly infectious mumps and measles, whose reproduction numbers are 10 and 18, respectively.

But the picture looks different when one considers the real numbers of people who could become infected. The Lancaster researchers estimated that nine days from now, by Feb. 4, there could be more than 190,000 cases in the Chinese city of Wuhan, where the outbreak started in December.

“Our work suggests that a basic reproductive number for this … outbreak is higher compared to other emergent coronaviruses, suggesting that containment or control of this pathogen may be substantially more difficult,” the researchers wrote.

Regardless of where the reproductive number exactly lies, this is a fact: The new coronavirus is spreading so quickly that China's emergency quarantine measures affecting 50 million people may not be enough to keep it contained in central China.

In a late-night news conference on Sunday, the mayor of Wuhan announced that 5 million people fled Wuhan in recent days and scattered around the world, despite the unprecedented quarantine. That likely means many more infections and deaths than if the city's residents had been more closely contained.

"The effectiveness of an unprecedented quarantine around the viral epicenter in central China’s Hubei Province has become a key question, as Chinese and international authorities ponder how to rein in the outbreak — and, at this point, whether it could be contained at all," the Post's Gerry Shih and Simon Denyer write.

"A scientific assessment of the spread of the disease, assuming an optimistic 90 percent quarantine, still predicted more than 59,000 infections and 1,500 deaths — twice the toll of the 2002-2003 SARS outbreak," they add.

Even as the country kicked off its traditional New Year’s celebrations, China's leader Xi Jinping warned of a "grave situation" with an "accelerating spread’"of the coronavirus and more than 50 million people were ordered on lockdown in central China with a travel ban covering 16 cities in the central Hubei province.

“Transmissibility is increasing,” Health Minister Ma Xiaowei told reporters yesterday. “The outbreak has come to a severe and complicated situation.”

He added that there could “still be new developments” as the virus mutates. “We still don’t know the risks of transformation,” he said.

Tedros Adhanom Ghebreyesus, director-general of the World Health Organization:

And now there are five confirmed cases in the United States, including two new cases in California and one in Arizona. The Centers for Disease Control and Prevention said all of the patients had traveled from Wuhan and all are hospitalized.

“As of midafternoon Sunday, the CDC has been investigating 100 people in 26 states, including the five who were confirmed infected,” our colleagues write. “Of those, 25 people have been tested and are not infected with the virus.”

Politico's Sarah Owermohle:

Infections have also been confirmed in France, South Korea, Japan, Nepal, Thailand, Singapore, Vietnam, Taiwan and Australia (check out this Post tool mapping where the virus started and where it has spread).

Experts say China's actions may not be enough to prevent the virus from spreading around the world and even perhaps joining the ranks of respiratory viruses that regularly infect people, Stat News reports.

“The more we learn about it, the greater the possibility is that transmission will not be able to be controlled with public health measures,” Allison McGeer, a Toronto-based infectious disease specialist who contracted SARS in 2003, told Stat.

And now Chinese health officials say people carrying the new coronavirus could infect others even while they do not show any symptoms for as long as 14 days, a period known as incubation. That implies that, unlike SARS, seemingly healthy travelers could have unwittingly infected others. Yet CDC officials say they're not yet convinced that's the case.

So far, the virus appears less dangerous than the SARS virus, which killed 774 people. It's nowhere close to as deadly as Ebola, but it is more easily transmitted. 

“The Wuhan coronavirus has caused mild to severe respiratory illness, fever, coughing and shortness of breath,” our colleagues explain. “The CDC believes symptoms can manifest two to 14 days after exposure.  At this time, no drugs or vaccines have been recommended specifically to treat the virus.”

Yet there are not nearly enough resources in China to care for the new cases reported every day, The Post's Anna Fifield reports.

“Hospitals are so short of space that a pop-up quarantine facility with 1,000 beds is being rapidly built on the outskirts of Wuhan,” Anna writes. “State media broadcast footage Friday of four dozen excavators and bulldozers working to prepare land for the temporary hospital, which will be completed within six days.”

“The site being built is to remedy the shortage of existing medical resources,” the state news agency Xinhua said in a report Friday. “Because it will use prefabricated buildings, it can be built fast and also won’t cost much.”

Construction workers also worked over the weekend to transform a medical center in Huanggang, a city also under quarantine about 30 miles from Wuhan, into a hospital with more than 1,000 beds within 48 hours. Medical workers are so strained that some wear adult diapers because they don't have enough time to visit the bathroom or don't want to risk ripping their hazmat suits. One exhausted doctor died of a heart attack on Thursday while tending patients.

