Enlarge / Information officer wearing protective mask, gloves, and goggle, as prevention of novel coronavirus epidemic, at international arrival gate of Bali Ngurah Rai International Airport in Kuta, Bali, Indonesia on February 4, 2020. (credit: Getty | Nur Photo)

The Chinese businesswoman who spread the 2019 novel coronavirus (2019-nCoV) to four colleagues in Germany while reportedly experiencing no symptoms of the infection actually did have symptoms, according to a news report in Science.

The woman’s case, published January 30 in The New England Journal of Medicine, was considered the most clearly documented evidence that the novel viral infection could spread silently from asymptomatic people. Public health experts have been particularly anxious about such transmission because it could potentially ease disease spread and negate outbreak control efforts, including screening travelers for symptoms, such as fever.

“The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak,” the authors of the NEJM article concluded.

But that conclusion now appears to be based on false information. And, while the new information on these specific cases doesn’t rule out the possibility that asymptomatic spread has occurred or is occurring in other cases, it could help ratchet down fears that asymptomatic spread is driving the now mushrooming outbreak.

Experts at the World Health Organization have said repeatedly that even if asymptomatic spread is occurring, it is likely a minor source of infection; coughing and sneezing people are simply much more likely to spread the virus.

Moreover, the corrected version of the NEJM article may highlight a more pressing threat to outbreak control—the fact that all five cases in the cluster were mild and unremarkable amid standard cold and flu season.

Missed signs

According to the new report in Science, the businesswoman’s 2019-nCoV infection symptoms went unrecognized because they were mild, masked by over-the-counter medications, and—most notably—the authors of the NEJM article didn’t speak with her before the article was published.

The woman, a Shanghai resident who had visited Germany from January 19 to 21, tested positive for 2019-nCoV in China on January 26. The other four cases were identified in Germany by January 28, and the case report appeared in NEJM just two days later.

Without direct communication with her prior to the publication, the NEJM article’s authors relied on the accounts of her four sickened colleagues in Germany, who said she didn’t seem sick during her visit.

But government health officials in Germany were later able to reach the Shanghai woman by telephone. People privy to details of the call told Science that she said she felt tired, had muscle pains, and took a fever-reducer during her visit.

Officials at the Robert Koch Institute (RKI), the German government’s public health agency, have sent a letter to NEJM informing them of the error in the article, according to an RKI spokesperson who spoke with Science.

One of the NEJM authors, Michael Hoelscher of the Ludwig-Maximilians University of Munich Medical Center, told Science that they should have been clearer about where they had gotten the information about the woman’s symptoms. “If I was writing this today, I would phrase that differently,” he said.

Another author on the article, virologist Christian Drosten of the Charité University Hospital in Berlin, said, “I feel bad about how this went, but I don’t think anybody is at fault here. Apparently, the woman could not be reached at first and people felt this had to be communicated quickly.”

Drosten went on to say that—despite the correction—the five cases highlight a potentially dangerous feature of this outbreak—that is, that the infection may not be very dangerous.

“There is increasingly the sense that patients may just experience mild cold symptoms, while already shedding the virus,” he said. “Those are not symptoms that lead people to stay at home.”

Circulating unknowns

Indeed, as the outbreak has continued to escalate, experts have noted that the virus appears more contagious than initially thought and that the early outbreak responses focused heavily on identifying the most severe cases, such as those involving pneumonia and respiratory distress. That focus may have potentially missed the spread of mild disease, which may be far more extensive than what is known even now.

As of Tuesday morning, there are reports of 20,704 cases worldwide and 427 deaths. According to the World Health Organization’s latest figures, approximately 13.5 percent of cases are severe—though that estimate could change dramatically if many mild cases are missing, which is likely.

Of the outbreak cases, a little over 200 are outside of mainland China, scattered in around two dozen countries. Some of those countries have reported limited person-to-person spread, including the United States.

