AI tool predicts which coronavirus patients get deadly 'wet lung'

Doctors are learning on the fly about COVID-19, and one AI tool appears able to help steer them in the right direction.

Researchers in the US and China reported on Monday they developed an artificial intelligence tool that is able to accurately predict which newly infected patients with the coronavirus go on to develop severe lung disease.

Once deployed, the algorithm could assist doctors in making choices about where to prioritise care in resource-stretched healthcare systems, said Megan Coffee, a physician and professor at New York University’s Grossman School of Medicine who co-authored a paper on the finding in the journal Computers, Materials & Continua.

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The tool discovered several surprising indicators that were most strongly predictive of who went on to develop so-called acute respiratory disease syndrome (ARDS), a severe complication of the COVID-19 illness that fills the lungs with fluid and kills about 50 percent of coronavirus patients who get it. 

The team applied a machine learning algorithm to data from 53 coronavirus patients across two hospitals in Wenzhou, China, finding that changes in three features – levels of the liver enzyme alanine aminotransferase (ALT), reported body aches, and hemoglobin levels – were most accurately predictive of subsequent severe disease.

Using this information along with other factors, the tool was able to predict risk of ARDS with up to 80 percent accuracy.

By contrast, characteristics that were considered to be hallmarks of COVID-19, such as a particular pattern in lung images called “ground glass opacity,” fever, and strong immune responses, were not useful in predicting which of the patients with initially mild symptoms would get ARDS. 

Neither age nor sex were useful predictors either, even though other studies have found men over 60 to be at higher risk.

“It’s been fascinating because a lot of the data points that the machine used to help influence its decisions were different than what a clinician would normally look at,” Coffee said.

AI in medicine

Using AI in medical settings isn’t a brand new concept – a tool already exists to help dermatologists predict which patients will go on to develop skin cancer, to give just one example. 

What makes this different is that doctors are learning on the fly about COVID-19, and the tool can help steer them in the right direction, in addition to helping them decide which patients to focus on as hospitals become overwhelmed, said co-author Anasse Bari, a computer science professor at NYU.

The team is now looking to further refine the tool with data from New York and hope it is ready to deploy sometime in April. 

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Pandemic speeds up iPhone makers' plans to exit China

Wistron Corp, one of Apple’s manufacturing partners, said last week that half its capacity could reside outside China within a year.

The declaration underscores how the Asian assemblers that keep the world supplied with iPhones and other gadgets are shifting to a higher gear after the coronavirus showed the folly of staking everything on one country.

The move to shift production out of China has been under way since the trade war between Washington and Beijing reached its zenith last year.

Now, the Covid-19 pandemic is expediting that. Decisions by companies such as Wistron and other Apple partners including Hon Hai Precision, Inventec and Pegatron could reshape tech supply chains.

Taipei-listed Wistron is targeting India – where it is already making some iPhones – along with Vietnam and Mexico, setting aside US$1 billion (S$1.35 billion) to fund the expansion this year and next. “We understand from a lot of messages from our customers that they believe this is something we have to do,” chairman Simon Lin said on an earnings call. “They’re happy and appreciate that we can continue to make such a move and they will continue to work with us.”

Pegatron, which assembles iPhones, is also diversifying its manufacturing sites, including by adding capacity back home in Taiwan. Chief executive officer Liao Syh-jang said last Thursday that it hopes to kick-start manufacturing operations in Vietnam next year, after setting up a new plant in Indonesia last year, and it is further looking at India as a location for new facilities.

The firm said last Friday that it had agreed to purchase land and a plant in northern Taiwan.

Inventec, Apple’s main assembly partner for AirPods, said last Tuesday that it is preparing to establish a unit in Vietnam.

More than any other assembler, Hon Hai encapsulated how the coronavirus brought China, the world’s No. 2 economy, to a standstill. Better known as Foxconn, it signals a potential shift in a global production paradigm that has governed the electronics industry for well over three decades.

