Coronavirus - worldwide spread and control

Taking this thread off track but with a pollution link.

I' m currently doing an essay on energy from waste.( from the energy viewpoint) There are health issues associated with this which are mitigated by the cleaning up of exhaust flues , though the spec varies .EfW ( energy from waste), should not be the growth business it is. Where introduced recycling tends to go down in volume, and the energy balance does not make any sense. It Is solely to avoid landfill.

Interestingly there are large plants near Hubei, ( and Wuhan) in Bergamo, Breschia and Milan and in London. Plants in Singapore and Sputh Korea. Thd combination of this with other contaminants may be a deadlier cocktail.
Perhaps a pollution link worthy of further investigation?

 

https://twitter.com/user/status/1248504389477662720


From the lancet offline link:

“This disease is unlike anything I have seen before. If you end up on ICU, you are potentially in real trouble. I have never seen anything like it before.” These words were written by one intensive care physician working at a London teaching hospital. As deaths accumulate, the early message that severe acute respiratory syndrome coronavirus 2 causes mostly a mild illness has been shown to be dangerously false. One in five patients develop complications and are at grave risk.

A further misunderstanding concerns age. An impression was given that only older people are at risk of serious illness. But the average age of nonsurvivors is under 70 years. Twothirds of those admitted to hospital in China were younger than 60 years. The complexity of illness in these often quite young patients is challenging to comprehend. Patients are not commonly dying, for example, from hypoxaemia. The cause of death is often cardiovascular, with highsensitivity cardiac troponin I being a more reliable marker for mortality. Thromboembolic disease, hypercytokinaemia, secondary sepsis, hypovolaemia, and renalcomplicationsareatoxiccombinationofproblems for intensivists to manage.

The number of patients admitted to intensive care units has been doubling every 2 days. Deaths are so frequent that hospitals have created emergency mortuary space, often in car parks, moving bodies at night to avoid media scrutiny.”


I don’t understand why this sort of thing isn’t reported in the media so that the public know the truth of it, and why doctors aren’t speaking about this more. How on earth can herd immunity even be considered when this is happening?

 

I hope more NHS workers speak out. Even with the threat of bullying and feeling like they need to remain united, I would have thought that more would have, since they are the ones who can see what’s happening in the hospitals, who is dying, etc. The lancet makes a good point.

“The response is now framed as a fullblown war: “we are at war against an invisible killer”, Hancock has said. War metaphors are powerful political and emotional instruments that grip public attention and are widely understood. And, in a war, there is a sense that we have to unite, to forge an unprecedented alliance, to look forward not back, to create one national effort.

But war metaphors also have dangers. They suggest there will be a simple victory or defeat. They emphasise treatment over prevention. And they encourage the view that criticising government strategy is somehow unpatriotic. The Lancet is receiving many messages from frontline health workers reporting “bullying”—bullying National Health Service (NHS) staff by threatening disciplinary action for raising concerns about workplace safety, testing, and access to personal protective equipment.

“I never thought I lived in a country where freedom of speech is discouraged”, wrote one doctor. The NHS is fortunate to have a Duty of Candour, endorsed by professional regulators: “As a doctor, nurse, or midwife, you must be open and honest with patients, colleagues, and your employers.” For those who believe now is not the moment for criticism of government policies and promises, remember the words of Li Wenliang, who died in February, aged 33 years, fighting COVID19 in China—“I think a healthy society should not have just one voice”.”

 

Right. But after they first started talking about herd immunity, coronavirus hit the UK - so they can actually see the reality now here. They will know it’s impossible to carry on with herd immunity because nothing will function for a long time and far too many people will die and suffer complications. I find it just unbelievable really that they can still hold the same viewpoint.

 

Meanwhile, I, like many PwME and other vulnerable people, will be living in total isolation until there's a vaccine (possibly never) or the UK govt doesn't just flatten the curve but eradicates the virus here, and if they're not going to do that, we're looking at years of being completely alone.

