Coronavirus - worldwide spread and control

A really shocking and sobering blog post from Dr Malcolm Kendrick on Covid-19 in care homes in the UK:

https://drmalcolmkendrick.org/2020/04/17/care-homes-and-covid19/

I was also shocked by some info from Dr Kendrick in the comments on the subject of GDPR (General Data Protection Regulation).

As someone who opted out of having my GP records passed around to all and sundry I am shocked and horrified about this. And to give it to Rory Collins of all people! The man is a **********************. I had to self-censor that bit - it would have got me in trouble.

 

I am not in favour of releasing genuinely confidential information. However, what I think we desperately need now is a day to day analysis of the most likely source of infection of the 5000 cases being identified each day. If the general public is going to systematically adhere to necessary distancing we need to be clear what really looks to be necessary.

Are most cases in the last 3 weeks family contacts for instance?
Are there cases that look to have picked up virus from public transport?
Are there cases that look likely to have picked up virus in parks?
Do shop staff appear to be a source of virus - or other shoppers?
Is virus still being spread in hospitals?
Is virus getting in to care homes via agency staff?

And so on.

It should not be beyond the wit of the British public health system to get these data in a form that does not impact on privacy.

 

I had not been keeping an eye on the number of new cases and I did not know around 5,000 new cases were still being identified each day.. and that’s with the fact we are not even massively increasing testing. Is that not really concerning? Should that number not have gone down by now? Around 4-5,000 cases a day have been identified from April 1 and is still happening, according to worldometers.

 

How can that be happening with lockdown? Or is it something more alarming? With no lockdown then for sure the cases per day would have carried on accelerating, meaning there would have been many more cases per day by now than there are. But if the lockdown were really effective then the daily numbers should presumably have been starting to reduce by now. Does this mean the lockdown is still not as effective as it needs to be? Or has the lag between cause and effect still really not fed through yet?

 

If it takes 2 weeks from exposure to being infectious enough to pass on the with a lockdown date of 23rd March there would still be, today, members of family showing up as infected having caught the virus from someone who caught it just before lockdown. but that is being generous on incubation time. One might have hoped that numbers would start dropping about a week ago.

The implication may be that R0 has been reduced to 1 but not below. That is not good enough, but better than an exponential curve.

What I think may be very confusing is that we are probably looking at hundreds of mini-epidemics in different social groups in different localities (as Pollock suggested). London numbers have fallen but East of England is just beginning an uptick. The positive aspect of this is that where there are pockets of rapid spread, local saturation may genuinely occur - as is sadly occurring in a number of care homes. The numbers from that pocket then fall off.

The Chinese curve is quite interesting in that the downturn stutters and then finally slips away quite quickly.

As Adrian says, the only way to know if we are any where near the right track is to have detailed data and it seems likely that nobody is collecting it. There seems to be paralysis in terms of rolling out that sort of tracking - which I would have thought ought already to be going on using the army or police if nobody else is available.

 

Based on the worldometers info, I can't work out why the USA figures for Deaths per Million are half those of the UK (US 118 vs UK 237). Can anyone give some plausible reasons for this? As far as I can tell the USA and the UK were and are as bad as each other in terms of preparation for a pandemic.

 

There is no "natural tendency", infection rates is always related to human behaviour and many humans will change behaviour self-isolate even if there is no law. All models as such are highly speculative.

The UK rates show it is not under control, I guess the good news is that at current rates it will take 30 years before everyone is infected. The bad news is you're going to have another 15,000 deaths even if you manage to get it under control in a few weeks.

I think the key lesson is early travel restrictions and forced quarantine of all overseas visitors - by the time there is community spread and people are demanding lockdowns, it is already too late.

 

The US are not testing enough. In fact daily tests regularly drop as equipment shortages become critical. Equipment and resources states need to do their own testing keep getting seized, the federal government has stopped being involved in testing (other than seizing resources bought by the states) and private labs haven't stepped in because there's no money to be made there. In fact states have to buy equipment in secret and do crazy schemes to prevent the federal government from seizing them.

Many states have repeated that the bottleneck is in chemicals, which only the federal government can fix.

Real cases in the US are far higher than reported. And now many states are starting to re-open, some as they are about to hit the exponential growth stage. Oh and hospitals are laying off people because they're not making money from elective surgeries and otherwise face bankruptcy.

On the other hand, the large medical insurers are still raking in massive profits so there's that.

Edit: added sources

 

Regarding spread and intersecting risk factors (poverty, age, ethnicity etc.)

U.S. county-level characteristics to inform equitable COVID-19 response

"The spread of Coronavirus Disease 2019 (COVID-19) across the United States confirms that not all Americans are equally at risk of infection, severe disease, or mortality.