The company also has facilities in India, where it began churning out iPhones last year, and Vietnam. “Trade, the virus, all these things will make the world very different in the next decade,” Mr Alex Yang, the firm’s investor relations chief, said in a recent call.

But it is unlikely that China will fully give up its place as the world’s electronics workshop any time soon. This is because it is difficult to replicate the intricate network of suppliers, competent workers, efficient distribution systems and large home market that the country offers. Large-scale relocation of manufacturing capabilities would also take time.

Apple chief executive Tim Cook said late last month that the company was not looking to make any quick moves out of China in the light of virus-related supply-chain interruptions. “We’re talking about adjusting some knobs, not some sort of wholesale, fundamental change,” he said.

Still, the outward-bound trend is accelerating, especially among smaller-scale manufacturers. That extends to gadget-makers serving customers other than Apple.

Meiloon Industrial, which makes speakers and counts Harman International and Xiaomi among its clients, is seeking alternatives to China-based production and speeding up a move of capacity to places like Taiwan and Indonesia, said spokesman Eva Kuo.

The singularly trying experience of dealing with the outbreak in China will reverberate well after Covid-19 subsides, raising questions about the globalised business model of modern corporations.

“It’s a wake-up call,” Mr Joerg Wuttke, president of the European Union Chamber of Commerce in China, said last month. “China was a given, it was the perfect infrastructure for us to source and buy from there, and to sell. Now, of course, we have to reconsider scenarios, how to deal with China in the future.”

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China's $43 trillion market promise beckons global wealth firms

HONG KONG (BLOOMBERG) – China’s trillion dollar asset-management market opens wider this week, forcing BlackRock, Vanguard Group and other global firms to make a strategic decision: Go it alone or work with an entrenched local partner.

While the further liberalisation of the investment banking and money management industries in China has been overshadowed by the coronavirus crisis, wealth firms are nonetheless laying out plans to tap a market poised to reach US$30 trillion (S$42.8 trillion) in assets by 2023, according to consultant Oliver Wyman.

Starting April 1, they can apply for licenses to set up wholly-owned mutual fund management firms for the first time.

Vanguard and BlackRock are among firms going that route, people familiar have said.

Other options include boosting ownership of existing joint venture partnerships to 100 per cent, as JPMorgan Chase & Co. plans to do, people familiar have said.

“With so many license options and changing policies, one of the biggest questions all foreign players face is where to allocate their resources,” said Jasper Yip, a principal in the financial services practice at Oliver Wyman in Hong Kong.

“Asset management could be one of the most competitive sectors because of the opportunities.”

Here are the different paths asset managers can pursue in China and how some of them plan to proceed:

WEALTH MANAGEMENT SUBSIDIARIES

The China Banking and Insurance Regulatory Commission has been encouraging foreign asset managers to work with the wealth management subsidiaries of Chinese banks or insurers.

Global players are expected to bring to the table product design expertise, while the Chinese firms provide a vast distribution network and relationship managers.

BlackRock is in talks with China Construction Bank to set up a joint venture for a wealth management subsidiary, according to people familiar with the matter.

Goldman Sachs Group has discussed a similar structure, people familiar have said.

“Chinese banks have great distribution channels and client relationships, but many of them lack expertise to create long-term investment products with sufficient risk controls, so they would benefit from working with foreign players,” said Harry Qin, a partner at PricewaterhouseCoopers LLP in Beijing.

WHOLLY-OWNED COMPANIES

This is the go-it-alone option.

China is planning to allow applications for foreign-owned fund management licenses that would grant control of mutual funds.

At least six firms, including BlackRock and Vanguard, have told regulators they intend to apply to the Chinese securities watchdog, people familiar with the matter have said.

China regulators are trying to shift consumers away from shadow banking products underpinned by loans sitting outside banks’ balance sheets.

That’s creating an opportunity for mutual funds that are expected to increase assets by more than 10 per cent annually, according to Oliver Wyman, a unit of New York-based Marsh & McLennan Cos.

The fund management licenses will allow global asset managers to sell mutual funds to individual investors.