The US Centers for Disease Control and Prevention has confirmed 11 cases in the country so far, including nine travel-related cases and two cases of person-to-person transmission within the US among close contacts. The first case identified in the US, a 35-year-old in Washington state, has been released from the hospital and is now in isolation at home. The second identified case, a Chicago woman in her 60s, has been described as doing “quite well” and is primarily being hospitalized for isolation purposes.

“The look and feel of the exported cases, I think, really support the argument that there’s a lot of mild disease that is not being detected in China at the moment for the very good reason that they just can’t do it,” Dr. Allison McGeer told Stat News recently. McGeer is an infectious diseases researcher at Toronto’s Mount Sinai Hospital, who helped respond to other outbreaks of emerging coronaviruses, namely those behind SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome).

Public health experts and media are now volleying predictions of how the outbreak will play out—whether it will be contained and fizzle out or become a pandemic (that is, with worldwide spread), and whether it could resurge occasionally or join its four common coronavirus cousins in continually circulating among humans.

The answer is still unclear, of course, and, for now, the CDC still considers the risk to the general American public to be low.

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We can tell you about the growing problem of medical debt and how hospitals are suing thousands of patients for having the gall to be both sick and poor, or how debt collectors screw-up and use illegal tactics to get paid for debts they often can’t even prove that anyone owes. But that’s nothing compared to the sight site of a goofy English guy forgiving $15 million in medical debt he bought for pennies on the dollar.

On Sunday’s Last Week Tonight, host John Oliver took a long, multifaceted look at the messy, shady world of debt collection and debt buying.

If you’re a regular reader of Consumerist, much of what Oliver talks about is nothing new: news: Debt buyers purchase debt from creditors and other debt buyers. Sometimes that debt isn’t even owed, as the relevant statute of limitations has expired. If the alleged debtor begins making payments on those bills, it may resurrect the debt as so-called “zombie” debt.

Oliver says the zombie metaphor is “quite apt, because just like on The Walking Dead, zombie debt comes back from the grave, is incredibly hard to deal with, and seems to disproportionately impact minorities.”

Sometimes the debt buyers are buying nothing more than a name and a dollar figure, with little to no proof that the amount is correct or other evidence that the debt is still owed. However, because debt buyers pay so little for these lists of debtors, they only need to convince a small number of people to pay up in order to make their money back.

In more than half the states, you can legally buy debt without a license. In 17 states, you don’t even need a license to collect debts.

“There are places in this country where you need to fill out less paperwork to start collecting money from peoples’ pockets than you do to collect fish from a f*cking lake,” explains Oliver.

He continued: “It is pretty clear by now that debt-buying is a grimy business and badly needs more oversight. As it stands, any idiot can get into it, and I can prove that to you, because I’m an idiot and we started a debt-buying company… And it was disturbingly easy.”

For a $50 fee, Oliver and his team registered their new debt-acquisition firm, Central Asset Recovery Professionals — CARP, named after the bottom-feeding fish — in Mississippi, complete with a website that was nothing more than the logo you see here.

“With little more to go on than that website,” says Oliver, “we were soon offered a portfolio of nearly $15 million of out-of-statute medical debt from Texas.”

The asking price was less than $60,000 for $14,922,261.76 in this zombie debt — or around $.004 for every dollar of debt owed. Purchasing the debt would give CARP the names, current addresses, Social Security numbers, and amount owed (or previously owed, as the statute of limitations had expired) for nearly 9,000 individuals.

“So, we bought it, which is absolutely terrifying,” admits Oliver. “Because it means if I wanted to, I could legally have CARP take possession of that list and have employees start calling people, turning their lives upside down over medical debt they no longer had to pay. There would be absolutely nothing wrong with that, except for the fact that absolutely everything is wrong with that.”

Thus, rather than try to collect on the debt, Oliver decided to stage the “largest one-time giveaway in television history,” nearly doubling the estimated value of that time Oprah gave everyone in her audience a new Pontiac G6, a moment that has been a gift for meme-makers, but didn’t do much to save the Pontiac brand.

Thus, rather than take possession of the debt, CARP had it sent to RIP Medical Debt, an organization that specializes in forgiving medical debt while without leaving the former debtor without any tax consequences.

