U.S. to make More Drugs Easily Available, Cutting Role Doctors Play - <AUTHOR> https://www.bloombergquint.com/business/2018/07/17/u-s-to-make-more-drugs-easily-available-cutting-role-docs-play <comment><USER2> I live in a country where this scheme is already the norm (Saudi Arabia) and I can say that while it's not necessarily ideal, I much prefer it to the alternative. It plugs some seriously annoying holes in the healthcare experience and frees up doctors' time for more patients.

As it is, the only medications that require a prescription to buy in Saudi are psychotropic ones, narcotics, and most recently, antibiotics. Things like insulin, birth control medications, hypertension medications, even antidepressants and anti-psychotics- they are all OTC. And I think they should remain so, because from what I've seen the damage from misusing those drugs against pharmacists' advice is far less than the damage from going without them due to the difficulties encountered in seeing a doctor.

The reason that this is the norm here is twofold; one, health insurance wasn't much of a thing here until a few years ago. The second reason (and the reason health insurance didn't factor in until recently) is that the socialized healthcare system here was (and still is) stretched thin; seeing a doctor to get prescriptions for every little thing becomes prohibitively difficult, with appointments taking months.

It's asinine to expect someone suffering from, say, an acute athsma attack to try to navigate ERs or try to see a doctor on short notice during a crisis, when a pharmacist would be able to dispense the exact medication needed, leaving the others free for more complex cases that need closer attention.

Edit: this actually created a bit of culture shock for an older friend of mine. He was traveling to an EU country for the first time and didn't do his homework- he thought he he could simply walk into any pharmacy and ask for a pack of his cholesterol medication, as he usually does back home. I don't envy the poor pharmacist that had to keep trying to explain the dispensing system to him and to emphasize that yes, they are aware that it's Lipitor, not morphine, it's just how the regulation is.

<comment> Engineering-MD I'm not I agree. The first reason is that many medications carry significant risks. For instance you mention insulin. For someone already prescribed insulin, yes it should be easy to access in case they should be able to get more (and that is the purpose of a repeat prescription). However, to provide insulin over the counter to someone never previously prescribed it could be incredibly dangerous, and indeed fatal. This is Similarly true for some cardiac medication.

Second, i think such a system makes pharmacists de facto community doctors, but without the time, training, or patient medical data to function correctly. Community doctors can make better decisions when they see the same patient multiple times, and have access to blood pressure readings, a list of other medical conditions etc. Buying over the counter makes a lot of this difficult and inefficient.

Third, I think it leads to a risk of encouraging patients to manage conditions without valid medical advice. For instance, depression is often treated best with psychotherapy. By buying antidepressives OTC, it prevents patients getting the holistic care needed. Similarly, patients may follow quack medical advice and do themselves significant injury by taking medications not needed (in the short term or long term).

Ultimately doctors offer a lot of value more than just prescribing medication, and often medicines need oversight to ensure the benefits outweigh the risk.

<comment><USER3> Read the article, it will have a questionnaire to determine if people should be given the drug

I think allowing diabetics access to life saving medication is preferable, even if there's some moron that's going to kill himself by injecting something he has no idea about (and they do that already)

The proposal wouldn't allow the sale of controlled medication like antidepressants

The rest just sounds like undue gatekeeping

<comment><USER4> > I think allowing diabetics access to life saving medication is preferable,

I don't think anyone is arguing for diabetics to not have access.

My problem here is how someone knows they are diabetic.

But I saw little in the article actually describe what the process would be for deciding what can be sold like this, I know diabetes is not mentioned.

<comment><USER3> > My problem here is how someone knows they are diabetic.

Again, I don't really see why this would be the problem of the person selling it, unless you prefer living in a nanny state.

There are a multitude of OTC and other readily sellable stuff that if misused can cause death. Complaining about selling insulin freely and the dangers of it in a place where guns are sold like candy is a farce.

Make them sign a waiver and be done with it.

</comment></comment></comment></comment></comment><comment><USER5> There are better ways to go about this. As others have noted, there must be a mechanism for a continual prescription to be easily filled, e.g. insulin, metformin, etc. I could see a long term prescription that has to be renewed each year and is good at any pharmacy.

For the short term prescriptions though, cutting the doctor out of it makes people much more susceptible to marketing (instead of 'ask your doctor if you need X' we'll get 'You need X if you have any of a, b, and c...get it now before it's too late'.

Also, the doctor is aware of your health history and can spot reasons you specifically shouldn't take a drug, or better alternatives. Maybe you are overweight and one diabetes drug would work for you, but this other one will also help you lose weight. Maybe you have a loss of kidney function, and shouldn't be taking metformin. Your pharmacist should catch drug interactions, but they can't catch problems that would result from your past medical history.

For me this is big pharma getting their way, at our cost, in more ways than one.

<comment><USER6> _Also, the doctor is aware of your health history_

Your doctor skims your notes in the 20 seconds between the receptionist calling your name and you entering her office, in handwriting she can barely read herself, and has forgotten you before you're even back in the waiting room after spending 5 minutes talking to you while she's really thinking about the new Audi. That's as far as the awareness goes.

<comment><USER7> Thanks for speaking for the entire medical profession. That is in fact what a terrible physician does, and not what myself or other newly trained physicians aspire to do.

<comment><USER8> You may not aspire to it, but you likely will have to do it if you want to remain employed in many areas.

I have multiple friends who made it all the way through residency and have since stopped practicing within years of "graduating. The OP describes the profession much better than you do, as a whole.

Double booking patients, requiring certain revenue targets, massive amounts of useless paperwork, etc. Considering the varying ranges of where they took up residency I'd say this is endemic industry-wide. Also jives with my personal experiences with the medical field.

<comment><USER9> They should start their own practice and set their own rules. Good practices/doctors in my area are so in demand most aren't accepting new patients.

<comment><USER10> Is it even possible to set up an individual practice these days? Most individual practices were established decades ago. Most new physicians will work with an established group practice on contract.

<comment><USER11> Its not because billing is so complicated that it takes up to 50% of the doctors tie to manage his own practice.

Big companies have more people doing billing alone than doctors themselves. Pretty clear cut case that regulation is the enemy of efficient markets.

<comment><USER9> Wouldn't this be a perfect opportunity for a startup to handle billing for small doctor's offices?

<comment><USER11> There are several but its not as easy as it sounds. Its a very labor-intensive task. Its kind of like saying that a startup should be going to peoples homes and cook for them according to their liking.

The issue is that doctors work for insurance companies and that means you need to do things a certain way they like while matching the way they practice and document their medical decisions.

I could explain more since I am part of one of these startups :)

</comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER12> When you already know what drug you need and just need somebody to sign a prescription, it's a very silly and awkward process to find a doctor, make the appointment, wait for the appointment, show up to the appointment, fill out the history forms and so on, meet with the doc, tell them you've got [disease] and the drug for it is [drug], let them examine you until they agree with your "diagnosis" of [disease], and let them recommend and prescribe [drug]. It makes you feel sorry for the doctor almost.

<comment><USER13> I agree with this. Many of the supplements I get online are just as risky as anything a doctor can prescribe to me. I already know more about these chemicals and drugs than any doctor I have met. What's more, I have yet to meet a doctor that even cares about the supplements I take.

<comment><USER14> Yes well I am sure that's what the guy next to me when I was in hospital last year thought until he took supplements plus his prescribed meds and had 100% kidney failure.

<comment><USER15> Do you remember what supplements and meds he took?

<comment><USER14> Large doses of Zinc some reaction with his other meds and the hadn't told his GP about the zinc pills.

</comment></comment></comment></comment></comment><comment><USER16> I have mixed feelings about this, especially considering the US is the only first world country where direct-to-consumer marketing is allowed for medications.

Bypassing the prescription requirement is of course of significant value to drug companies, who expend quite a bit of resources to sway doctors with free lunches, conferences and soft persuasion tactics.

Usually I welcome the freedom to chose but this doesn't increase availability: the bottleneck is not with the doctors, it's with pricing. Drug prices aren't going to go down with this measure, and will remain 3-5x the price of the exact same meds sold in Europe.

<comment><USER17> One of my friends has type I diabetes, in more than one times, she needed urgent visit/call to her doctors just to get the medicine she has being taken for years.

<comment><USER18> I have type 1 diabetes, and this is a constant fear of mine. It's absurd that I should have to go through my insurance company to be able to get more medicine if I need to.

<comment><USER19> This is the most atrocious thing to do by not to letting people with Type 1 buy their Insulin medication. I just don't see a reason why this is so much regulated. Like some meds which are partially regulated, where you can request a Pharmacist and they can give you would be reasonable in this case.

<comment><USER20> Insulin is regulated because you can very easily die from using it improperly.

<comment><USER21> Older versions are available OTC in at least parts of the US.

</comment></comment></comment></comment></comment></comment><comment><USER22> Similar to this idea, the province of Alberta in Canada allows pharmacists to write prescriptions for patients with only the only limit that they can't prescribe controlled substances.

<comment><USER23> I like this, with the exception of anti-biotics because misuse would spread immunity.

<comment><USER24> You can already buy most standard antibiotics without a prescription if you don't mind taking fish medication ;) amoxicillin, ciprofloxacin, penicillin, etc are all readily available through amazon and are identical to the human version.