Some firms already hold private asset management licenses that let them target institutional investors and high-net-worth individuals, much like hedge funds.

“Wholly-owned fund management licenses will be one of the most sought after options for foreign companies,” said Rachel Wang, director of manager research for China at Morningstar.

“It allows them to offer more products and have a wide outreach to different types or sizes of customers.”

The potential is significant.

Even with the market opening, foreign players are expected to only account for 6 per cent of revenue generated in the asset management space by 2023, according to Oliver Wyman. Still, that small piece of the market could be worth US$8 billion.

“Chinese regulators are very eager to attract foreign players in the financial sector,” said James Chang, China consulting leader at PricewaterhouseCoopers.

“The government thinks the market is big enough for the local players to handle the competition.”

JOINT VENTURES

This is the legacy option.

Several investment banks already have mutual fund joint ventures in China. With foreign companies now free to control operations on the ground, it’s unclear whether partnerships still provide value.

“Many of the joint venture asset management firms that foreign players set up with their Chinese counterparts have not been performing as expected, partly due to limited product offerings and less than ideal collaboration with the Chinese brokerages,” said Qin from PwC.

The solution for some is to buy out their partners.

JPMorgan is seeking 100 per cent ownership of its fund management joint venture, people familiar have said.

The New York-based bank is in talks with Shanghai International Trust to acquire its stake in China International Fund Management, which oversees 150 billion yuan (S$30 billion).

Vanguard meanwhile has a robo-advisory joint venture with Jack Ma’s Ant Financial Services Group that started providing mutual-fund recommendations to Alipay app users in late March.

PRIVATE FUNDS

A go-slow approach.

Foreign companies were first allowed to apply for private fund licenses in 2016. Some 25 firms, ranging from banks to hedge funds and insurance companies, have won these licenses, according to Natasha Xie, a Shanghai-based partner at the JunHe law firm.

The private funds run three types of assets: stocks, private equity and pilot programs introduced by the Shanghai and Shenzhen governments that allow global asset managers to raise yuan-denominated funds from qualified clients to invest overseas.

“It would make sense for players who can’t commit significant investment or headcount to apply for the private fund management license,” said Xie.

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China guards against second wave of coronavirus coming from abroad

WUHAN, China (Reuters) – The growing number of imported coronavirus cases in China risked fanning a second wave of infections at a time when “domestic transmission has basically been stopped”, a spokesman for the National Health Commission said on Sunday.

“China already has an accumulated total of 693 cases entering from overseas, which means the possibility of a new round of infections remains relatively big,” Mi Feng, the spokesman, said.

In the last seven days, China has reported 313 imported cases of coronavirus but only 6 confirmed cases of domestic transmission, the commission’s data showed.

There were 45 new coronavirus cases reported in the mainland for Saturday, down from 54 on the previous day, with all but one involving travelers from overseas.

Most of those imported cases have involved Chinese returning home from abroad.

Airlines have been ordered to sharply cut international flights from Sunday. And restrictions on foreigners entering the country went into effect on Saturday.

Five more people died on Saturday, all of them in Wuhan, the industrial central city where the epidemic began in December. But Wuhan, the capital of Hubei province, has reported only one new case on the last 10 days.

A total of 3,300 people have now died in mainland China, with a reported 81,439 infections.

Saturday marked the fourth consecutive day that Hubei province recorded no new confirmed cases. The sole case of domestically transmitted coronavirus was recorded in Henan province, bordering Hubei.

With traffic restrictions in the province lifted, Wuhan is also gradually reopening borders and restarting some local transportation services.

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“It’s much better now, there was so much panic back then. There weren’t any people on the street. Nothing. How scary the epidemic situation was,” a man, who gave his surname as Hu,

told Reuters as he ventured out to buy groceries in Wuhan.

“Now, it is under control. Now, it’s great, right?”

All airports in Hubei resumed some domestic flights on Sunday, with the exception of Wuhan’s Tianhe airport, which will open to domestic flights on April 8. Flights from Hubei to Beijing remain suspended.