Where is the social movement that we can all pile onto, to demand this policy? Where is the giant petition? Where is the person in an influential position who is leading this?

And if none of this exists, how can we make it happen?

 

If your health care system isn't overwhelmed, as appears to have happened in Lombardy Italy, then your chances of survival are higher (lower death rate). The number of new cases in Australia looks impressively low (Australia is testing to identify those who are infectious/quarantine them). So bear in mind that this figure may reflect the fact that they have controlled the outbreak much better than others e.g. the UK. The other thing that lowers the death rate is testing i.e. since you are finding more cases, rather than just the people who are admitted to hospital - the approach in the UK. As you are aware, you need to be consider the methodology used/way data is collected.

 

I think someone has already posted the link earlier to the report with a group of experts that are speaking out publicly:

https://twitter.com/user/status/1248006240963190784


But with that, there’s another bit of recording from that video here:

https://twitter.com/user/status/1248005070567772160


“I’ve been an emergency prepared-ness planner for over 20 years. I’ve never, ever, ever, sat at the committee and discussed people dying alone. How is it possible that in the United Kingdom, a rich and affluent and a free nation, that people are dying alone Because we haven’t got PPE? This is really really distressing. We have to do something about this immediately. We can. We must”.

This Senior clinical lecturer, Dr Bharat Pankhania, also has been at various news and radio stations trying to talk about all of this.

https://twitter.com/user/status/1248251362648952836

 

I agree with you. It’s very distressing.
I find it very hard to understand that we’ve got tens of thousands of NHS workers who are seeing this every day, but they don’t seem to be leading a coordinated effort to demand a change.

I feel that the media is complicit in this - the extent of the problem is not coming out in the media, maybe little drips here and there in the Guardian or the Independent, but not the true extent of what this virus does and how govt policy has contributed to it, herd immunity, how different that is from other countries, what’s going on in hospitals, despite what Vallance/Whitty say. Not holding them to account, not really, even when deaths on a day by day basis will surpass Italy & Spain. And the press conferences are a joke. A lot of the public presumably think because they are listening to the “science” and the top advisers, that they’re trying their best.

From what I can see, there are experts speaking out - links people have posted here, but I don’t know how far it’s going to influence the govt. Some doctors speak out anonymously. there are petitions for various things. I’ve always had my doubts how much they influence govt but I do sign anyway.

(My friend from just Dubai messaged me saying “I saw the video outside st thomas on the thames and noone is wearing masks and just standing together and clapping. Are people okay?”. It’s pretty clear to people outside that lockdown isn’t being taken seriously here.)

 

My mum says my local hospital keeps coming up on the news, saying it’s one of the most affected in the country

 

Yip they'll be able to bring it home to infect vulnerable members of their families who will die --- what's not to like with this approach!

 

This (posted on Twitter by Carol Cadwalladr and reposted here by @lunarainbows) includes Anthony Costello on the panel of speakers. It's 45 minutes long and looks worth watching.

@Jonathan Edwards

https://www.youtube.com/watch?v=05-jbrHRmrs

 

45 minutes? Anyone have a summary?

 

I’m watching this. There’s no visual footage of hospitals, patients etc, it’s a panel discussion (Zoom I think). Have watched half now.

Anthony Costello says look at South Korea, China, Singapore - between 1 and 3 deaths per million of the population. In the UK, 103 deaths per million.

Talking about testing. Dr Bharat Pankania says it’s not antibody tests that’s helpful, it’s the PCR which tells you if someone’s infected, you take them out of circulation, trace their contacts etc. He says he does not see anyone he recognises at the top table - no one who is an expert in communicable diseases, who understands the logistics or organisation needed. It’s very top down, coming from one place.