</comment></comment></comment><comment><USER8> Beyond time. I find it pathetic that living in the "land of the free, home of the brave" I need to travel out of the country to be able to pick up basic medications without a permission slip from the authorities. I utterly refuse to pay $100+ so I can get a signed hall slip from a doctor to get what I knew I already needed.

This perhaps will save me some travel costs every few years when I go to restock the personal pharmacy.

</comment><comment><USER25> My pharmacist friends have long bemoaned the 'go to the doctor for everything' scheme. Some conditions are easily diagnosable and the side effects of the drugs are minimal. They'd much rather see the doctor as an escalation if treatment isn't responding or the patient has additional symptoms that could indicate something more serious. The behind-the-counter system is a great idea.

<comment><USER26> Yes, it's incredibly inefficient to have highly trained, expensive doctors acting as tier-1 tech support. But they have a powerful union, so they can keep being paid top dollar for their grunt work.

<comment><USER27> The kinds of doctors that work as "tier-1 tech support" \-- that is, primary care -- are not being paid top dollar, believe me. After you account for the cost of education, delay of entry to the workforce, hours worked per week, and the fact that insurance compensation models are biased towards specialty care and procedures, and it starts to look like bad financial planning.

</comment></comment></comment><comment><USER28> Bravo. The AMA/FDA/insurance cartel cannot die soon enough.

I don't care if you want a free market, or you want socialized medicine, both are preferable to government-enforced racketeering.

<comment><USER29> You mean the AMA and FDA should stop preventing patients from taking contraindicated combinations or failing to understand the risks they're taking on by self-medicating? Pharmacology is complicated and dangerous. Letting corporations go hog-wild will harm many people.

<comment><USER30> ...that and we'd better start inventing some new antibiotics now. As it is now, physicans can barely prescribe them responsibly. If they are available as cold medicine antibiotic resistance will surge even harder than it is now. antibiotic resistance is a dramatically underappreciated problem.

<comment><USER31> Isn't human misuse of antibiotics a drop in the ocean compared to the livestock feed? Pretty sure we could completely stop all human misuse and we'd accomplish nearly nothing toward the goal of stopping antibiotic resistance.

<comment><USER30> I very much agree that live stock antibiotic use is a major issue, even with the recent regulatory advances, but I cannot agree that minimizing human misuse is trivial. Ignoring either issue leaves a flank wide open for attack.

</comment></comment></comment></comment></comment><comment><USER32> I'm always struck by the intensity with which some HN folks hate their doc - reminded of this by the number of comments invoking conspiracy theories about docs scheduling extra appointments to bill more or push more generic drugs.

Perhaps obvious but perhaps not: in the US and most EU countries I'm aware of, you can choose a new doc. You can shop around. Despite the flaws in online reviews, just as with Amazon, you can read between the lines. Choosing instead to avoid healthcare completely seems self-defeating.

I'm sorry to read so many horror stories - going to the doctor even for docs (especially for docs?) can be a frustrating experience. But while you're burning down the FDA, at least shop around and find yourself a good primary care doc.

<comment><USER33> For me the issue is not exactly "burning down" the FDA, but rather changing its purpose from regulatory to only advisory (and hopefully changing associated statutes). The FDA provides a very valuable service by identifying the risks associated with various food and drug. It is one thing to educate the public and say "XYZ presents risk of ABC for this specific group of consumers." It is a very different thing to also add "therefore, consumers cannot make the decision to take on the risks associated with XYZ because the FDA (and associated governing bodies) have decided the general population should not take these risks (regardless of the overall risk level and their individual risk factors)."

<comment><USER34> This is more or less how I've felt. There are so many high-risk behaviors which are perfectly legal, and when our right to take risks in those ways is challenged, there is generally backlash; but in the case of drugs we are legally prohibited from taking risks.

I think the FDA's prohibitive authority does more to protect the interests of established pharmaceutical manufacturers, than the interests of consumers.

</comment></comment></comment><comment><USER35> Yikes, my girlfriend is applying to med school as we speak. The medical industry is certainly a highly regulated, potentially overpriced service for decades now.

When I see a headline like this, I have to seriously ask myself: "Is this when the bubble finally pops, or will it be status quo for another generation?"

<comment><USER36> Does your GF really want to rubber stamp things epipen Rxs? Once you have the allergy diagnosis, it generally doesn't go away.

It's kind of like low tech automation.

<comment><USER35> I think these days, whether or not a doctor or physician assistant "wants" to do something isn't really considered in the equation.

Basically, the schools jack up the medical practitioners with hundreds of thousands in debt, and the practitioners will do absolutely whatever is required to pay it off and eek out a living :(

<comment><USER37> I wouldn't do absolutely whatever is required to pay off my debt nor would my peers. But we can relate to the concerns of hundreds of thousands in debt as far as we can't "want" anything. We're just as trapped in the system as the patients we treat. No wonder why there is a spike in suicides after medical school.

</comment></comment></comment></comment><comment><USER38> I think this is good. For many people a lot of the costs are the doctor visits. Look at the Walmart 100 common generics for $4. I wouldn't be surprised if 50% of the hospital visits can be solved by one of these generics but then we add an expensive doctor visit to get a $4 medicine. There needs to be a more affordable solution.

<comment><USER39> > I wouldn't be surprised if 50% of the hospital visits can be solved by one > of these generics but then we add an expensive doctor visit to get a $4 > medicine.

Its really not surprising that the expensive part isn't the drug but the expertise to select the correct drug; it's true in lots of fields that the equipment or consumables aren't nearly as expensive as the brain to choose which of those to use and how.

Bits are a lot less expensive than the software engineers that arrange them.

</comment></comment><comment><USER40> The true root of the problem is largely systemic: healthcare is a for-profit system in this country and was poorly designed in the first place.

For example, employment based health insurance is largely a relic from WW2 because companies couldn't increase wages and offered it to entice workers. This was logical at the time, but in the 21st century makes very little sense.

Until we can turn it into a true public service, little will change. We can band aid the solution as much as we want but we will never be able to resolve the true core problems.

</comment><comment><USER41> Let me know when I can get Adderall without having to jump through endless hoops...I can probably get cocaine delivered to my door with less effort.

</comment><comment><USER42> > Patients could answer questions on a mobile-phone app to help determine > whether they should be able to access a medication without a prescription.

The primary issue I am concerned with is self ownership of my body, and the freedom to choose for myself which drugs I will consume. Transferring the permission process from a human medical professional to an algorithmic goverment agent does not give me anymore of what I want.

<comment><USER43> A permission process seems inextricable from a system in which there are regulations. But algorithmic agent would theoretically make approved drugs more accessible. The expense and time of a doctor visit is enough friction to stop people from getting drugs they may find beneficial.

<comment> wu-ikkyu There are many systems in which production requires the following of regulations but the purchasing and consumption does not, i.e. food.

<comment><USER43> There is definitely more leeway with food. But the FDA, for instance, bans raw milk from interstate sales: [https://www.npr.org/sections/thesalt/2015/02/20/387558373/wh...](https://www.npr.org/sections/thesalt/2015/02/20/387558373/why- some-states-want-to-legalize-raw-milk-sales)

Local governments can also regulate what food is purchaseable, more specifically, who is legally allowed to sell food; restaurants have to agree to pass health inspections, for instance. As another example: Peking Duck was effectively illegal because of health regulations until legislators (of Asian descent) were able to pass laws saying otherwise: [https://www.nytimes.com/1982/03/31/us/around-the-nation- cali...](https://www.nytimes.com/1982/03/31/us/around-the-nation-california- panel-backs-a-chinese-duck-bill.html)

</comment></comment></comment></comment><comment><USER44> This can't come soon enough. I hate going to the doctor in general, but especially for basic shit I've been using for years.

</comment><comment><USER45> Nurse practitioners are already great for when you just have an infection and need some anti-biotics. They have little clinics with them in many drugstores these days.

<comment><USER16> NPs can already prescribe drugs (just not narcotics, iirc).

<comment><USER46> Nurse Practitioners can prescribe Class II narcotics in most states, if their supervisor physician allows it.

<comment><USER16> Thanks for clarifying that.

</comment></comment></comment></comment><comment><USER47> Interesting that they mention Naloxone.

In Australia (VIC at least), Naloxone is available for free over the counter at the pharmacy. Needles are also readily available (and I'm fairly sure they're free).

It doesn't really make sense for Naloxone to be prescription. Smack users aren't going to go to the doctor for a prescription. You can't get high off the stuff, all it can do is take you off a high and keep you breathing until an ambulance arrives.

On the other hand, if I want painkillers with opioids like panadeine (codeine + acetaminophen), I need to get a prescription. Same if I want cold medicine containing psuedaephidrine, because I might make methamphetamine with it.

<comment><USER48> If you are in Australia you can get pseudoephedrine without a prescription - you just give the pharmacist your drivers license and ask for the stuff that works. How pharmaceutical companies can be allowed under our fair trading laws to sell phenylephrine I don't know.

</comment></comment><comment><USER49> Given the degree to which people waste time and money taking supplements that do absolutely nothing, this doesn't seem like a great idea. Sure, if you are on HN and stay up late reading meta-analyses it would be fine, but then governing the "Democratic Republic of HN" would be very easy in many ways.

If there was actually a proper system to enable evidence based and cost- effective usage of pharmaceuticals without doctors it might improve things for patients, but I don't see that there is.