A range of intersecting biological, demographic, and socioeconomic factors are likely to determine an individual's susceptibility to COVID-19. These factors vary significantly across counties in the United States, and often reflect the structural inequities in our society.

Recognizing this vast inter-county variation in risks will be critical to mounting an adequate response strategy.

Using publicly available county-specific data we identified key biological, demographic, and socioeconomic factors influencing susceptibility to COVID-19, guided by international experiences and consideration of epidemiological parameters of importance"

 

is there a place online that one can see data of positive test numbers by localised area that is regularly updated (eg by city/county), for example wherever you found out that east of England is increasing...?

Well I'm sure there is, but i'm hoping someone might be able to give me a link please? I'm sure it's up thread but i'm just not up to searching for it, or trawling through the google results when I dont know what sources are reliable.... so if anyone has a link handy please?

 

The London and east of England curves were on BBC News. There is a site that gives the cases for all individual county/borough areas that comes up on Google user Coronavirus cases by region. But it does not show curves, just the latest total.

 

I think the USA are a bit behind the UK in time frame. The USA got its cases mostly from China and then into New York maybe from business flyers. There are probably lots of states that got cases late. The UK got its spread from several thousand people returning from Italy to every corner of the country.

 

This has been circulating on social media:


So basically, in case anyone is confused about the guidelines as we enter the three-week extension to the current lockdown in the UK, herewith below is a summary of the advice, for full clarity. Any questions?.....
1. You MUST NOT leave the house for any reason, but if you have a reason, you can leave the house
2. Masks are useless at protecting you against the virus, but you may have to wear one because it can save lives, but they may not work, but they may be mandatory, but maybe not
3. Shops are closed, except those shops that are open
4. You must not go to work but you can get another job and go to work
5. You should not go to the Drs or to the hospital unless you have to go there, unless you are too poorly to go there
6. This virus can kill people, but don’t be scared of it. It can only kill those people who are vulnerable or those people who are not vulnerable people. It’s possible to contain and control it, sometimes, except that sometimes it actually leads to a global disaster
7. Gloves won't help, but they can still help so wear them sometimes or not
8. STAY HOME, but it's important to go out
9. There is no shortage of groceries in the supermarkets, but there are many things missing. Sometimes you won’t need loo rolls but you should buy some just in case you need some
10. The virus has no effect on children except those children it effects
11. Animals are not affected, but there is still a cat that tested positive in Belgium in February when no one had been tested, plus a few tigers here and there…
12. Stay 2 metres away from tigers (see point 11)
13. You will have many symptoms if your get the virus, but you can also get symptoms without getting the virus, get the virus without having any symptoms or be contagious without having symptoms, or be non contagious with symptoms...
14. To help protect yourself you should eat well and exercise, but eat whatever you have on hand as it's better not to go out shopping
15. It's important to get fresh air but don't go to parks but go for a walk. But don’t sit down, except if you are old, but not for too long or if you are pregnant or if you’re not old or pregnant but need to sit down. If you do sit down don’t eat your picnic
16. Don’t visit old people but you have to take care of the old people and bring them food and medication
17. If you are sick, you can go out when you are better but anyone else in your household can’t go out when you are better unless they need to go out
18. You can get restaurant food delivered to the house. These deliveries are safe. But groceries you bring back to your house have to be decontaminated outside for 3 hours including Pizza...
19. You can't see your older mother or grandmother, but they can take a taxi and meet an older taxi driver
20. You are safe if you maintain the safe social distance when out but you can’t go out with friends or strangers at the safe social distance
21. The virus remains active on different surfaces for two hours ... or four hours... six hours... I mean days, not hours... But it needs a damp
environment. Or a cold environment that is warm and dry... in the air, as long as the air is not plastic
22. Schools are closed so you need to home educate your children, unless you can send them to school because you’re not at home. If you are at home you can home educate your children using various portals and virtual class rooms, unless you have poor internet, or more than one child and only one computer, or you are working from home. Baking cakes can be considered maths, science or art. If you are home educating you can include household chores to be education. If you are home educating you can start drinking at 10am
23. If you are not home educating children you can also start drinking at 10am
24. The number of corona related deaths will be announced daily but we don't know how many people are infected as they are only testing those who are almost dead to find out if that's what they will die of… the people who die of corona who aren’t counted won’t be counted
25. You should stay in locked down until the virus stops infecting people but it will only stop infecting people if we all get infected so it’s important we get infected and some don’t get infected
26. You can join your neighbours for a street party and turn your music up for an outside disco and your neighbours won’t call the police. People in another street are allowed to call the police about your music.
27. No business will go under due to Coronavirus except those businesses that will have already gone under.

 

If you scroll down on this, there’s case numbers by area: https://www.theguardian.com/world/2...w-many-cases-are-there-in-my-area#maincontent

I would really Like to see even more localised areas than that, and ways it spreads, but as discussed above, that’s not available..