Alyson is talking about protecting populations. Some places had no cases a few days ago, and now they have 3-4. This didn’t have to happen if those places had been protected and they stopped people moving around. Cordon sanitairs need to be put in place and the govt should have been doing this. Now it’s a strategy the govt must and needs to follow. (A cordon sanitaire (French pronunciation: [kɔʁdɔ̃ sanitɛʁ], French for "sanitary cordon") is the restriction of movement of people into or out of a defined geographic area, such as a community, region, or country. The term originally denoted a barrier used to stop the spread of infectious diseases.)

 

Second half

Alyson: (about the deputy chief medical officer saying that we don’t need to follow WHO as that’s for poorer countries), says: I think it’s British imperial arrogance

Bharat & Alyson both talk about the fact that we’ve decimated our public health laboratories, communicable disease control, restructured everything so there’s no longer local resilience. There will be a public enquiry But we also need to learn from WHO and other countries eg South Korea

Alyson: still making it up as we go along. Scientific advisory committee still full of behavioural scientists & maths modellers, but no communicable disease experts or public health experts (did the same thing during swine flu)

Deenan Pillay (virologist): politicians love modellers as they give some sort of certainty. Modellers didn’t even include testing / tracing in modelling due to political constraints, and yet they say they’re “following the science”. “Following the science” is speaking to a level of scientific illiteracy in our political class. We need a strategy that includes testing + labs but also all the other aspects determined by that test result.

Paul Mason (journalist): criticism is being taken as “politicising”. We know many MPs are being told by their constituents, do not politicise it.

Afua Hirsch (journalist): First, we were told it’s a great leveller. But actually it’s not hitting everyone equally. Striking how many doctors from ethnic minority backgrounds. In critical care in England NI & Wales, 1/3 in critical care are from Ethnic minority background which is 3x what we would expect if proportional representation.

Bharat: very sad. Don’t know a lot yet. Those from south Asian countries have more propensity to underlying conditions. If this is the case and it is shown, urgent action needs to be taken.

Alyson: also, it could be occupational hazards - like working in care homes etc. Don’t have PPE. We need urgent data, but PHE has not been releasing the data or situational reports. Contacts, cases by area, contact tracing, occupational status of those infected and dying, all marked “confidential”. Not in public domain.

Deenan: also looking at the ring of places around London (not central London) that have affected, like Northwick Park etc, serve very different communities than the wealthier parts of central London. Messaging on lockdown and social distancing not nuanced. In many of these communities, tradition of looking after the elderly, families together within communities.. lockdown means very very different things. Also poor people always do much worse in infectious diseases.

Anthony Costello: when I was in hospital, noticed how many were from different countries. Bus drivers, why don’t they have masks?

Care workers was also talked about, govt has no plan for care workers or for the very vulnerable residents. Many of these ethnic minorities. Plan has to be a priority if we want to not see death on a catastrophic scale.

 

My prediction is that the reality will be inescapable by July. It may become so via a number of different route but I don't think the current advisory regimen will be able to remain credible unless they change tack by then. Moreover, there will nothing to salvage in the airline business by then anyway so there will be no point in trying to carry on regardless.

 

What about in the meantime. I see an easing of restrictions in May followed by an increase in cases in June.

There will be all sorts of noise and excuses then. They may be tempted to put their heads in the sand for a while but they should eventually come to their senses. I remain to be convinced however.

 

My guess is that there will be no easing of restrictions in May. Either other countries will do it first and it will be clear how bad an idea it is or they won't in which case the government will have to explain why it is acting differently to those working in health care who by then will barely be able to drag themselves to work.

 

The Cadwalladr video gives a clear and unanimous view from people who actually know what epidemics are about.
What they say is nothing more than a third year medical student would be expected to write in a pathology exam if asked how to handle a new virus epidemic (at least when I was a student).
There is also the telling point that the mathematical modellers did not model such a policy because everyone already knew that they did not have the resources to deliver it. They still could have mobilised those resources though, as others on the panel point out.

 

I see now that Spain may be going to ease some restrictions. That is not going to look good. The new infection rate has stabilised just below peak. It would be crazy to lift restrictions at this point

 

How do we explain reports out of South Korea that recovered COVID patients are testing positive again?