</comment><comment><USER50> This sounds like a bad idea until I remember that most countries have this arrangement and I've made liberal use of it to great benefit... but mostly that has to do with the lower cost of drugs everywhere but the United States. I stock up every time I go to Europe, and I just made a run to Tijuana for medication my insurance company doesn't cover.

The downside is that insurance wouldn't cover these often expensive medications if they are OTC.

</comment><comment><USER51> looks like this is a draft guidance document, so it may not actually come into effect for a while. something like this seems like it would be massively controversial, and thered probably be a lot of debate on both sides. overall though the idea is very interesting.

something like 20% of US health spend is on outpatient care. i dont know how much of that relates to medication management, but id imagine a lot does. PCPs get paid more when they manage a patients medication, and many psychiatrists make nearly all their income from adjusting prescriptions. im sure other specialties are similar. so this theoretically enables some of that work to be done without the physician. this could significantly reduce cost of outpt services, although it will depend very much on how hard it is for pharma companies to demonstrate non rx use of their products is safe and effective. it may be the case that only a few meds actually are eligible, or that many are, once the guidance is finalized

i havent read the guidance doc yet so dont really know how this would play out in terms of who decides what to rx if not a doc.

i personally am sort of disappointed to see doctors becoming even more sidelined. doctors really do an important job of filtering info for patients, advocating / negotiating with insurance companies, and looking out for them. this could potentially be one less protection for patients as large companies get more power to control info. id like to see cost taken out of the system by reducing pricing power by breaking up large providers rather than disintermediating doctors, but that isnt within fda's mandate, so i understand why fda would go for something like this

this could be good for patients if it is implemented in a way that doesnt give pharma too much power over patients. cost would decrease and access to meds could increase. however there may be more patients taking medicines for reasons other than the health benefits (ie marketing power / influence)

<comment><USER31> > i personally am sort of disappointed to see doctors becoming even more > sidelined. doctors really do an important job of filtering info for > patients, advocating / negotiating with insurance companies, and looking out > for them

Tell that to my doctor, who on a routine checkup sent me to the lab for lab work without clearing it with my insurance company. I got a nice $600 bill for the lab work that the insurance company didn't agree was 'preventative.' After calling the insurance company they ended up waiving it, but told me that in the future I should clear every single thing the doctor orders with them, because the doctors won't do it.

The supply of doctors in the US is artificially constrained, and physician care costs more here than anywhere else in the world. Anything that removes them from the equation, especially for basic things like prescriptions, is a plus in my book.

</comment></comment><comment><USER52> Exciting news. My only hope is they they would simultaneously dial back medication advertisements.

</comment><comment><USER53> In China, you can't even buy loperamide. I think, they think that you can get high on it if you eat a bucket load of it

</comment><comment><USER54> Sounds like a way to mimic the success of over the counter medications like ibuprofen, whose prices have been slowly creeping up for years.

Many of the major profitable blood pressure and statins are off patent, so the drug companies need to make more money.

I'm sure this status will limit or eliminate insurance contributions, so now you'll pay more for generic because 50 million individuals lack the buying power of CVS and the other PBMs.

<comment><USER55> Incorrect. 200 mg Ibuprofen is 2 cents a pill at Walmart.

[https://www.walmart.com/search/?query=ibuprofen%20200mg%2050...](https://www.walmart.com/search/?query=ibuprofen%20200mg%20500%20count&cat_id=0&typeahead=ibu)

<comment><USER56> Pointing at a single data point is not enough evidence to show that an upwards trend does not exist.

<comment><USER57> The single data point is the exact same single data point mentioned in the comment as the only evidence that an upwards trend existed in the first place.

</comment></comment></comment></comment><comment><USER17> Finally we come to common sense.

</comment><comment><USER58> This will be great for pharmaceutical profits, not so great for insurance premiums.

<comment><USER59> You have that 100% backwards.

Insurance premiums will go down since OTC drugs are not covered by insurance. Pharmaceutical profits will also go down because people are much more price sensitive for OTC drugs, so they can't charge as much.

<comment><USER60> I could be wrong, but I was under the impression that some plans will cover OTC medication if a doctor "prescribes" them for you.

According to the article, these drugs won't be considered OTC, they still need a pharmacists approval. I don't know how that will affect coverage, if at all.

<comment><USER59> > I could be wrong, but I was under the impression that some plans will cover > OTC medication if a doctor "prescribes" them for you.

Yes, that is correct. But the idea here is to have a person decide to take it without having a Dr prescribe it, so insurance will not cover it.

</comment></comment></comment></comment><comment><USER61> How do they propose to deal with the potential dangers of drug interactions?

<comment><USER13> Today you can research drug interactions online just like many doctors do. I have to do this for the combination of supplements and the one prescription, since most doctors are not trained in this area.

<comment><USER61> You're fortunate to have both the intelligence and the time to do that effectively. Not everyone has the capability to assemble, decipher, and fully understand that information.

<comment><USER13> In my opinion, everyone should take the time to study the drugs that they are prescribed, as well as the interactions to foods and supplements. I believe this is more important that anything related to one's career or investments. You only get one body.

<comment><USER61> It sounds to me as if you're failing to grasp just how difficult that is to do for at least 80% of the population.

<comment><USER13> I completely understand that a majority have a big learning curve ahead of them. I am just not a fan of corporations and laws targeting the lowest common denominator. I should have the ability to consent to making these decisions myself, assuming I am willing to take the risks. I would even be fine with getting a government issued certification that verifies I am educated enough to make an informed decision.

</comment></comment></comment></comment></comment></comment><comment><USER62> > Patients could answer questions on a mobile-phone app to help determine > whether they should be able to access a medication without a prescription.

Day 2: Websites showing the correct answers to get anything you want show up.

This is an absolutely bonkers idea.

<comment><USER63> As opposed to the alternative where people buy said meds from a dude in an alleyway?

<comment><USER64> By that logic, I should already be able to buy medication from back-alley dudes.

While I could quite easily get ahold of Marijuana and other illegal drugs on the street or the dark side of the net, I have never seen an offer for non- narcotic prescription drugs.

</comment></comment></comment><comment><USER65> This is a good thing. Doctors, while good for some tasks, can have an adverse effect on the flow of medical issue processing and patient care commodity distribution. This initiative will lift the barriers to competition that forces us to depend on the stodgy old-fashioned personal visits. Medical issue processing should require no more than a few snapchats per conflict.</comment>


Show HN: stream music from your Amazon S3 bucket to Android  - <AUTHOR> https://market.android.com/details?id=com.matteobrusa.android.s3

<comment><USER2> I love the idea. Right now google music is free and i've uploaded everything already, but depending on the price I can definitely see using this. Good thing because s3 just allowed for folder uploading with their latest release.</comment>


Netlify was down - <AUTHOR> https://www.netlifystatus.com/?Sep15 <comment><USER2> I spent about 10 minutes trying to work out why `netlify dev` was hanging on my local machine, thinking I'd accidentally nerfed something in npm, before I tried to check the docs and discovered _they_ were down. I forgot that `netlify dev` even _needed_ an internet connection.

Not sure how I feel about this "connected local development" concept at the moment...

<comment><USER3> i think the connection's for getting the environment vars from netlify

<comment><USER2> It also does some magic with node modules in lambda functions, so that you can import them without packaging them locally. Any functions using that...I don't know what to call it, _module proxy_ I guess...break in offline mode.

</comment></comment></comment><comment><USER4> >Investigating - We are currently investigating outages and latencies from our origin server.

This seems strange. Is the netlify origin hosted in a single region or something?

<comment><USER5> If Netlify is completely static I could see there being a single server being the master copy and every edge server being just a caching proxy in front of that.

</comment></comment><comment><USER6> is this related with Level3/CenturyLink/Lumen outages two weeks ago

<comment><USER7> How do you imagine that to be possible?

<comment><USER8> I think this was meant to be satire.

</comment></comment></comment><comment><USER9> I understand it's nice to have easy CI/CD with a simple git push to your repo. But there is something to be said for roll your own hosting IMHO.

<comment><USER9> I'd like to clarify a little... With hosting your own, I don't necessarily mean running your own physical server, although that is surely possible. Heck some people run their blog on their raspberry pi. Netlify is a pretty great service. But if your use case is merely a simple static website, and nothing fancy. Your hosting doesn't need to be either.

Merely pointing out having websites distributed, and not freely at one huge vendor leaves me thinking I'm glad I don't put all my eggs in the same basket.

<comment><USER8> Sure, you could easily use Github Actions paired with an s3 bucket if all you're doing is CI/CD to push to static hosting. That said, Netlify does offer value adds beyond just production hosting.</comment></comment></comment>


DigitalOcean offering $100 in credits for 60 days, new accounts only - <AUTHOR> https://m.do.co/c/f139acf4ddcb <comment><AUTHOR> Normally it's $30 in credits for 30 days.

Get it while you can.

Disclaimer: That link is a referral link. My apologies, You cannot make use of the promotion without a referral. Otherwise I would have posted it.</comment>


Show HN: Umbrella JS, a 2.5kb jQuery alternative - <AUTHOR> https://umbrellajs.com/ <comment><AUTHOR> I submitted this 3 years back [1] when I was starting. But now I think it's finished and well polished, so I am resubmitting it. I am happy to say that I don't normally find bugs anymore and the bug reports have slowed down while adoption has skyrocketed [2] [3]

It follows loosely a subset of jQuery methods, but it adds some others where relevant for common JS patterns (.handle() == .on() + e.preventDefault()) and the existing ones are generally more flexible.

