The Thai coronavirus paradox

Dr. Wiput Phoolcharoen, a public health expert at Chulalongkorn University in Bangkok who is researching an outbreak of the coronavirus in Pattani in southern Thailand, noted that more than 90 percent of those who tested positive there were asymptomatic, much higher than normal.

“What we are studying now is the immune system,” he said.

Dr. Wiput said Thais and other people from this part of Southeast Asia were more susceptible to certain serious cases of dengue fever, a mosquito-borne virus, than those from other continents.

“If our immune systems against dengue are so bad, why can’t our immune system against Covid be better?” he asked.

Here is more from the NYT, good to see coverage of this.  Finally we are getting somewhere.

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Most non rich western nations have handled the coronavirus well. They don’t engage in magical thinking about infectious disease, because they can not afford to.

Americans and W Europeans, meanwhile, fantasize that the disease will magically go away of its own accord, or that our societies have vast percentages of secretly immune people.

It’s embarrassing, quite frankly.

Should be “non rich OR non western nations”

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But non-western societies have the handicap of not having geniuses like the Georgia goovernor .
https://www.cnbc.com/2020/07/17/georgia-gov-kemp-urges-people-to-wear-masks-after-suing-atlanta-over-mask-mandate.html

He's part of the Lincoln Project working to cull Trump voters.

No Trump voter should be protected by government from his pro-death-after-birth political ideology. After all, Trump ran on killing jobs, killing people on the job, killing people in their homes, and destroying their homes quickly by preventing legal action, all to increase profits, the money never paid to the workers Trump needs to vote for Trump.

Don’t be silly. Cuomo, among others, has promulgated policies worse than anything Trump’s done.

Your TDS makes every one of your posts repetitive and suspect.

God of thunder: So many words, so little said.

Most of Asia is using the tests with excess of 50% false positive results. It is likely that we won't know how these countries did in the Covid-19 pandemic for 18 months or more.

A large covid outbreak is difficult to miss. Overrun hospitals, people refusing to go outside, large numbers of excess deaths.

You did notice that important point that we are talking about asymptomatic covid-19 which means they aren't in hospitals or dying???

More to the point is that much of the ado about nothing in the politics of covid-19 is the increase in cases even when deaths are going down. In fact these "increases in cases" go hand in hand with increases in testing. Any casual fool would know that if you test more you will find more. But Nooooo, not our politicians an increase in positive tests MUST mean everyone stay home and wear masks in the shower. There is a serious problem with false positives in these tests. We don't even know how many false positives but they seem to be at the 50% rate. That is a serious error rate.

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-1

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Wuhan democrat hoax virus! Who cares? Its a hoax! No worse than the common co(breaks down coughing).

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Fauci lied, people died.

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the BGC vaccine wins again

*BCG

Or the MMR vaccine. Many nations less than 1st world have had national vaccination programs more recently. And there seems to be enough covid 19 antibody crossover with the Rubella virus. Maybe not totally protect, but prevent more serious cases. Could explain the low rate of serious covid disease with so many infected Teddy Roosevelt sailors.

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No, you misread TC. He is saying SE Asians were exposed historically to bat coronaviruses (of the natural kind, note SARS-CoV-2 is almost certainly a mashup of three different viruses, two of which are chimeric, but I digress) and therefore SE Asians are more likely to have an immune response to Covid-19, hence their low numbers. Nothing to do with the BCG vaccine, which has been disproved (CatInTheHat is the resident authority here)

"CatInTheHat is the resident authority here"

There might not be any flying cars, but sometimes the 21st century is as cool promised and weirder, too.

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it is thought all coronaviruses originate in bats and there are more bat species in South East Asia , maybe 450 species out of 1400. In Europe + Middle East + North Africa, only ~ 50 species. However the country with the most bat species (180) is …. Colombia which hasn’t done particularly well with Covid-19.
I think the 4 human Coronaviruses ( HCoV) that cause the common cold are well mixed worldwide.
Exposure to animal CoVs as evidenced by a recent paper on T cell responses ( linked to by Tyler 2 days ago) could be a factor in (perhaps partial) immunity.
It would be good to study T cell responses in populations with less infections and more bats ( South East Asia) vs high infections and less bats ( Europe)

Point of order. FEWER infections. FEWER bats. OK. My grammatical work here is done.

Thanks for correcting my sloppy English. Yes use "fewer" when talking about countable things

Nothing personal. I try not to indulge my grammar despot tendencies...it was more tongue in cheek than anything. And wow, but I appreciate your knowledge on the viral details.