“I don’t want do this job any more. Just fire me! Kick me out, send me back home,” a doctor at Wuhan No. 5 Hospital yelled into the phone, frustration and exhaustion exploding out of him.

And hospitals are running short of equipment such as surgical masks, full-body hazmat-style suits and protective goggles. “Current supplies would last only three to five days, ThePaper.com, a Chinese news site, reported Friday,” Anna writes. “On social media, hospitals and health authorities have been issuing urgent requests for donations of basic supplies like masks.”

Amid all of this, the Chinese government is being criticized for its slowness in acknowledging the situation — similar to h the way it denied information in 2003 related to SARS. While the outbreak was first reported on Dec. 31, it was not until Jan. 21 that the National Health Commission confirmed that the virus could be transmitted from person to person.

Former FDA commissioner Scott Gottlieb: 

AHH, OOF and OUCH

AHH: The Trump administration threatened to withhold federal funding from California if the state doesn’t stop requiring private insurance plans to cover abortions. 

The announcement was made on the morning of the annual March for Life in Washington, where Trump headlined as the first president to address the event in person. 

“No one in America should be forced to pay for or cover other people’s abortions,” Roger Severino, director of the Office for Civil Rights at the Department of Health and Human Services, said in a statement.

“The administration issued a notice of violation, declaring that California was not complying with the federal Weldon Amendment, which says that certain funds can be withheld if a state or local government discriminates against a ‘health care entity' for not providing or paying for abortions,” the New York Times’s Pam Belluck reports. “The announcement was intended as a warning shot to several other states that also require insurers to cover abortion, including New York, Oregon, Washington, Illinois and Maine.” 

HHS said it would give California a month to commit to dropping the requirement. 

From California Attorney General Xavier Becerra: 

Gov. Gavin Newsom (D) said the state won’t change its requirement: 

OOF: Hundreds of regional grocery stores are shuttering their in-store pharmacy counters, in part because major drugstore chains are dominating the market. 

“Grocery pharmacies are getting hit on several fronts, analysts and the companies say. They are too small to wrest competitive reimbursement rates on drugs, they aren’t connected to big medical networks or insurers, and they generally lack walk-in clinics and other health services that draw many customers to CVS and Walgreens locations,” the Wall Street Journal’s Sharon Terlep and Jaewon Kang report. “ … Grocery pharmacies are the latest casualty of industry consolidation that has for years been forcing mom-and-pop drugstores to close. Even some big players have rethought the market. Target Corp. sold off its pharmacy business to CVS Health Corp. five years ago.” 

In 2017, the latest year with available data, the number of pharmacies in grocery stores dropped from 9,344 to 9,026.

OUCH: Hundreds of Marshall Islanders living in Dubuque, Iowa were allowed to relocate there in the 1980s after the U.S. dropped nuclear bombs on their island. But while the government promised them access to health coverage via Medicaid, it yanked it away in the mid-1990s welfare reform deal, Politico’s Dan Diamond reports in this magazine piece. 

“In Washington, a small band of lawmakers is trying to restore the islanders’ Medicaid coverage, a fight that one Democrat already has fought and lost for a decade,” he writes. 

“Here in Iowa, meanwhile, these islanders are finding that Dubuque offers them something they desperately need: The promise of free health care, delivered at a local clinic. And for residents of the Marshall Islands, where some radiation levels are still higher than Chernobyl, that’s more than enough to travel across the globe, to move to this chilly city nestled near the border of Illinois and Wisconsin.” 

Sen. Mazie Hirono (D-Hawaii) has led the effort to restore the islanders’ Medicaid coverage. But she has "struggled to win over colleagues and party leaders because of a simple legislative calculus: The islanders aren’t voters, and lack the key advocacy groups willing to go to war with Congress on their behalf,” Dan writes. 

REPRODUCTIVE WARS

— Pastor Paula White, a spiritual adviser to Trump, said she was speaking metaphorically in a now-viral sermon in which she said she prayed for all “satanic pregnancies” to end in miscarriage. 

In a clip of the Jan. 5 sermon, posted by the liberal advocacy group Right Wing Watch, White said: “We declare that anything that’s been conceived in satanic wombs, that it will miscarry, it will not be able to carry forth any plan of destruction, any plan of harm.” 