[1] [https://news.ycombinator.com/item?id=10954191](https://news.ycombinator.com/item?id=10954191)

[2] [https://npm- stat.com/charts.html?package=umbrellajs&from=201...](https://npm- stat.com/charts.html?package=umbrellajs&from=2016-01-01)

[3] [https://www.jsdelivr.com/package/npm/umbrellajs](https://www.jsdelivr.com/package/npm/umbrellajs)

<comment><USER2> Looks interesting. How compatible with jquery is it? You say a subset, but is that an exact subset that would pass tests for those methods? Either way, well done!

<comment><AUTHOR> No, no method would pass all of the tests for said method in jQuery. I believe a part of those tests in jQuery are retroactive to settle the behavior of very edge undocumented cases, which might be different in Umbrella.js.

I did in fact try to improve the size of jQuery, but the tests are too coupled to the internal behavior of the methods, even if undocumented and (potentially) unintended initially. So it was very difficult even to change the most basic things, let alone change the internal structure of the whole method.

With Umbrella JS I'm trying to get to somewhere closer to _native_ Javascript than jQuery. See for instance the arguments of any looping function (follows similar to the native arrays), or how things like _.addClass(name)_ [1] are thin wrappers around _.classList.add(name)_ (but quite more permissive/flexible). So it will follow closer to _classList_ behavior than to whatever is defined in jQuery's tests, which is a win-win IMHO (since it also makes for a much smaller size, compare to jQuery's _.addClass(name)_ [2]).

[1] [https://github.com/franciscop/umbrella/blob/master/src/plugi...](https://github.com/franciscop/umbrella/blob/master/src/plugins/addclass/addclass.js)

[2] [https://github.com/jquery/jquery/blob/master/src/attributes/...](https://github.com/jquery/jquery/blob/master/src/attributes/classes.js#L27)

</comment></comment></comment><comment><USER3> This looks pretty great - I really like the look of Picnic, the author's lightweight (10KB) bootstrap alternative as well: [https://github.com/franciscop/picnic](https://github.com/franciscop/picnic)

<comment><AUTHOR> Thanks! I have two other libraries (besides Umbrella JS) that I really care about: _Picnic CSS_ [1] and _Server.js_ [2]. I'll be trying to do some cleaning in my spare time, but both of those require humongous amounts of work to get to the quality level of Umbrella JS.

[1] [https://picnicss.com/](https://picnicss.com/)

[2] [https://serverjs.io/](https://serverjs.io/)

<comment><USER4> Two suggestions, both slightly pedantic:

1\. I went by the name and typed picniccss.com instead of picnicss.com and it didn't work. picnic-es-es does sound weird in one's head too.

2\. On the website, you say '10kb' but should probably use '10kB'. The small-b is conventionally used to indicate bits and the capital-b is used to indicate bytes.

<comment><USER5> are u joking?

</comment></comment></comment></comment><comment><USER6> I don't want to be "that guy", but haven't most people moved on to something like Vue instead of manipulating the DOM directly? Every developer I've worked with learned the basics of Vue quickly (less than a day) and marveled at how great it was compared to manipulating the DOM through jQuery (or something similar like Umbrella JS). But sure, there are edge cases where jQuery and similar libs still serve a purpose.

<comment><USER3> Vue and React make sense for large SPA-style applications, but I often find myself wanting to drop a few lines of JavaScript onto a page to implement something simple without pulling in a massive framework dependency that requires a webpack compile step.

<comment><USER6> jQuery is 84 KB minimized, while Vue is 85 KB. Not much of a difference (although, granted, Umbrella JS is notably smaller). You don't necessarily need Webpack for Vue, you can just include Vue in a script tag and write your code.

<comment><USER7> But it's also about abstraction overhead. You wouldn't bring in Vue to add a Select All button that checks a bunch of checkboxes.

You wouldn't use jQuery/Umbrella for that either, but there might then exist a middleground where you would. e.g. any time you're adding JS to an existing page but don't want a whole component abstraction.

<comment><USER8> You might use VUE for that if you need it to work across pages/tabs and use a state/store like vuex to maintain the state of the checkboxes....or the react equivs...I mean you can use localStorage..but I prefer vuex.

</comment></comment></comment></comment></comment><comment> GuB-42 How does it fare when it comes to browser compatibility?

IIRC, one of the main selling point of jQuery is compatibility with browsers like IE6.

<comment><AUTHOR> jQuery doesn't claim compatibility with IE6, they dropped it on jQuery 2.0 to IE8+: [https://jquery.com/browser-support/](https://jquery.com/browser- support/)

Umbrella JS supports Internet Explorer 11+, with some of the known bugs and wont-fix here: [https://github.com/franciscop/umbrella#support- ie11](https://github.com/franciscop/umbrella#support-ie11)

There is a polyfill to help here: [https://github.com/franciscop/umbrella/blob/master/polyfill....](https://github.com/franciscop/umbrella/blob/master/polyfill.js)

<comment><USER9> Thanks for those links. Also the latest jQuery now only supports Internet Explorer: 9+

</comment></comment></comment><comment><USER10> There are established tiny jQuery alternatives:

Zepto: [https://github.com/madrobby/zepto](https://github.com/madrobby/zepto)

Cash: [https://github.com/kenwheeler/cash](https://github.com/kenwheeler/cash)

How is yours better?

<comment><AUTHOR> Zepto is intended as a full clone; objectives are quite different from Umbrella, so I don't see an overlap here since size is not such a priority. Using plugins? Zepto. Care about size a lot? Umbrella. Flexible methods? Umbrella.

About Cash, first Umbrella is about 0.5x the size. The version 1.0 of both were released the same year (Umbrella a bit later), so back then it was not _established_. Then, there are these differences (opinionated ofc):

 _Better documentation_ in Umbrella. As an example, let's see the .addClass() in Cash [1] and in Umbrella [2]. Umbrella has many input examples, a lot more flexibility in the arguments (functions, comma-separated, etc), practical explained examples and related methods. This holds true for every single method.

 _Better testing_ in Umbrella. Compare Cash tests [3] with Umbrella tests [4]; Cash has 663 LOC of testing while Umbrella has 2234 LOC, a 3.3x improvement. Not only that, but Umbrella has a public testing page so you can test it in any browser you want: [https://umbrellajs.com/tests](https://umbrellajs.com/tests)

 _Cleaner code_ in Umbrella. If you want to modify any method, it will be self-contained in `src/plugins/NAME/`. In there you will find the relevant documentation displayed from the readme.md, the relevant tests and the actual code. To modify Cash's addClass you'd have to chase down the code [5], the tests [6] and the documentation [1] while in Umbrella you'd only need to go to the plugin folder [7]

 _More methods_ in Cash. This is the one I've seen that seems nicer, since it supports many more methods. Still, Umbrella's objectives is to be the minimum useful set. _.insert()_ is enough and there's no need for _.insertBefore()_ IMHO, but that's just different opinions. Some people prefer to have the choice, so this one is for Cash.

 _Extra useful methods_ in Umbrella. _.handle()_ is the common pair of _.on()_ \+ _e.preventDefault()_. _.size()_ returns an object with the size of the element like _{ width: 20, height: 20, top: 10, ... }_.

 _Better methods_ in Umbrella. Examples: .append(), .prepend(), etc will clone events and values (if any) from the DOM. More functions accepted as arguments.

[1] Cash docs: [https://github.com/kenwheeler/cash#fnaddclass-](https://github.com/kenwheeler/cash#fnaddclass-)

[2] Umbrella docs: [https://umbrellajs.com/documentation#addclass](https://umbrellajs.com/documentation#addclass)

[3] Cash tests: [https://github.com/kenwheeler/cash/blob/master/test/index.js](https://github.com/kenwheeler/cash/blob/master/test/index.js)

[4] Umbrella tests: [https://github.com/franciscop/umbrella/blob/master/docs/test...](https://github.com/franciscop/umbrella/blob/master/docs/test.js)

[5] Cash addClass code: [https://github.com/kenwheeler/cash/tree/master/src/attribute...](https://github.com/kenwheeler/cash/tree/master/src/attributes)

[6] Cash addClass tests: [https://github.com/kenwheeler/cash/blob/master/test/index.js...](https://github.com/kenwheeler/cash/blob/master/test/index.js#L57)

[7] Umbrella addClass folder: [https://github.com/franciscop/umbrella/tree/master/src/plugi...](https://github.com/franciscop/umbrella/tree/master/src/plugins/addclass)

</comment></comment><comment><USER11> Angular Ivy hello world is 2.5kb as well

<comment><AUTHOR> That is a very early, highly experimental minimal demo from what I found...

</comment></comment><comment><USER12> oh good, maybe that will help reduce the general reliance on CDNs... (me dreaming)

</comment><comment><USER13> Is anyone actually still using jQuery in a new project? I can't think of a single good reason to do so.

<comment><USER14> You still need jQuery for Bootstrap

<comment><USER13> Another great reason to never use Bootstrap

<comment><USER15> Not sure why you get downvoted haha

</comment></comment></comment></comment><comment><USER16> KB != kb.

</comment><comment><USER17> Slightly off topic, but I have this OCD that my brain hurts when I see people use wrong capitalization for products.

> It is strongly influenced by jquery...

Please use jQuery instead, thank you.