A train arrived in Wuhan on Saturday for the first time since the city was placed in lockdown two months ago. Greeting the train, Hubei Communist Party Secretary Ying Yong described Wuhan as “a city full of hope” and said the heroism and hard work of its people had “basically cut off transmission” of the virus.

More than 60,000 people entered Wuhan on Saturday after rail services were officially restarted, with more than 260 trains arriving or traveling through, the People’s Daily reported on Sunday.

On Sunday, streets and metro trains were still largely empty amid a cold rainy day. Flashing signs on the Wuhan Metro, which resumed operations on Saturday, said its cars would keep passenger capacity at less than 30%.

The Hubei government on Sunday said on its official WeChat account that a number of malls in Wuhan, as well as the Chu River and Han Street shopping belt, will be allowed to resume operations on March 30.

Concerns have been raised that a large number of undiagnosed asymptomatic patients could return to circulation once transport restrictions are eased.

China’s top medical adviser, Zhong Nanshan, played down that risk in comments to state broadcaster CCTV on Sunday. Zhong said asymptomatic patients were usually found by tracing the contacts of confirmed cases, which had so far shown no sign of rebounding.

With the world’s second-biggest economy expected to shrink for the first time in four decades this quarter, China is set to unleash hundreds of billions of dollars in stimulus.

The ruling Communist Party’s Politburo called on Friday for a bigger budget deficit, the issuance of more local and national bonds, and steps to guide interest rates lower, delay loan repayments, reduce supply-chain bottlenecks and boost consumption.

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China reports second consecutive day of no new local coronavirus transmissions, imported cases rise

BEIJING/SHANGHAI (Reuters) – Mainland China reported a second consecutive day of no new local coronavirus infections as the epicentre of the epidemic Hubei province opened its borders, but imported cases rose as Beijing ramped up controls to prevent a resurgence of infections.

A total of 67 new cases were reported as of end-Wednesday, up from 47 a day earlier, all of which were imported, China’s National Health Commission said in a statement on Thursday.

The total number of cases now stands at 81,285.

The commission reported a total of 3,287 deaths at the end of Wednesday, up six from the previous day.

All of the new patients were travellers who came to China from overseas, with the mainland reporting no locally transmitted infections on Wednesday.

Shanghai reported the most cases with 18 followed by Inner Mongolia region at 12 and Guangdong province at 11.

The number of new daily cases remain down sharply from the height of the outbreak in the country in February, allowing Beijing to push for restarting economic activity in the world’s second biggest economy.

Hubei province, home to some 60 million people, reported no new cases on Wednesday and opened its borders. Public transport restarted and residents in the city of Xianning strolled the streets wearing masks.

The lockdown of Hubei’s capital Wuhan, where the virus first appeared late last year, will be lifted on April 8, a milestone in China’s war against the epidemic as Beijing shifts its focus towards stemming imported cases and rebooting the economy.

Fearing a new wave of infections from imported cases, authorities have ramped up quarantine and screening measures in other major cities including Beijing, where any travellers arriving from overseas must submit to centralised quarantine.

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Explainer: China's symptom-free coronavirus carriers raise fears of new wave of infections

SHANGHAI (Reuters) – The existence of a substantial but unknown number of asymptomatic carriers of coronavirus in China has raised concerns among the public that people could still be spreading COVID-19 without knowing they are sick.

As the virus continues to wreak havoc across the world, China is close to declaring victory and is already easing travel restrictions. The border of Hubei province, epicenter of the virus, opened on Wednesday after a two-month shutdown.

But there are concerns that the end of the lockdown will release thousands of infectious people back into circulation.

Asymptomatic cases present a huge challenge in the control of infectious disease, making it harder to detect and stop transmission.

In China, the number of known asymptomatic cases is classified, and it is not included in the official data, though the South China Morning Post, citing unpublished official documents, recently said it was more than 40,000.

China had reported 81,218 coronavirus cases, and 3,281 deaths by the end of Tuesday.