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I think Ray is correct. I recall there being a study on precisely this subject from pre-covid. Don't recall what % they found carried immunities to their tests.

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If you look at the BCG geographic evidence only, neglecting everything else, all the Asian countries that have done well have the vaccination ( S. Korea, Japan, Vietnam, Cambodia, Thailand, Taiwan ,Laos, Myanmar). None of the European counties have it except Portugal and Ireland. Portugal is at 165 deaths per M, Ireland at 355 per M. much worse than South East Asia ( Japan = 8 per M).
Some other countries with BCG also have high totals, Chile, Peru and Brazil ( 436, 388 and 367 deaths per million , respectively).
I would say not totally ruled out but inconclusive at best.

We can also add the Philippines, Malaysia and Indonesia to the tally of BCG countries that have done well.

It depends on what you mean by "done well"; the Philippines and Indonesia still have climbing rates. I tried to see if there's a strong correlation between degree of urbanization and Covid-19 rates, but the data doesn't seem to support any clear trend, data below. The thesis is that rural populations in bat infested countries are doing better since the population has, over 100s of years, been exposed to bat coronaviruses and has developed humoral and/or cellular immunity. Hell, in the Philippines a fruit bat fell out of our palm tree in our country house, oozing a yellow pus, and we buried it so that nobody would touch it by hand. Common. But I could not find a strong correlation. I think a more plausible thesis is that since C-19 virus is so "novel" (read: chimeric), that it's "unprecedented" with a huge "gain-of-function" and even if you have antibodies against historical strains of bat coronavirus in your system, it won't help you that much against this strain of bat coronavirus.

Data:
Country - % Urbanization - from https://en.wikipedia.org/wiki/Urbanization_by_country#Countries - Degree of Curve flattening
***Colombia - 81.4% - still exponential *** ***Argentina - 92.1% - still exponential *** ***Chile - 87.7% - flattened and declining *** ***Thailand - 51.4% (surprised Siam still so rural) - flattened and declining *** ***Laos - 36.3% - flattened and declining *** ***Philippines - 47.4% - flattened but rising *** ***Indonesia - 56.6% - flattened but rising *** ***India - 34.9% - still exponential *** ***Brazil - 87.1% (incredible!! I thought Brazil was more rural, like India) - flattened and stable ***

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Maybe cohorting these countries by year that the vaccine became mandatory would reveal more consistency? Or percent of populations at different age bands to have the vaccine?

I don’t know the data but I’d be curious to see the % of age 65+ Brazilians with the vaccine versus that same age group in Ireland or Vietnam

The year the vaccination was introduced is available for some countries:
• Peru( 1945), Chile (1948), Ireland (1955), Brazil (1976)
• Japan( 1947, Taiwan (1951), S. Korea (1975), Thailand (1977), Indonesia(1999)

http://www.bcgatlas.org/

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“I don’t think it is about immunity or genetics alone. It has to do with culture. Thai people do not have body contact when we greet each other. This is how the countries in the Mekong region greet each other as well,” Dr. Taweesin added.

Wasn't this the same story we heard about Japan and why Spain and Italy didn't fare as well?

Yet Australia has had as few per capita deaths (115) as Japan (985) and South Korea (295) despite 1) shaking hands and kissing, 2) not wearing masks much and 3) having high obesity and heart disease.

How does one explain that?

985 per capita deaths in Japan? I knew that "a coward dies thousand times", but even so I am surprised.

Seriously, Australia has a very low density, especially in comparison with Japan, and a summer climate in winter (if you see what I mean). Its low death rate's is less surprising than Japan's and we'll see what happens there in October, which corresponds to April in the northern hemisphere.

No, this is wrong.

Japan has had 985 total deaths.

South Korea 295.

Taiwan 7.

These aren’t per million, they’re total

Mate, Australia may be a continent the same size as the USA, but its a country of 5 capital cities-the most highly urbanised on Earth.

'Summer climate in winter'

Can you torture the seasons any more bizarrely?

?

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Mate, Australia may be a continent the same size as the USA, but its a country of 5 capital cities-the most highly urbanised on Earth.

Ummm...sorry, mate. Australia is an incredibly sparsely populated country:

https://www.businessinsider.com.au/this-map-shows-population-density-across-australia-2017-7

It is not even **close** to Japan in terms of population density:

https://commons.wikimedia.org/wiki/File:Japan_Population_density_map.svg

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Sydney at 5 million isn't a small city - Stockholm only has 1 million but has had thousands of deaths. Australians are more obese than Swedish and probably have more physical contact.

Japan's outcome isn't remarkable relative South Korea: almost no contact with strangers (Koreans have more) and less testing than in any large Western country.