<comment><AUTHOR> English is my 3rd language so please forgive some typos and inaccuracies like these. I understand that these are similar for some people as when I see people using "their" when they mean "they're".

I agree it looks less professional, so I'll try fixing those. Is there any other bit that sounds off?

Edit: That should be fixed! Also a couple of missing `css` => `CSS`, `umbrella` => `Umbrella`, etc.

<comment><USER17> Thank you for the quick fix. And no, I don't go crazy over grammar or spelling (English is my second language as well). I think the website looks pretty cool and well written overall.

</comment></comment></comment><comment><USER18> The fake scrollbar on the documentation page is infuriatingly nonfunctional.

<comment><AUTHOR> Uh? There is definitely no purposefully fake scrollbar, could you please share a screenshot and/or the device and browser you are using please? Ideally in Github as an issue: [https://github.com/franciscop/umbrella/issues/new](https://github.com/franciscop/umbrella/issues/new) , but here is fine as well.

<comment><USER19> I believe hughes means: "when you click on an entry of the documentation, e.g. '.wrap' in the "Contents" you see a scrolling animation instead of just the entry you'd like to read."

So not "scrollbar" but "scrolling" as the result of the click, on the documentation page:

[https://umbrellajs.com/documentation](https://umbrellajs.com/documentation)

I'm one of those who have the problem with the animations in the UIs too. Believe or not some people get effectively a real sickness feeling just by looking at some specific movements, in my case that page manages to achieve that.

<comment><AUTHOR> Ah I see, that makes sense. Unfortunately for me it's the opposite! These kind of animations helps me know where I am, if it jumps suddently without any notice I tend to not know the size/position I am in respectto the whole page.

<comment><USER18> No, I really meant that the scrollbar was broken. I wasn't clickable or draggable and was not a system scrollbar.

I'm pretty confused now, as it seems to be working.</comment></comment></comment></comment></comment>


Today is 265th day of the year – Day of the Programmer - <AUTHOR> This particular day was proposed by Valentin Balt and Michael Cherviakov, employees of Parallel Technologies (a software company). As early as 2002, they tried to gather signatures for a petition to the government of Russia to recognize the day as the official Day of the Programmer. (Wikipedia) <comment><USER2> I would propose the 404'th day of the year?

<comment><USER3> Seriously?

</comment></comment><comment><USER3> You have a typo, I believe</comment>


Show HN: Faster.js – a micro-optimizing JavaScript compiler - <AUTHOR> https://github.com/vzhou842/faster.js <comment><USER2> This is cool, but array methods are so rarely the bottleneck; Even in the highly-specialized demo, the difference is near-negligible.

It's a fun project and might have application in specialized situations (and maybe for Node, where time spent in synchronous iteration blocks all other requests?). But I feel like this does more harm than good in most cases (larger bundle, extra build step, less readable output code can make debugging harder, etc)

<comment><USER3> I agree, while this is a cool idea it doesn't seem to be useful beyond being a proof of concept of an optimization technique. For example, my browser rendered the faster.js version 50ms slower at this point: [https://i.imgur.com/G5b10Ns.jpg](https://i.imgur.com/G5b10Ns.jpg). It does appear to perform better in the long run ([https://i.imgur.com/u3ApYYl.jpg](https://i.imgur.com/u3ApYYl.jpg)) but it's an improvement of less than 1%, and when your renders are taking 30+ms there are probably other things you should be looking at :P

Also, unless I'm misunderstanding the README, using the plugin introduces the huge caveat of breaking code that uses "restricted names" (certain names of Array functions) - the example given is a class that defines a map() function, which apparently would cause some kind of failure. In larger codebases where you don't control all code used in production this seems like a big problem.

</comment></comment><comment><USER4> Optimizing JavaScript is hard.

v8 for instance, has the interpreter (ignition), and optimizing compiler (turbofan), that have a lot of undocumented behavior that people just to try to probe via microbenchmarks.

\- [https://en.wikipedia.org/wiki/Inline_caching](https://en.wikipedia.org/wiki/Inline_caching)

\- [https://static.googleusercontent.com/media/research.google.c...](https://static.googleusercontent.com/media/research.google.com/en//pubs/archive/43823.pdf)

If you want to understand what is going on the only way is to read v8's source code or running a profiler.

For example, did you know that touching the prototype of a RegExp object makes it slow? You had no way of knowing that.

</comment><comment><USER5> Prepack, [https://prepack.io](https://prepack.io), is also in the same realm of an optimizing Javascript compiler.

<comment><USER6> Prepack is rather nice. It allows you to execute part of your code at compile time, like a macro.

<comment><USER7> Closure compiler in ADVANCED_OPTIMIZATIONS mode does this too.

        function add5(x) {
          return x + 5;
        }

        console.log(add5(3));

compiles down to

        console.log(8);

<comment><USER8> Prepack is doing much more than GCC can because it effectively evaluates the whole code and then serialises its heap. This is both its biggest strength and weakness.

Unlike GCC, it can unroll any kind of metaprogramming, but it needs to have a model of the environment (e.g. it won't execute code relying on DOM) and it can produce larger code (in terms of absolute size).

<comment><USER9> I would avoid using the name GCC to refer to the closure compiler, since there's already an extremely well-known compiler named GCC.

Admittedly it doesn't take JS as input, but I was somewhat confused when I read your comment nonetheless.

</comment></comment></comment></comment></comment><comment><USER10> On the demo page in Chrome, Faster.js is actually slower.

<comment><USER11> For me faster.js was faster for 2 seconds then it became slower and slower in Firefox

<comment><USER6> faster.js was about 9ms faster on my mobile device.

</comment></comment></comment><comment><USER12> I'd like to be able to specify restrictions on type usage in Javascript. For instance, in some cases I know that my array will always be 6 items larges - no smaller, no larger, never sparse. But I can't specify this, yet it allows for certain optimizations (e.g. loop unrolling).

Lately I was memory profiling an application in Javascript using Chrome. The fact that it used ES6 classes really helped, as some anonymous classes where hard to find memory leaks with, but the typed classes was a simple text query.

I can imagine ES6 classes with decorators may enable specialized optimizations too.

</comment><comment><USER13> Probably, you can optimize .forEach even more. You can get 'arr.length' and 'let i = 0' outside of the for-loop.

It could be faster according to this test: [https://jsperf.com/extended-array- loops-performance](https://jsperf.com/extended-array-loops-performance)

</comment><comment><USER14> Why is this called a "compiler", though?

</comment><comment><USER15> Their first example

for (let _i = 0; _i < arr.length; _i++) { results.push(_f(arr[_i], _i, arr)); }

This is recalculating length on each iteration

<comment><USER16> The mystery of JIT optimization. The optimizer will turn that into a dereferenced register value. I remember reading that v8 used to add an extra instruction if you assigned the variable yourself.

</comment></comment><comment><USER17> Are you using this in a real application?

<comment><AUTHOR> I've been trying it out in prod on a small site I run: [http://geoarena.online](http://geoarena.online)

</comment></comment><comment><USER18> The demo page basically shows this is pointless practically - and sometimes _slower_.

These kind of optimizations _were_ very useful in hot paths even just a few years ago. However browser engines have optimized functional patterns (what this mostly rewrites) to be within absolute microseconds of imperative versions.

In some cases it can even make useful assumptions in an FP method (immutability, etc) that it can't in the standard loops - which is why sometimes this is slower.

Long story short: concentrate on shipping _less_ JavaScript and good practical solutions/algorithms and not stuff like this.

</comment><comment><USER19> I thought I was in new and not the front page. You're telling me that as a demonstration of perf gains, in a graphics context I win back .8 ms in exchange for another dependency and unnecessary cognitive load?

</comment><comment><USER20> This is a good example of premature optimization.

<comment><USER21> I think this is an example of _optimization_. An optimization that is easily applied as a transform for Babel, but that's just it.

Whether it is premature or not, it would depend on if you apply it carelessly without knowing whether you need it, or if you apply it when you know you need. Right?

<comment><USER20> The optimization is transforming all code that matches the pattern independent from whether the code is hot or not.

The transformation comes with cognitive cost for the developer as it can turn correct code into incorrect code (sparse arrays).

By enabling this one trades complexity for potential performance gains.

This is how I understand premature.</comment></comment></comment>


New coronavirus can spread between humans, but started in a wildlife market - <AUTHOR> https://www.nationalgeographic.com/science/2020/01/new-coronavirus-spreading-between-humans-how-it-started/ <comment><USER2> I'm bordering on conspiracy theory territory here, but I'd also like an real investigation into whether the virus actually originated from the Wuhan Biosafety Laboratory. It's the only level 4 (BSL-4 highest rating) lab in all of China designated to handle the most dangerous pathogens. And it's located 20 miles from the reported epicenter in the wildlife market. It was first opened two years ago and at the time multiple scientists worried that the lack of an open culture could lead to potential security problems.

Was there some breach in containment security? Were experimented animals not disposed of properly? We don't know.

There might be nothing here, but it's a hell of a coincidence and if there's some broader security problem, it should be acknowledged and fixed.

Background on the lab: [https://www.nature.com/news/inside-the-chinese-lab- poised-to...](https://www.nature.com/news/inside-the-chinese-lab-poised-to- study-world-s-most-dangerous-pathogens-1.21487)

<comment><USER3> I think it's a perfectly valid question, although the wildlife market is equally valid on the evidence we have. We know that the Chinese Government is hugely overreacting to public information at this point in time - terrible as the published numbers are they are not that out of whack with a normal bad flu epidemic, which also causes significantly higher death rates.