Asymptomatic cases are currently found through “contact tracing”. China identifies people exposed to someone with a confirmed diagnosis, and if they test positive, they are quarantined whether or not they manifest symptoms.

“Asymptomatic patients have all been discovered during our contact tracing,” said Wu Zunyou of the China Center for Disease Control and Prevention at a briefing on Tuesday. “So will they be able to create transmission? They won’t.”

Still, the failure to include them in the official data has raised concerns about Beijing’s commitment to transparency, and some experts say it could also create a misleading picture about how the epidemic spreads and whether or not it is under control.

Despite recording zero new infections from March 18 to March 22, the COVID-19 hotspot city of Wuhan disclosed on March 20 that one newly diagnosed case was not included in the official data because the patient, a 62-year old man surnamed Zhang had shown no symptoms.

Citing hospital sources, the news magazine Caixin also reported that a new case in Wuhan on Tuesday was a doctor who had been infected by an asymptomatic patient.

China says asymptomatic patients will be added to the list of confirmed patients if they show symptoms at a later stage. But it remains unclear how many asymptomatic cases remain undiagnosed and therefore unquarantined.

Some experts warn that undetected, asymptomatic patients could create fresh transmission routes once lockdowns are eased.

“It is especially concerning given that many countries have yet to implement sufficient levels of widespread community testing,” said Adam Kamradt-Scott, a public health specialist at the University of Sydney.

It is also unclear how much they might infect others.

“We know that that is possible, but we do not believe that that’s a major driver of transmission,” said Maria Van Kerkhove of the World Health Organization at a briefing early in March.

New studies show that asymptomatic carriers could pose risks. One analysis of the Diamond Princess cruise ship outbreak showed that 33 of the 104 infected passengers remained asymptomatic even after an average of 10 days of observation at the Self-Defense Forces Central Hospital in Japan.

While many appeared healthy throughout, a few other initially asymptomatic passengers quickly became seriously ill.

Another study published on March 23, looking at cases in the southwestern Chinese city of Chongqing, said 18% of patients were asymptomatic. Another even found that people are more likely to transmit the disease when symptoms are at their mildest.

The Yale School of Public Health said the existence of presymptomatic (asymptomatic) patients meant that screening procedures at airports and other points of entry were insufficient to prevent the coronavirus passing from China to other countries.

“The real picture will only come to light when we have a serological test to find out who has been infected,” said Ian Henderson, Director of the Institute for Molecular Bioscience at Queensland University.

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One fifth of American companies in China back to normal operations: Survey

BEIJING (REUTERS) – More than one fifth of American companies in China are back to normal operations after widespread disruptions caused by the coronavirus epidemic, a survey showed on Wednesday (March 25).

Nearly a quarter of the respondents to the survey by the American Chamber of Commerce in China said they expected a return to normal operations by the end of April, although another fifth expect delays throughout the summer.

“This is one of the areas that I think provides some sense of optimism,” the chamber’s president, Alan Beebe, said at a news conference accompanying the survey’s release.

The outbreak began in the central Chinese city of Wuhan late last year, causing massive disruptions to business operations, supply chains and economic activity. The outbreak has killed more than 3,200 people and infected more than 81,000 in China alone.

Half of the 119 respondents to the survey are experiencing revenue declines of over 10 per cent, and 14 per cent reported losing at least a half-million yuan (S$102,000) per day as a result of delays to re-opening businesses.

The survey also highlighted the reliance of American companies on China’s small and medium-sized businesses (SMEs), which have been slowest to get back to work and are most vulnerable to cash flow disruptions.

“Longer-term policy measures aren’t enough for the little guys,” said Greg Gilligan, the chamber’s chair, warning that some may not make it long enough to see government support.

Eight in ten respondents said SMEs contribute up to half of annual revenues, and over a tenth said that 75 per cent or more of their supply chain depends on SMEs.

The chamber is calling for its members to directly support their SME suppliers and customers, Beebe said.

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