Coronavirus - worldwide spread and control

Basically the Northern Ireland Health Minister followed the UK Westminster Government approach --- were going to get it anyway, best to get it out of the way --- not damage the economy.

In the Republic of Ireland the (stand in) prime minister (Leo Varadkar) is a former doctor whose family members and partner are doctors in Ireland/UK. The Republic of Ireland basically followed WHO guidance i.e. test (health care staff & members of the public as resources permit), trace contacts, quarantine (they have Covid-19 hotels!) --- reduce transmission. As @Trish has indicated above this may in part be due to the knowledge --- of the decision makers in Government --- Leo Varadkar was a Doctor and he has family who are front line Doctors.

So basically the question in Northern Ireland is do you follow the UK or Republic of Ireland.

As @Jonathan Edwards has said "people have very definitely been sitting on their arses for two months now"; Doctors etc. knew that there were insufficient ventilators to meet the demands months ago. The difficulty for the Northern Ireland Health Minister is that he now has to explain the policy of sitting on their arses--. I'm not much taken with calling on the people to stand outside and clap our amazing health care workers or "praying for more ventilators" --- I grudgingly admire the PR though.

 

I wouldn't have expected temperature to make any difference, the environment in the viruses hosts is broadly constant and independent of external climate. The amount of sunshine (UV) might have made a difference in ease of transmission, but temperature, in the ranges people are comfortable living in, not very likely IMO (as someone who knows nuffin')

 

Are we sure that's down to temperature and not the increase in UV during summer?

 

Regarding: "I have. I just don't think there's enough information there on which to base any judgement."
There are 5 million people in Veneto and 10 million people in Lombardy -- what do you mean there [not] "enough information there on which to base any judgement."? The death toll was 500/million in Lombardy and EDIT 57/million in Veneto.

From Harvard Business Review:
"The most notable example is the contrast between the approaches taken by Lombardy and Veneto, two neighboring regions with similar socioeconomic profiles.

Lombardy, one Europe’s wealthiest and most productive areas, has been disproportionately hit by Covid-19. As of March 26, it held the grim record of nearly 35,000 novel coronavirus cases and 5,000 deaths in a population of 10 million. Veneto, by contrast, fared significantly better, with 7,000 cases and 287 deaths in a population of 5 million, despite experiencing sustained community spread early on."
[https://hbr.org/2020/03/lessons-from-italys-response-to-coronavirus]

 

Thanks, I found this very interesting, and looking at comments on the video, where people are thinking they or their family members may have had the virus towards the end of last year.

Early January my husband and I, and a lot of people locally, had what seemed at the time and unusual virus, which started with a dry cough for a few days before developing into a more recognizable viral infection when it then affected more our voices and into our chests, though not really, really deep down and feeling virally aches etc but for us no temperature and debilitating energywise. I was having to get up 2-3 times a night to cough up muck and clear my chest. It was all very exhausting. I have very rarely in my life had chest infections so it was unusual and others commented it was an unusual virus. I'd say it's only in the last 3 weeks or so that we've felt back to "normal" after it. OK I quite appreciate it may have been another virus completely, but from hearing this about it possibly being out there earlier I do wonder.

I spoke to a doctor whose son in law works in international trade, including with China, and he had told him there had been delays/problems with getting deliveries from China October/November time because of some virus going around affecting workers in ports. Again it may have been some other virus, who knows, but interesting.

 

Thanks - I read it. Lots of maybe's.

 

This is a long article, and mostly focused on USA issues (from NPR, National Public Radio), but I found it interesting. Explains some of the testing failures in the USA.

Fighting COVID-19 Is Like 'Whack-A-Mole,' Says Writer Who Warned Of A Pandemic

https://www.npr.org/sections/health...ack-a-mole-says-writer-who-warned-of-pandemic

The story has an audio link (42 minutes, I didn't listen) and a written version (summary with interview highlights).

Here's a quote from a section labeled, "On how American hubris and exceptionalism have contributed to the slow response"

 

Chracteristics of Covid-19 patients dying in Italy. Report based on available data on March 20th 2020.