So it's either the actual death rates are higher (well, almost certainly), and/or they know or suspect something more serious.

Bearing in mind too, that even China doesn't trust China on reporting - witness the central committee order a few days ago to the regions to be accurate with reports or else.

<comment><USER4> _We know that the Chinese Government is hugely overreacting_

Do we know that? All of the criticism I've seen has been of the government under-reacting. In fact, in a speech yesterday Xi told the local authorities that they weren't doing enough.

Non-Chinese estimates (as of 24 January) are that there's 6,000 people infected vs. 1,300 from the Chinese government.

The 6,000 figure comes from the Laboratory for the Modeling of Biological and Socio-technical Systems at Northeastern University in Boston: [https://www.mobs-lab.org/2019ncov.html](https://www.mobs- lab.org/2019ncov.html)

<comment><USER5> It seems like the local government under-reacted, and now the central government is (hopefully) over-reacting.

</comment></comment></comment></comment><comment><USER6> From what I've read it came from bats. Most probably bats being eaten.[1]

Bats have been the source of at least 4 pandemics. It's interesting to note that current coronavirus spreading in China and the SARS outbreak of 2003 have two things in common: Both are from the coronavirus family, and both were passed from animals to humans in a wet market.[2]

I tried to put together a page for coronavirus in China here where I tried to gather all the information in one place in order for us to easily follow stuff ([https://thestrife.co/wuhan-coronavirus-media- coverage](https://thestrife.co/wuhan-coronavirus-media-coverage)) and photos[3].

1\. [https://www.vice.com/en_us/article/xgqy3n/scientists-now- thi...](https://www.vice.com/en_us/article/xgqy3n/scientists-now-think-they- know-what-started-chinas-deadly-coronavirus-bats)

2\. [https://www.businessinsider.in/science/news/experts-think- th...](https://www.businessinsider.in/science/news/experts-think-the-wuhan- coronavirus-jumped-from-bats-to-snakes-to-people-bats-have-been-the-source-of- at-least-4-pandemics-/articleshow/73569703.cms)

3\. [https://thestrife.co/wuhan-coronavirus- gallery](https://thestrife.co/wuhan-coronavirus-gallery)

<comment><USER7> I've heard the bat eating theory, but the virus is airborne and infects the lungs. So it seems that eating a bat probably didn't cause this.

<comment><USER8> Method of transmission does not stop bats from being a reservoir for the virus.

It was already capable of making the species jump (else it wouldn't), and could have further adapted to using other transmission routes once it got into humans.

The long incubation time makes me think it takes awhile for the virus to get a foothold.

</comment></comment></comment><comment><USER9> How common is for SARS coronaviruses to share the same envelope proteins? I downloaded 200 CoV envelope proteins from NCBI, and I couldn't find any pair of identical proteins. As someone unfamiliar with virology, I'm curious if there are any explanations for how come the protein envelope of 2019-nCoV[1] is the same as the protein envelope described by the Institute of Military Medicine Nanjing Command 2 years ago in the unpublished paper "Genomic characterization and infectivity of a novel SARS-like coronavirus in Chinese bats"[3]? Is it just a coincidence? The bats used in the paper were from Zhejiang not Hubei.

[1] [https://www.ncbi.nlm.nih.gov/protein/YP_009724392.1](https://www.ncbi.nlm.nih.gov/protein/YP_009724392.1)

[2] [https://www.ncbi.nlm.nih.gov/protein/AVP78033.1](https://www.ncbi.nlm.nih.gov/protein/AVP78033.1)

[3] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135831/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135831/)

<comment><USER10> It's almost certainly a coincidence. Bats don't have an inflammatory response to viral infections like other mammals [1] so viruses are basically harmless to them and they are perfect carriers, with many species having life expectancies reaching 2-3 decades. Studies of regional populations of bats have found that if a virus makes it into a bat population, it will usually spread to 50-90% of the total population (where virus = rabies and region = Western Europe) [2]. This Wuhan virus evolving from another SARS-like virus while maintaining surface markers is squarely in the realm of possibility.

[1] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410205/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410205/)

[2] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1539106/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1539106/)

</comment></comment><comment><AUTHOR> Key quote from the article:

> "If we were to shut the wildlife markets, a lot of these outbreaks would be > a thing of the past," says Ian Lipkin, director of Columbia University's > Center for Infection and Immunity, whose lab worked with Chinese officials > to develop early diagnostic tests for SARS.

> That's because both SARS and the new outbreak are zoonotic, meaning these > diseases started in animals before spreading to humans. Zoonotic diseases > rank among the world's most infamous. HIV, Ebola, and H5N1 influenza, for > example, all percolated in wildlife before close interactions with humans > spawned international outbreaks. With SARS, food preparers and people who > handled, killed, and sold wild animals made up nearly 40 percent of the > first cases. The earliest episodes were also among people who were more > likely to live within walking distance of wildlife markets.

<comment><USER11> Maybe (hopefully?) China will shut down these markets after this outbreak. They've been known to take serious measures in the past when necessary. Surely the benefit of these markets cannot outweigh their costs (including on the local wildlife, not just infectious diseases).

<comment><USER12> Won't that just drive it underground? Then nobody would even know where it started when the next outbreak happens.

<comment><USER11> Don't underestimate how effectively a totalitarian and surveillance state like China can be in discouraging behaviors they don't want. People aren't willing to risk their lives just to eat exotic animals. And that could be what's at stake here; witness what happened to some of the people involved in the melamine baby milk formula scandal.

<comment><USER12> Seems like they are already risking their lives eating exotic animals.

<comment><USER13> Thinking that the wild animals are more healthy

</comment></comment></comment></comment></comment></comment><comment><USER14> President Xi has warned that the virus is spreading. His intervention seems to be unprecedented. Is it worse than what it seems to be?

They have quarantined whole cities and are building a hospital at war scale especially for this.

Maybe the Chinese know something that the world doesn't know yet.

<comment><USER15> Anecdotal (not official) reports suggest as many as 100,000 infections in Wuhan area. There are claims the virus may be spread through eyes as well as inhalation. Additional unsubstantiated claims suggest low to no fever during incubation period, making detection difficult. The most sensationalist claim making the rounds is that a known Wuhan area PLA biolab may have failed to contain this pathogen.

In the end none of the above matters at all. What matters is the willingness globally to take political and economic action to contain transmission. The World Health Organization's failure to declare this a global emergency is risky if the characteristics stated above turn out to be accurate. Timing is key.

<comment><USER16> Is transmission through eyes that odd?

The common cold already is. You rub your eyes, the virus enters your tears, which drain to your nose.

<comment><USER15> It matters because face masks are not enough to prevent transmission, which matters relative to the common cold only because this virus kills. The common cold does not.

<comment><USER17> But this is taken care of by face marks and hand washing, because what would be happening is you touch your eyes.

If you're using a face mask, you should be washing your hands anyway, because if you think it's working, the moment you touch it you've come in contact with virus.

<comment><USER18> how long can a virus live on a face mask?

<comment><USER17> For an enveloped virus like this? "Awhile". I'm sure there's estimates for SARS or Influenza somewhere that are probably pretty correct for this too.

</comment></comment></comment></comment></comment></comment></comment><comment><USER19> Can someone explain [https://blast.ncbi.nlm.nih.gov/Blast.cgi?RID=2PUA1EJK114&CMD...](https://blast.ncbi.nlm.nih.gov/Blast.cgi?RID=2PUA1EJK114&CMD=Get) to me?

This is a comparison between 'bat SARS-like coronavirus' and 'Wuhan seafood market pneumonia virus'. Under Alignments, it looks like the envelope proteins are identical. Wouldn't that be unlikely for a natural mutation? Would this not lead credence to this being a leak from their BSL-4 lab about twenty miles away from the Wuhan seafood market?

Thanks!

<comment><USER20> Yes. There's a biology from Harvard who has noticed this. I think people are catching on it's from the lab. I've seen PhD level biologists on twitter making the same observations

Here it is:

Wuhan virus is essentially SARs [http://virological.org/t/missed-orfs-in- ncov/345](http://virological.org/t/missed-orfs-in-ncov/345) "Anyone notice two 'accessory' ORFs not annotated in nCoV? Orf13 (aka 9b) (28284:28577) and Orf14 (28734:28955) . One is ~ 70% ID and other ~ 90% to syntenous ORFs in BAT SARS 2017 ?"

This was a lab break.

<comment><USER21> For non-biologists among us ORF = open reading frame. It has roughly the same meaning as a gene.

</comment></comment></comment><comment><USER22> I saw this map on Reddit today, and I'm probably going to add to ignorant hysteria:

[https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...](https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6)

I just can't believe the real number of infected is as low as the reported confirmed number based on that map. It's got to be all of over China if the confirmed cases are all over like that (not to mention it made to NA and Europe).

</comment><comment><USER23> I'm amazed that there's not a movement to stop eating and being around animals as much world-wide, given that so much disease (and environmental damage) comes from consumption of and proximity to animals:

\- MERS-CoV: bats via dromedary camels

\- nCoV-2019: bats or snakes?

\- Influenza: pigs, birds

\- E. coli O157:H7: cows and other farm animals.

...