Japan's outcome is remarkable because they live in a country that is 12x denser than the US, has some of the world's oldest demographics, and they failed to lockdown until well into April. All of those risk factors should have lead to US/Italy/Spain like results.

The comments above have corrected you on Japan's total deaths at 985, not per capita and this in itself is remarkable.

They never locked down, although Hokkaido had 2 weeks of voluntary business closures.

Anyone who’s done business in Japan will have a good chuckle at the idea of most businesses there being able to do remote work.

Although, FWIW looks like subway traffic was down 20-60% for about 3 weeks in April depending on metro area.

Yeah, I'm well aware that Japan's 985 deaths are not per capita. So what explains their phenomenal "success"? They have the lowest testing and never locked down but 1/60th the deaths of the U.S.

I'm sure Tyler will have an in depth analysis soon. After all, he called it over a month ago: Japan is about to be in a national emergency, and it has been! 1,000 deaths of those over 75. Japan may not recover....

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They aren't the per capita figures. Australia is currently 4 per million.

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If you believe Japan, I have a bridge to sell you.

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https://www.medrxiv.org/content/10.1101/2020.07.16.20154088v1.full.pdf

Respiratory failure appears more related to antibodies than to virus. It's an allergy of a sort? That's a narrative that fits with certain stereotypes.

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Ah ha ha ha ha ha ha ha ha ha ha ha, Wiput!

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Small differences can make for large differences in outcomes. Some refuse to acknowledge this because it might cast blame on Trump. The pictures at the link tell all one needs to know. Look at the picture of kids in a classroom, each with a desk surrounded by a plastic shield. What school district in America plans to do that? Or what about the picture of two diners sitting at the same table at a restaurant with a plastic shield between them. What restaurants in America plan to do that? Down here in the South coronavirus is just the flu, and to take precautions is to deny God's will. Americans are stupid. And proud of it.

Bingo. Finally, we are getting somewhere.

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It’s Trump’s fault, uniquely! But why stop there, let’s add another ridiculous generalization: “Americans are stupid. And proud of it.”

Consider these before you bash your keyboard in your daily attempt to be relevant, rayward: 1) Trump’s response to Covid, like that of others, such as the CDC’s or Fauci’s, has been less than optimal; 2) it’s still been better than many Governors and Mayors; 3) the East coast was hit by a more virulent variant of the virus.

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Americans are stupid. And proud of it.

I am impressed how Raymond has managed *from*one*thread*to*the*next* to backflip. He was condemning the Prosperity Gospel people and praising Bonhoeffer while talking about Simone Weil. Well, fine. But if Bonhoeffer is famous for anything it is his distinction between Costly Grace and Cheap Grace. It is easy to love the loveable. We are commanded to love our neighbors whether they are loveable or not. It is a function of us not them. At times this message will carry a high price - as it did for Bonhoeffer.

The truth is we live in a time of Cheap Grace. No one will suffer like Weil or Bonhoeffer. The prosperity gospel is indeed the right message for this time. But so is Raymond's cheap shot at his neighbors. It costs him nothing.

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I can think of several things that might need further study:
• Thai culture has more built in social distancing as mentioned in the article
• Covid-19 is sometimes mistaken for Dengue fever. They share clinical and labs characteristics ( with Covid-19 you can serologically test positive for Dengue ( link below), so you could have missed cases.
• Heat and humidity with no AC, especially humidity . As Tyler linked to several days ago, higher humidity leads to a less viscous more effective respiratory mucosal secretion , the first line of defense. If this first line of defense is more robust, then you get a smaller viral inoculum ( viral dose). This is correlated to less severe disease, or even perhaps no disease at all. Every virus always has a minimal dose required for infection.

adding the link
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7128937/

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Dengue exposure is likely unrelated. Brazil has high levels of Dengue infection along with high SARS-CoV-2 infection

No, it has neither.

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Is this like back when this site was hailing the underappreciated and excellent response of Florida's governor to coronavirus?

It's a novel disease, and there's a lot of noise in the data. Stories like these should be taken with a whole shaker full of salt. We will know pretty definitively if Thailand is doing a great job in 2-3 years. Now? Not so much.

On the topic of Florida, it's been interesting to see that several hospitals there that were reporting a 100% positivity rate are now admitting that those numbers are wildly false, and absolutely no one in authority or the media has any interest in exploring how this mis-reporting happened, nor why nobody thought a 100% positivity rate was at all questionable.

