Coronavirus - worldwide spread and control

From the current press conference:

It seems unlikely that we're going to be able to prevent this from spreading around the world, so doesn't that make it very difficult for individual nations to pursue an eradication strategy? If they succeed, what then? Given that infectious people are often not symptomatic for a good period of time after infection, and that virus seems to spread so easily, keeping infections out of the country would then be incredibly difficult.

 

Then, after the country has eradicated it, air travel could be seriously restricted, and with anyone who really has to come in - 14 day quarantine upon landing regardless of symptoms, in a specific location set up specifically for this; with continuous checks and blood tests to confirm no virus after 14 days. They’re doing this in parts (maybe all?) of China.

 

Not at all. Tuberculosis has spread throughout the world but most countries have an eradication strategy. Success varies but it is still an eradication strategy and most the time it works pretty well even with international travel.

But the key point is that the only alternative to an eradication strategy cannot work without crashing a health care system. So an alternative strategy only makes sense for countries that effectively have no health care - such as a number of subsaharan countries. Those countries will develop herd immunity and actually be less of a problem for the world community than countries trying to preserve health care at a reasonable level.

I think the problem is that a lot of so called experts on this are assuming that because this is a virus it should be handled like flu. But being a virus is not what matters. What matter are the infectivity rate, the severity of illness, the immunity that develops and so on and so on. For pathogens that produce lethal illness in as high a percentage as Covid19 you cannot take a flu approach. It might be a TB approach or a plague approach or a polio approach or a malaria approach and probably a unique one. But there is no realistic alternative to attempting eradication and either succeeding or at least keeping levels very low simply because of the dynamics of the clinical presentation and the implications for healthcare resources. Costello understands that. I don't know who Powis is.

 

I remember who Powis is. He was in the UCL department of medicine based at the Royal Free. He was sufficiently outstanding that I never heard of him. He seems to have gone into administration early. He is not an epidemiologist. Costello makes absolute sense on all of this He knows the field and knows the dynamics. Like me he is retired so he does not have to say what suits.

Basically that sentence from Powis is non-sequitur.

 

https://www.bloomberg.com/news/arti...testing-in-china-finds-more-symptomless-cases

 

I can't believe Neil Ferguson actually believes we will plateau in a week to 10 days ...what planet are these people on ?

https://www.theguardian.com/uk-news...-old-child-among-latest-uk-coronavirus-deaths

 

The other day he said there are early signs that the epidemic is “slowing down”. Which I thought was a weird thing to say at this moment

https://www.independent.co.uk/news/...ews-update-neil-ferguson-deaths-a9433111.html

 

I am looking on a daily basis at the site someone flagged up at:

https://www.worldometers.info/coronavirus/#countries

UK figures have been showing a suggestion of plateauing but until now they seem to keep slipping up again. I think it is reasonable to hope that the social distancing rules brought in about two weeks ago will begin to show an effect about now and show full effect in one to two weeks. Up until now there has been no particular reason to hope for a slowing but now there is. My suspicion is that there will be a fairly complete flattening of the curve for new cases next week. That is what I think Ferguson means and I would agree. It would of course be nowhere near getting numbers of new cases down, but it would indicate the reproduction number R0 is coming down to 1 and once below that the process should subside. Judging by the Chinese curve getting numbers of new cases to fall right down may be slow for another 3-4 weeks but then they should switch off quite quickly. That of course assumes that our rules are as watertight as China. I think using masks might be an important ingredient in that. Tighter control on air traffic as well.

 

Thanks Jonathan for all your input, interesting and informative, keep safe x

 

Expert Streeck said that you can not compare experts because they all are different -

So here both of you will probably agree with each other.


I would think the situation is still unclear.

 

Thanks @Jonathan Edwards. That’s really helpful.

Do you think that in 12 weeks time, we will be able to have a functioning healthcare system again? 12 weeks is the amount of time us extremely vulnerable people have been told to stay indoors. One of the things I’m most concerned about is the healthcare system and whether appointments / surgeries will be safe and possible to do again, after that.

 

Today the number of patients in intensive care has declined for the first time in Italy

 

In the Netherland number of new patients coming into hospitals has declined, according to tv. They said there is hope for being optimistic, but keep distancing and stay at home.

I don´t know when the Dutch implemented the rules.


I think also Spain is on a mere good way.

 

https://www.worldometers.info/coronavirus/country/sweden/

New cases and deaths have yesterday declined in Sweden; to be seen if the trend is going to carry on.