(Edit: I mean along the lines of how safer sex is encouraged to prevent STDs, hand washing is encouraged to prevent food-borne illnesses, ... I haven't seen a call for the above.)

<comment><USER24> The worst thing you can do to the human immune system is to cease to expose it to pathogens.

<comment><USER25> It's not a dichotomy - removing animals from our diet does not leave a sterile environment for humans. Humans and their environment are plenty filthy on their own.

<comment><USER24> Then this is purely a vegan argument unrelated to the virus.

<comment><USER26> Again, not a dichotomy. Humans will remain exposed to pathogens even if we eliminate one source of new and dangerous ones.

</comment></comment></comment></comment></comment><comment><USER27> Based on documented facts and best epidemiological guesses about the novel coronavirus 2019-nCoV, I think it will _probably_ turn into a pandemic affecting most countries. Let's review:

      • human-to-human transmission while asymptomatic, truly the killer feature [1]
      • 15% mortality rate in first patients (6 of 41 are dead) [2]
      • cases/deaths doubling every 2 days [public data]
      • epidemiologist predicts 100x more infections in 10 days [3]

Caveats:

• mortality rate sample is small (41) and the first patients are likely to be the most severe cases (pre-existing conditions, weak immune systems, etc); so the true rate could be less.

• public reports of cases/deaths could be increasing slower than reported because Chinese authorities could be trying to be more truthful (IOW reported numbers are finally catching up w/reality); or alternatively public reports could be lagging reality because authorities could be increasingly hiding the facts or simply be less and less able to report and monitor as Wuhan is turning into a bigger unmanageable chaos every passing day

• availability of medicine may limit the outbreak. The pulmonologist who discovered the SARS coronavirus says they have several medicines ready: [https://twitter.com/hhh05146721/status/1220953373622534145](https://twitter.com/hhh05146721/status/1220953373622534145)

[1] [https://thelancet.com/journals/lancet/article/PIIS0140-6736(...](https://thelancet.com/journals/lancet/article/PIIS0140-6736\(20\)30154-9/fulltext)

[2] [https://thelancet.com/journals/lancet/article/PIIS0140-6736(...](https://thelancet.com/journals/lancet/article/PIIS0140-6736\(20\)30183-5/fulltext)

[3] [https://medrxiv.org/content/10.1101/2020.01.23.20018549v1](https://medrxiv.org/content/10.1101/2020.01.23.20018549v1)

<comment><USER28> I don't know if you do this intentionally or if Hanlon's razor, but you intermix source backed claims with made up ones. Nature does not claim the mortality rate is 11%. They do make a comparison to SARS' mortality rate which was about 11% and argue that Wuhan coronavirus is lower in that regard[1].

[1] [https://www.nature.com/articles/d41586-020-00166-6](https://www.nature.com/articles/d41586-020-00166-6)

<comment><USER27> You are right, I misremembered Nature's video ([https://www.nature.com/articles/d41586-020-00209-y](https://www.nature.com/articles/d41586-020-00209-y) claimed SARS, not nCoV-2019, had an 11% mortality rate.) I edited the comment.

</comment></comment></comment><comment><USER29> Neil Ferguson, an epidemologist at Imperial College, suggested that the 2019 novel coronavirus' Basic Reproduction Number (R0) [1] is about 2.5, which aligns with figures from other research groups. The 1918 pandemic-causing flu's R0 was between 2 and 3 [1] while seasonal flu's figure is only 1.3 [2].

This is not to say everyone should panic as the strict containment policy that China and the Chinese adopted should help reduce the R0 significantly. However, the asymptomatic period is long, thus it remains to be seen what the full impact of this virus will be.

Other countries may need a better policy to track high-risk individuals already in their territories.

"Neil_ferguson @neil_ferguson

R0 estimates for flu pandemics lie in the 1.5-2.5 range. Yes, Measles is much higher (10-15). An epidemic with an R0 of 2.5 could still infect between 60% and 90% of the population, depending on contact patterns and assuming no prior immunity. Not all might be symptomatic though."

[https://mobile.twitter.com/neil_ferguson/with_replies](https://mobile.twitter.com/neil_ferguson/with_replies)

[1] [https://en.m.wikipedia.org/wiki/Basic_reproduction_number](https://en.m.wikipedia.org/wiki/Basic_reproduction_number)

[2] [https://www.newscientist.com/article/2231333-what-are-the- sy...](https://www.newscientist.com/article/2231333-what-are-the-symptoms-of- the-new-coronavirus-and-how-deadly-is-it/)

<comment><USER30> > as the strict containment policy that China adopted should help reduce the > R0 significantly

What strict containment policy?

<comment><USER29> Quarantine of 12 cities and 35 million residents. Suspension of tour groups out of the whole country.

What more can you do?

[https://qz.com/1790891/china-expands-quarantine- to-12-cities...](https://qz.com/1790891/china-expands-quarantine-to-12-cities- and-35-million-residents/)

[https://www.nytimes.com/2020/01/25/world/asia/china- coronavi...](https://www.nytimes.com/2020/01/25/world/asia/china- coronavirus.html)

<comment><USER30> They quarantined Wuhan, and announced it 8 hours before they did it, they estimated 200k people left Wuhan in a rush. Yet people are still entering and exiting Wuhan for CNY. So as far as I'm concerned this quarantine is just political face.

<comment><USER29> That is still 98% quarantine rate and should significantly reduce the chance the infection will establish in other cities.

</comment></comment></comment></comment></comment><comment><USER31> I don't understand why people eat monkey or bats? if they have all these virus or diseases in them. It's 2020 we have more food in the world than we did years ago no need to eat a bat just grab an apple.

<comment><USER32> We're talking about a place where this is common practice.

[https://m.youtube.com/watch?v=zrv78nG9R04&feature=youtu.be](https://m.youtube.com/watch?v=zrv78nG9R04&feature=youtu.be)

<comment><USER33> Supposedly the Chinese government is paying for the output from this sewage/gutter oil process (for combustion in power plants) in order to prevent it from ending up in the food supply chain as cooking oil. Attempts at being resourceful can have some unintended consequences/second order effects.

[https://www.reddit.com/r/videos/comments/et981n/this_is_how_...](https://www.reddit.com/r/videos/comments/et981n/this_is_how_chinese_recycle_sewage_oil_into/fff8d1o/)

</comment></comment></comment><comment><USER4> For those of you into charts and graphs, here's a little tool from a reputable source that shows the risk of each country getting a case:

[https://datastudio.google.com/u/0/reporting/e693c1f9-13fa-42...](https://datastudio.google.com/u/0/reporting/e693c1f9-13fa-42f6-86e6-c637b159a742/page/CIXCB)

</comment><comment><USER34> Let's assume the worst-case scenario. It has a high mortality rate and is spreading with a high reinfection rate. Other cities will lock off shortly like in china. What are the steps to survive? How do you think the world will react? Will this lead to collapse? At least in the first step for tourism.

</comment><comment><USER35> The official name for this is 2019-nCoV.

And for Twitter that is #2019nCoV.

Using the correct name (or including it in parenthesis somewhere) is a way to help your publications stay connected to the wider discussion.

</comment><comment><USER36> According to a former Harvard public health researcher, the Wuhan coronavirus has a R0 value of 3.8. That is significantly higher than SARS (estimated at between 2-4). This means is will spread rapidly unless transport in/out of Wuhan is completely stopped:

[https://threadreaderapp.com/thread/1220919589623803905.html](https://threadreaderapp.com/thread/1220919589623803905.html)

<comment><USER37> That 3.8 may have since been revised downward....looking for the link again.

<comment><USER36> Different research groups are providing different estimates. But the estimates of estimates (model averaging) indicates that this epidemic has a good chance of sweeping the globe. Containment is needed to prevent it sweeping the globe, so we are at the mercy of the Chinese authorities...

<comment><USER17> My group's estimated R0 for MERS was very securely in the same ballpark. There's a lot more needed for "sweeping the globe" than a single R0 measurement in a single context (R0 isn't actually a biological constant, despite people treating it like it is).

</comment></comment></comment></comment><comment><USER38> I get a fair number of mail and packages from China, living in Australia. Some virus' can survive quite a while on non-porous surfaces like plastic, especially if the contents itsef is contaminated.

I now open packages outside of the house and spray the contents down with alkohol.

Yea keep those sneaky vectors in mind.

</comment><comment><USER39> Very strange. Given HK is the 2nd most affected (and most affected last time) why it was not mentioned.

As regards to the source we really hoped it is not from the lab in Wu han, one of the few la e in the world with category 4 lab handling sars etc.

</comment><comment><USER39> Latest figure is 56 death out of 1900. About 3%. Not high but that is the problem. The spread and low death rate meant widespread. Hope closing the cities would work.

</comment><comment><USER40> the darkest time of coronavirus crisis is over,[https://wubigo.com/post/the- darkest-time-of-coronavirus-cris...](https://wubigo.com/post/the-darkest-time- of-coronavirus-crisis-is-over/)

</comment><comment><USER41> What exacerbates the spread of these viruses is the lack of indoor heating in South China during the winter. I wonder how much china could reduce these problems by just allowing people to heat their homes the way they do up north?

</comment><comment><USER42> Signup wall?

<comment><USER43> not for me. maybe cookie based? try a private/incognito window

</comment></comment><comment><USER44> A recent Time article [1] is theorizing that the source may come from wet markets.