Following analysis that granular is silly, because you end up with stories like that. See my point, above. With an event like this one, if you are that far in the weeds, you are probably lost. There will eventually be a place for super interesting granular analysis (it's even possible that I will write some of it). But right now the data is just too messy, and the event itself, like all such things, has a high degree of variability, because that's reality. That's precisely how Florida ended up in its current predicament. They used way too little data at a point way to early in the event to start believing their own hype.

Apparently they are also counting people who die in motorcycle crashes who test positive for coronavirus as COVID deaths. I liked it better when I thought my parents were just crazy prepper types.

https://www.fox35orlando.com/news/fox-35-investigates-questions-raised-after-fatal-motorcycle-crash-listed-as-covid-19-death

Yes, it's a FOX news station, but the response is from the Health Officer.

Yes, a single reporting error is a drop in the river and means absolutely nothing, but it's those types of incidents that make people question the data. People reporting the data need to be honest and clean up the reporting so that when you do your analysis (if you do it) you are actually working with useful data. Otherwise any analysis anyone does will be garbage.

I'm a retired internist, so I've filled out many a death cert. I would guess that covid 19 was detected in the motorcycle victim as a matter of routine ER testing. As we are trying to learn as much as we can about covid 19 right now, it is included on the death cert. most likely under the 'other significant conditions' header. But not the primary or antecedent cause of death.

Were that it was so. But it isn't. My BIL is a pulmonologist treating ICU patients of all types. He has told me of the pressure to put CoVid as cause of death on death certificates--including a man he had to keep in the hospital for 45 days (oh the money!!!) because he HAD been positive for CoVid (although he was admitted for a cardiac event)...by the time they found somewhere to move the guy to for rehab, he had another event--and died. He had been negative for CoVid for 5 weeks. My BIL refused to list CoVid as the cause of death--but the pressure was intense.

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Yes, but does somebody then add it to the COVID death totals? That is the relevant question, not whether the internist or medical examiner did their job correctly.

Welp, for that motorcycle death in Florida, they did.

Well if this is a pattern we will see the ratio of motorcycle deaths to accidents change.

The pulmonologist needs to stick to his guns if the covid had no bearing on the cardiac or death. Early this year cardiac implications from covid were much less described and well known. The covid should be in the 3rd slot on the death cert. Other significant conditions at the time of death, if not clinically important.

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It's good for hospital revenue and GDP to have a 100% SARS-CoV-2 positivity rate. According to our blog host "most people with private health insurance are pretty happy with their current arrangements" and alternatives are uncertain. Ergo nothing will change.

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This part of SE Asia (Yunnan, Myanmar, Loas, Thailand, Cambodia, Vietnam) has lots of bats. The ancestors of SARS-COV-2 in all likelihood came from this region. Look at this map of bat diversity - http://www.batcon.org/images/GlobalSpeciesRichness.jpg

It's not a stretch to believe a significant number people in this region have already been exposed to similar bat coronaviruses and have T cells that recognize SARS-COV-2 leading to no or asymptomatic infections.

it's an intriguing possibility, yes, I thought exposure to the 4 human HCoVs that cause colds would be more important; however a recent paper on T cell response emphasize , T cell ( NSP7-specifc T cells ) recognition of epitopes from animal betacoronaviruses

Good point, the exposure doesn't have to be directly from bats. It could also be bats --> chickens/pigs/cows/dogs --> people. People are exposed to animal viruses all the time. 99.99% of the time it doesn't start a pandemic.

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Thailand: 8,647 tests per 1 million of population
US: 139,302 tests per 1 million of population
(according to Worldometer)

Many cases in Thailand probably go un-noticed.....and deaths that would be coded as "COVID" in the US get attributed to the co-morbidity in Thailand.

Dream on.

Nah! Most covid 19 deaths are protracted enough and typically with enough respiratory symptoms and other diagnostic findings, to stand out even without specific testing for the virus.

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The problem with these claims of cover-ups is that China would have loved nothing more than a successful cover-up of what was happening in Wuhan and even gave it a serious shot in January (see the case of Li Wenliang). Yet they failed. There is undoubtedly undercounting almost everywhere in the world but it has been at least six months since this thing reached Thailand and we just don't see signs that the health system is being overwhelmed there.

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First, a question: Is there some way to remain logged in so that I don't have to fill out the comment forms every time?

Second: All of this deep digging into why one population fares better than another...why one country...with blame cast and much wailing and gnashing of teeth...

What if viruses follow an inescapable pattern once they are loosed upon the world? Human efforts to avoid or mitigate mean nothing. Certain populations will do better than others for genetic, cultural and historical reasons that we are in no position to appreciate in the middle of the maelstrom. It doesn't matter whether Florida opened last month or last week or last minute...the virus is going to do what it does because Floridians can't change their genetics, their culture or their history of exposure to other illnesses. Blaming the governor or blaming Trump or blaming Florida Man (ok, that MAY be reasonable; he is pretty whack) is just anxiety displacement.