In a blog post on the RIP website, the organization says that because of Sunday’s show, “there are a lot more of us now privy to this collection industry practice and the debt treadmill it creates. In a painfully hilarious (debt as funny? Somehow, yes) piece, John Oliver triumphantly Out-Oprah’s Oprah in giving away valuable gifts.”

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Yahoo Japan is actually a good business, maybe because Yahoo doesn't touch it.

Welp, this is definitely the weirdest research I've read this month. alexx_kay, knowing my interest in surrealism, pointed me at the 2013 article in Psychological Science, titled "The Common Pain of Surrealism and Death: Acetaminophen Reduces Compensatory Affirmation Following Meaning Threats", by Daniel Randles, Steven J. Heine, and Nathan Santos. What Alexx didn't know is that I'm also way into meaning threats.

Here's the abstract:

The meaning-maintenance model posits that any violation of expectations leads to an affective experience that motivates compensatory affirmation. We explore whether the neural mechanism that responds to meaning threats can be inhibited by acetaminophen, in the same way that acetaminophen inhibits physical pain or the distress caused by social rejection. In two studies, participants received either acetaminophen or a placebo and were provided with either an unsettling experience or a control experience. In Study 1, participants wrote about either their death or a control topic. In Study 2, participants watched either a surrealist film clip or a control film clip. In both studies, participants in the meaning-threat condition who had taken a placebo showed typical compensatory affirmations by becoming more punitive toward lawbreakers, whereas those who had taken acetaminophen, and those in the control conditions, did not.

Okay, so, here's the thing. Meaning threat is – and until I started constructing this sentence, I didn't realize this was true, and a superior answer to my previous one – the heat of psychotherapy. That is, no matter which flavor of therapy a therapist is doing, there is a good chance that whatever is afflicting the patient, something that is causing or exacerbating that problem is an erroneous understanding of something, and the therapist is going to have to – one way or another – get the patient to realize that. And unfortunately, if the patient's problem has gotten to the point they want a professional's help with it, it may be becase they are really, really, really emotionally attached to that erroneous understanding.

Approaches to bearding that lion span the gamut from leaving the patient to flail around till the figure it out for themselves (e.g. "blank-screen" psychoanalysis, hardcore constructivist approaches), through socratic questions (e.g. Motivational Interviewing) and direct proposal of the counter hypothesis (e.g. Narrative Therapy), right on up to bluntly telling the patient "You're wrong" (implied: "and you should feel like an idiot for thinking that") (e.g. CT, REBT (ergo CBT), Gestalt). But pretty much all therapists have to deal, very regularly, with helping patients realize that the meaning they've made from some life experience – sometimes super-huge important ones – is badly wrong, and why they are stuck now: they are reasoning from false premises.

Doing this provokes negative reactions on at least four fronts. First, most people associate being wrong with justification for (or the expectation of) being humiliated by others, possibly abused, and losing both status and credibility. Second, the giving up of the wrong idea often involves some form of painful loss; often the reason the person is clinging to the wrong idea is out of wishful thinking – often a desperate hope. "Maybe this time I will be perfect enough to earn the love of my (now elderly) parent."

Third, finding out you are wrong about a big and important thing in your life tends to rattle your confidence in your ability to make meaning at all; you may wonder what else you've got wrong, or whether you can trust your own judgment. Fourth, being wrong can be several kinds of dangerous, from the "no, that ice isn't thick enough to be walked on" sort of dangerous to the "if the other people in your clan hear you say that you will be driven away to start on your own" sort of dangerous; finding out one has been wrong about something substantial can cause fear. Finding out one may be wrong, is worse for fear; ambivalence is more threatening.

All this is meaning threat. Threat of contradictory meanings, threat to one's sense of one's ability to make meanings, threat of having socially unacceptable meanings.

And what this article says is that they have evidence that 1000mg of acetaminophen reduces the negative emotional reaction to meaning threat.

Huh.

Was anybody looking for a PhD thesis topic?