1. Sample [table shows that in Lombardy 68% positive tested died, in Emilia-Romagna 16,4%, otherwise much less].

2. Demographics

3. Pre-existing conditions

Diseases [first number being N second number being %]
schemic heart disease - 145 - 30.1
Atrial Fibrillation - 106 - 22.0
Stroke - 54 - 11.2
Hypertension - 355 - 73.8
Diabetes - 163 - 33.9
Dementia - 57 - 11.9
COPD - 66 - 13.7
Active cancer in the past 5 years - 94 - 19.5
Chronic liver disease - 18 - 3.7
Chronic renal failure - 97 - 20.2

Number of comorbidities
0 comorbidities - 6 - 1.2
1 comorbidity - 113 - 23.5
2 comorbidities - 128 - 26.6
3 comorbidities and over - 234 - 4

4. Symptoms

5. Acute conditions

Acute Respiratory Distress syndrome was observed in the majority of patients (96.5% of cases), followed by acute renal failure (29.2%). Acute cardiac injury was observed in 10.4% of cases and superinfection in 8.5%.

8. Death under the age of 50 years

To date (March the 20th), 36 of 3200 (1.1%) COVID-19 positive patients under the age of 50 have died. In particular, 9 of these were younger than 40 years, 8 men and 1 woman (age range between 31 and 39 years). For 2 patients under the age of 40 years, no clinical information is available; the remaining 7 had serious pre-existing pathologies (cardiovascular, renal, psychiatric pathologies, diabetes, obesity).

 

A thought that struck me today is that the move from contact tracing and testing to 'mitigation', with a bit of herd immunity thrown in, without trying to keep up with contacts by testing may have a slightly different origin.

There seems no doubt that there was heated disagreement early on amongst UK advisors about how much to restrict activities like flights and football games and whether or not to 'let the epidemic warm up a bit' before locking down. Political pressures to protect business economics no doubt played a part - ironically since the result seems to have been the worst possible one for business. But health administrators prepared to be swayed one way or another may have been swayed by a different consideration.

It may have been realised, but perhaps deliberately never voiced at meetings, that the phase 1 part of the strategy of test and trace was going to collapse long before it had a chance of achieving anything simply because infrastructure had been eroded in 'reforms' in 2003 and reviews since 2010. Those responsible may have been faced with the prospect that if they pushed for testing and tracing, within a week it would be clear that there were no resources to do that. Closing down testing would have avoided a serious embarrassment. That embarrassment has come home to roost but since decisions seem to have been made by people with no practical understanding of clinical infectious disease medicine perhaps they thought it worth crossing their fingers and going for phase 2.

 

@Jonathan Edwards that’s interesting what you say. But I wonder if we really don’t have resources to do the testing and tracing? Jeremy Hunt said in a video which I posted a while ago, in parliament, that he thinks we would have had capacity to do it - if for example all the civil servants, people working in offices doing other jobs that were non-essential etc, could turn their attention to tracing, we do have a lot of manpower and capability to do it.

And I’ve seen people come on the TV from various labs, universities etc saying they also think they have the capability to do tests, to test everyone needed. I’m not sure about making tests, but even then, labs have been saying they have reagents I think? So to me it seemed a lack of will and not wanting to put the amount of time and money and resources needed into making it work.

 

I think it may be mindset as much as anything. For the last 20 years Uk health service administrators have only really had one job - that is to find ways to avoid doing things. They become highly skilled at finding reasons not to do things. That is why I resigned at 60. I was not allowed to provide a safe and effective service. People who have risen up the ranks because of being skilled in doing nothing are not the sort of people who can suddenly get things moving. The chemicals and tubes are there. What I suspect was not there was the administrative infrastructure to set up a big testing program.

 

Ah, but we know that employing the magical Chelsea scarf of protection against viruses makes anybody immune to COVID-19 - obviously so long as you believe in it enough..

 

Can't export this video, but the gist of the Taiwanese handling of the virus is here http://www.dailymirror.lk/opinion/I...-to-COVID-19-possible-in-Sri-Lanka/172-185720

 

Stealing a second article directly:
Early epidemiological assessment of the transmission potential and virulence of corona disease in Wuhan City, China, Jan-Feb 2020
Mizomoto et al

from the abstract

Full article available.

 

And that is a very very long time to be procrastinating and dithering when a pandemic is taking hold.

 

Just now at 13 hours EST I heard on CBC Radio that in the Province of Ontario 1 in 10 people affected with Covid work in health care; no further breakdown was offered.

 

This fits in with the report I mentioned yesterday, where the Italian doctor (who has recently published in the New England Journal of Medicine) stated that it is imperative to keep more Covid patients at home, to provide mobile units, and to place the severe Covid patients in a separate hospital or institution dedicated to them.