“White’s words are largely being interpreted literally — that she wishes for evil women to have miscarriages — but she shared a rare response to the criticism in which she explained that she was speaking in metaphor, praying for evil plans to be foiled in her congregants’ lives,” The Post’s Derek Hawkins and Angela Fritz write. “… Ephesians 6:12, according to the King James Bible translation, reads: For we wrestle not against flesh and blood, but against principalities, against powers, against the rulers of the darkness of this world, against spiritual wickedness in high places.” 

White tweeted referring to Ephesians 6:12 and insisting her words were taken “out of context”:

Our colleagues add: “But it is almost unheard of for a leader of an evangelical church to call for the death of unborn babies in any context. The belief in the right to life and opposition to abortion rights are paramount political issues for religious conservatives, and defections from those stances are rare, even in metaphor.” 

TRUMP TEMPERATURE

— The Veterans of Foreign Wars, the oldest major U.S. veterans group, is calling on Trump to apologize for comments minimizing the traumatic brain injuries suffered by U.S. forces in an Iranian air attack, The Post’s Anne Gearan reports. 

The Pentagon said 34 U.S. services members were diagnosed with varying degrees of brain injuries after the attack. Last week, the president played down the significant of those injuries, saying, “I heard that they had headaches, and a couple of other things. But I would say, and I can report it is not very serious. Not very serious.” 

In a statement, VFW National Commander-in-Chief William “Doc” Schmitz said Trump “minimized these troops’ injuries…The VFW expects an apology from the president to our servicemen and women for his misguided remarks.” He added Trump should work with the group to educate people about traumatic brain injuries, which can lead to depression, memory loss and other debilitating conditions. 

In response to a question about whether he thought these injuries were serious, Trump said no. He told reporters: ““I don’t consider them very serious injuries, relative to other injuries that I’ve seen,” he said. “I’ve seen what Iran has done with their roadside bombs to our troops. I’ve seen people with no legs and with no arms. I’ve seen people that were horribly, horribly injured in that area, that war,” Trump said, adding that some of those injuries were caused by weapons supplied by Iran.

— And here are a few more good reads:

AGENCY ALERT

“Joe Biden continues trying to hide his efforts to help Republicans cut Social Security,” Faiz Shakir, Sanders’ campaign manager, said in a statement.
Bloomberg

MEDICAL MISSIVES

There is a virus that has already sickened at least 13 million Americans this winter, hospitalizing 120,000 and killing 6,600 people. You may even know of it.
Kaiser Health News
Two papers published Friday offer some of the first rigorous analyses of patients who contracted a novel coronavirus that first broke out in China.
Stat News
Bennet Omalu became famous after telling the world he’d discovered CTE. His fellow brain doctors knew better.
Will Hobson

HEALTH ON THE HILL

The Democratic Congressional Campaign Committee (DCCC) is targeting 11 House Republicans over remarks President Trump made at the World Economic Forum in Davos, Switzerland, this week that suggested he could consider budget cuts to entitlements.
The Hill

INDUSTRY RX

Trump released a blueprint to lower drug prices in May 2018, but the administration has hit roadblocks rolling out parts of that agenda.
Politico

STATE SCAN

Party officials say they are running accessible caucuses. But Iowans seeking even the simplest accommodations say they are struggling to get firm answers.
New York Times
In July of 2019, Oregon passed a bill that allows students to take excused absences for mental health related issues. Students advocated for the bill, saying it would reduce stigma about mental health issues, and encourage young people to seek the treatment they need. Now, the California legislature is considering something similar.
KQED

SECOND OPINION

Monkey Cage
These decisions are an uneasy balancing act between science and politics.
Mara Pillinger

DAYBOOK

Coming Up

  • The House Judiciary Subcommittee on Crime, Terrorism, and Homeland Security holds a hearing on fentanyl on Tuesday.
  • The House Education and Labor Subcommittee on Health, Employment, Labor, and Pensions holds a hearing on the maternal and infant health crisis on Tuesday.
  • The House Ways and Means Committee holds a hearing on legislative proposals for paid family and medical leave on Tuesday.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on "Improving Safety and Transparency in America’s Food and Drugs" on Wednesday.
  • The House Veterans Affairs Committee holds a hearing on caring for veterans in crisis on Wednesday.
  • The Senate Special Committee on Aging holds a hearing on the Society Security impersonation scam on Wednesday.
  • The Senate Veterans Affairs Committee holds a hearing on pending legislation and nomination on Wednesday.
  • Politico hosts an event on "Navigating the Health Care Maze" on Wednesday.

SUGAR RUSH