This morning in German radio a reporter in Sweden said, that the politicians may change their handling, and may try to implement stricter orders (obviously not that easy there), instead of counting on possibilities (apparently an important tradition in Sweden).

 

Seems like the curves are flattening in multiple countries at the same time despite different starting points. Interesting. Could it have something to do with the weather?

 

Think I've found it (for ICU cases)


The increase in persons hospitalized in ICU due to COVID-19 also seems to be slowing down in a number of European countries as the Belgian graph below shows.


The death toll also seems to be plateauing


So I'm hoping that some countries are close to reaching their peak and that the number of new cases and deaths will be downhill from there.

 

Hm. We have not had a fully functioning health care system for about fifteen years now. But even the function we had in December will take a long time to restore. The epidemic has pushed back management of a lot of other problems by at least three months, especially elective surgery. There are also likely to be lots of people with Covid19 still in hospital in three months. Against that, hospital usage may be greatly reduced by people being afraid of going there.

I am not sure I can give a meaningful opinion on that one. It may be very dependent on what sort of service you need. Any specialist diagnostic service is likely to be put back several months. Routine GP services may return quite quickly and even improve. I just don't know.

In terms of it being safe to sit in waiting rooms and things like that - I think it depends on getting the infection rate right down and keeping it down. That will depend on how eager the government is to lift restrictions. My instinct is that they are not going to be given a chance to lift them in a way that allows slipping back to high rates of infection. I suspect what happens may be determined a lot by the way things go in continental European countries that are about two weeks ahead of the UK in the process. Italy and France will have to find out how to steer a sensible course before the UK has to make similar decisions.

 

It is gratifying to see such an intelligent discussion of the COVID-19 pandemic on S4ME. If the people who are actually managing this pandemic displayed as much knowledge of the subject as the people here, I think we would be in much better shape than we are.

Meanwhile, as the data accumulates, it's possible to gradually get a better idea of where we're heading. Yesterday was another bad day in the US, with COVID-19 deaths jumping by 1321 for a total of 7392. Here are the latest historical charts from Worldometer:

​

Note that I have selected the logarithmic scale for the first chart. To the extent that that data falls along a straight line, it means that growth is proceeding at a steady exponential rate. If you put a straightedge connecting March 2nd to April 2nd, you'll see that it fits the data very well. On average, since March 2nd, the total deaths have been increasing by a factor of 10 every 10 1/3 days. This means that after three cycles - 31 days - the total number of deaths has increased by a factor of 1000. Sure enough, March 2nd had 6 deaths, while April 2nd had 6071.

For those who wonder if 6071 is really a big deal, if the line continues at its present slope, the total deaths for April 12th will be about 60,000, and the total deaths for April 23rd would be about 600,000 - far above official projections. Hopefully, the mitigation procedures will be having much more of an effect by then, and we won't get anywhere near 600,000. On the other hand, if what we do isn't working, and we do see around 600,000 or so deaths by April 23rd, the next 10-day period ending on May 3 could see total deaths rise into the millions. A factor of 10 growth resulting in total deaths of 6 million would be unlikely in the extreme, as by this time there would be many forces working to level the curve.

The numbers for the UK are even worse. In the 30-day period ending today, total deaths rose from one to 3605 - almost exactly half the total deaths as in the US. And in the latest period that I described for the US data - March 22nd to April 2nd - the rise in deaths was also tenfold, just as in the US. In the case of the UK, it was from 281 on March 22nd to 2921 on April 2nd. (Although this is 11 days instead of 10 1/3 days, the rise is actually slightly more than tenfold.) Considering that the UK has only a fifth of the population of the US, this bodes poorly for total mortality as a percentage of population in the UK. Here are the most recent charts for the UK:

​

If these numbers look outrageous to anyone, please review the video in this post. It is in the nature of exponential growth to appear to be going nowhere for a long time, and then suddenly become totally overwhelming.

I don't think so, especially since cases are currently exploding in the tropical southern part of Florida (which is generally considered to be south of a west-east line drawn from Bradenton along the south shore of Lake Okeechobee to Vero Beach). This area includes all the high population centers of southeast Florida. California has a subtropical climate from the southern border up past the San Francisco area, and the cities along the coast (including Los Angeles and San Diego) are alos experiencing a major increase in the infection rate - not a decrease.

 

Precisely.