Beyond that...when this began, a friend of mine observed, "Koreans are small and compliant. Americans are large and unruly." Humorous, yes, but a pithy observation. Culture is culture. We aren't going to remake Americans into compliant, submissive, reserved humans EVER, let alone overnight.

And really. Let's have a moment of honesty. This is not the end times. Not the apocalypse. A virus a bit more lethal than a bad flu. Stop with the pandemic porn and catastrophizing. People die. They die, they die, they die. This virus isn't razing us like a scythe through wheat. We are losing our minds over something that should be of less concern than our society's enchantment with opiates.

Exactly how many people more you want to murder?

What an inane comment. I am not murdering anyone by asking questions. Thus, your response is moronic.

Two, being skeptical of the ability of humans to forestall natural events is not tantamount to wishing death upon people, which is again, not at all synonymous with being the proximate cause of their death, and doing so with malice and intent. Again, your comment is dumb.

But while we're playacting Dumb and Dumber...How many more people do you want to hand the razor blade to so that they can commit suicide? How many more children do you plan to beat and molest? How many more women do you hope will be battered? How many more homes to you wish to foreclose on? How many more businesses do you plan to close? How many more elderly people do you want to die alone, heartbroken and confused, without having seen kids or grandkids in months?

See, you dumbass, any fool can play this game. But I will give you an answer. Many. Many, many, many. Because I do not believe that what we are doing is making much of a difference. Until there is a cure that can be administered in a blanket fashion across billions of people, this virus is going to do what it will do--all of our supposed interventions may change the time course, but they will not change the outcomes.

What we should be spending our time and money on is therapies to treat those who get sick enough to need some sort of medical intervention. The only way that I see to change the morbidity and mortality of this disease is by better treating those that get severely ill. Just as until we have a cure for certain cancers, we aren't going to stop people from getting them, and so our efforts should be directed toward increasing overall survival of those who have the disease.

Shit, if critical care docs had any sort of communication with hematologists, they might have gotten a handle on cytokine release syndrome a mite quicker....and learned that hemes see it ALL the time...and manage it successfully as a matter of course.

+1"Until there is a cure that can be administered in a blanket fashion across billions of people, this virus is going to do what it will do--all of our supposed interventions may change the time course, but they will not change the outcomes."

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Thailand is near the equator so people make plenty of Vitamin D, bolstering their immune system. All we need to do in this country is take Vitamin D supplements in winter and expose our skin to the sun in summer. Most people are deficient in Vitamin D so they have weak immune systems.

Peru, Ecuador, Brazil, Colombia? All close to the equator.

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Thailand covid-19 cases: 3,239
deaths: 58

Miami-Dade county covid-19 cases: 77,866
deaths: 1,270

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We are not who we think. We are a bio skin constructed by a devious bunch of cells long ago. They live in our bone marrow and pass their offspring along by generating another bioskin. They are masters of the science of topology, construction engineers and self organized civilizations who run the farm..

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https://www.weather-th.com/en/thailand/bangkok-climate

Humidity: 66% to 79%
The average humidity ranges from 66% to 79%, and the city is warm throughout the year. Bangkok has three seasons: hot, wet, and cold.
---
Water in the air displaces other potential aerosols.

And a quick look tends to agree. The humidity would dominate a certain elevated region and other particulates pushed below or above. There would be partition. These are monster spheres, likely punched back to the ground, as a guess.

Thailand has three seasons hot, hot, and wet. Cold is a couple evenings in December, typically. The country may have the hottest average annual temperature of anywhere in the world.

But it is nice out now.

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Where is the data on deaths from flu?

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American deaths/7 day rolling average
July 3 626/555, July 4 265/518, July 5 262/515, July 6 378/516, July 7 993/556, July 8 890/585, July 9 960/625

July 10 849/657, July 11 731/723, July 12 380/740, July 13 465/753, July 14 935/743, July 15 1002/760, July 16 963/761

July 17 946/775

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When I see the extremely low numbers in SE Asia, I can't help but suspect that the population there has been exposed to similar diseases in the past, making their average immune response more effective. Yes, they're probably better in terms of behaving in ways that discourage contagion, but it seems unlikely that public health measures are the whole story.

Perhaps this disease or something similar was present in in SE Asia for an extended period. The breakout in Wuhan is when it mutated and/or traveled to an area where these types of corona viruses are not as endemic.

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