It also theorized that the source of the SARS virus might have originated from an infected cat. And Ebola may have originated from infected bat feces, that might have landed on a girl's toy, which she then put into her mouth. And the MERS virus in the Middle East may have come from an infected camel.

This appears to be a logical and scientific deduction.

So for this Coronavirus, it appears to follow the same pattern. Infected animal feces mutated into some virus, that made the transmission to humans.

My theory, is that perhaps an infected animal's feces, may have mixed with other fluids, like blood, from freshly slaughtered animals, and mutated into something that infected a human with a weakened immune system (easy target), who then transmitted it to other healthy humans by contact.

On one hand, it does seem that the best way to guarantee that you're sourcing your meat from a fresh and healthy animal, is to pick the animal that you want, and to slaughter it on the spot. This means that the meat vendor does not have to maintain a refrigeration system, and you don't introduce other chemicals or salts to preserve your meat.

But the problem is that you have to keep the animals in captivity, and the meat vendor must handle, and clean all their urine and feces. And when animals get sick, their feces and urine gets infected, thus you increase the probability of an outbreak like this.

What's the solution? Maybe China must begin eliminating wet markets, and eliminate the practice of keeping live animals in captivity, in order to minimize the incubation, mutation, and the transmission of such viruses. And instead, to begin using a refrigeration system, to preserve slaughtered animals.

[1] [https://time.com/5770904/wuhan-coronavirus-wild- animals/](https://time.com/5770904/wuhan-coronavirus-wild-animals/)

</comment><comment><USER45> Comparison between "Bat SARS-like coronavirus" and the "Wuhan seafood market pneumonia virus" seems to show a 100% match:

[https://blast.ncbi.nlm.nih.gov/Blast.cgi?RID=2PUA1EJK114&CMD...](https://blast.ncbi.nlm.nih.gov/Blast.cgi?RID=2PUA1EJK114&CMD=Get)

Bat SARS-like coronavirus WIV1 has been known since at least 2013.

[https://en.wikipedia.org/wiki/Bat_SARS- like_coronavirus_WIV1](https://en.wikipedia.org/wiki/Bat_SARS- like_coronavirus_WIV1)

In 2019, CBC reported "Canadian government scientist under investigation trained staff at Level 4 lab in China"

> A Canadian government scientist at the National Microbiology Lab in Winnipeg > made at least five trips to China in 2017-18, including one to train > scientists and technicians at China's newly certified Level 4 lab, which > does research with the most deadly pathogens, according to travel documents > obtained by CBC News.

> Xiangguo Qiu — who was escorted out of the Winnipeg lab in July amid an RCMP > investigation into what's being described by Public Health Agency of Canada > as a possible "policy breach" — was invited to go to the Wuhan National > Biosafety Laboratory of the Chinese Academy of Sciences twice a year for two > years, for up to two weeks each time.

[https://www.cbc.ca/news/canada/manitoba/national- microbiolog...](https://www.cbc.ca/news/canada/manitoba/national-microbiology- lab-scientist-investigation-china-1.5307424)

> Canadian lab's shipment of Ebola, Henipah viruses to China raises questions. > Shipment may be part of RCMP investigation into researchers evicted from > National Microbiology Lab. Scientists at the National Microbiology Lab sent > live Ebola and Henipah viruses to Beijing on an Air Canada flight March 31, > and while the Public Health Agency of Canada says all federal policies were > followed, there are questions about whether that shipment is part of an > ongoing RCMP investigation. Ebola and Henipah are Level 4 pathogens, meaning > they're some of the deadliest viruses in the world. They must be contained > in a lab with the highest level of biosafety control, such as the one in > Winnipeg.

[https://www.cbc.ca/news/canada/manitoba/ebola-henipah- china-...](https://www.cbc.ca/news/canada/manitoba/ebola-henipah- china-1.5232674)

"Wuhan" is the center of this outbreak too. It's too much of a coincidence.

[https://www.washingtontimes.com/news/2020/jan/24/virus- hit-w...](https://www.washingtontimes.com/news/2020/jan/24/virus-hit-wuhan- has-two-laboratories-linked-chines/)

> Mr. Shoham, now with the Begin-Sadat Center for Strategic Studies at Bar > Ilan University in Israel, said the virology institute is the only declared > site in China known as P4 for Pathogen Level 4, a status indicating it uses > the strictest safety standards to prevent the spread of the most dangerous > and exotic microbes being studied.

> The former Israeli military intelligence doctor also said suspicions were > raised about the Wuhan Institute of Virology when a group of Chinese > virologists working in Canada improperly sent samples to China of what he > said were some of the deadliest viruses on earth, including the Ebola virus. > In a July article in the journal Institute for Defence Studies and Analyses, > Mr. Shoham said the Wuhan institute was one of four Chinese laboratories > engaged in some aspects of the biological weapons development. He identified > the secure Wuhan National Biosafety Laboratory at the institute as engaged > in research on the Ebola, Nipah, and Crimean-Congo hemorrhagic fever > viruses. The Wuhan virology institute is under the Chinese Academy of > Sciences. But certain laboratories within it "have linkage with the PLA or > BW-related elements within the Chinese defense establishment," he said. In > 1993, China declared a second facility, the Wuhan Institute of Biological > Products, as one of eight biological warfare research facilities covered by > the Biological Weapons Convention (BWC) which China joined in 1985.

[https://www.dailymail.co.uk/health/article-7922379/Chinas- la...](https://www.dailymail.co.uk/health/article-7922379/Chinas-lab-studying- SARS-Ebola-Wuhan-outbreaks-center.html)

> China built a lab to study SARS and Ebola in Wuhan - and US biosafety > experts warned in 2017 that a virus could 'escape' the facility that's > become key in fighting the outbreak

> The Wuhan National Biosafety Laboratory is the only lab in China designated > for studying dangerous pathogens like SARS and Ebola

> Ahead of its January 2018 opening, biosafety experts and scientists from the > US expressed concerns that a virus could escape the lab

> In 2004, a SARS virus 'leaked' from a lab in Beijing

> Experts say the coronavirus that's infected more than 800 people mutated in > animals and became capable of infecting humans at the Wuhan seafood market

> But a 2017 article warned of the unpredictability of lab animals that > scientists at the Wuhan lab intended to inject with viruses

<comment><USER46> Sorry, this is wild speculation, not fact. The "100% match" you cited is for _one protein_ (and a small one, at that - just 75 amino acids long) which proves absolutely nothing (individual proteins can often be highly conserved - and amino acid alignment doesn't guarantee that the underlying genes are even the same).

SARS and MERS, highly similar viruses which emerged over the last 20 years, have a very similar emergence pattern to the new nCoV virus. Wuhan has a seafood market which has been known to house animals other than seafood. Initial cases were from those seafood markets. There's quite literally no evidence to suggest that the Wuhan lab had anything to do with this outbreak.

<comment><USER45> > Wuhan lab had anything to do with this outbreak

The Wuhan National Biosafety Laboratory is the only lab in China designated for studying dangerous pathogens like SARS and Ebola. What are the chances of coincidence that Wuhan is also the center of this current outbreak?

Maybe one of the lab animals somehow leaked and ended up in the food market.

<comment><USER47> Occams razor would posit that the presence of illegal food markets may be a higher predictor of illnesses than a BSL4 lab

</comment></comment></comment></comment><comment><USER48> I'm surprised no one has commented on how unhealthy, unhygienic and to some level immoral the consumption of genetically similar animals is. One more reason we should only eat creatures very genetically dissimilar to us. Eating bats, cows, rats, pigs etc will give you nasty results indeed because their pathogens can attack you very easily as opposed to a fish. (Actually eating undercooked fish can give you a nasty thing called liver flukes so even thats not safe)

</comment><comment><USER49> Is HN now part of the misinformation bubble? The paranoia, national agenda anti China hate brigade are strong here.

Seriously, can people take a chill pill and stop spreading fud?

I read [https://promedmail.org](https://promedmail.org) and I'm waiting for them to panic before I invoke contagion metaphors. It's way too early to state the infection and mortality rates

</comment><comment><USER50> Viruses are scary. My company switched to work at home maybe 18 months ago, so I no longer am exposed to the viruses of my coworkers.

At the grocery stores at which I buy most of my food I use the self checkout, so no interacting with humans there.

At McDonalds I order and pay at the kiosks, so no human interaction there except when they hand me the bag with my food. At Burger King and Wendy's I do order at the counter, so I am talking to another human who is maybe a meter or so in front of me.

Every three months I have to pick up prescription re-fills so deal with a human at the pharmacy, and perhaps stand in line there with other humans.

I live in a house in a low density neighborhood, with no other house nearer than 40 meters, although my neighbors on one side have an RV in their front yard that is only about 15 meters from me, with an older couple (their parents presumably) living in it. No human interaction here other than occasionally waving at someone walking their dog on the street in front of my house (about 20 meters away).

Yet I still get the occasional cold-like or flu-like illness in the winter. Who is passing on these viruses to me?

<comment><USER51> Are you avoiding human contact because you are worried about infection?

<comment><USER50> I'm not avoiding human contact. I use the self checkout because it is faster, not to avoid cashiers. Most of my social activities are online or solitary because those are what I enjoy, not because other activities would involve in person contact.

So when we switched to work at home, and so I was no longer in daily contact with people with school children (a big factor in spreading viruses), I hoped maybe it would mean much fewer colds and such.</comment></comment></comment>