Coronavirus - worldwide spread and control

Editorials
The UK’s public health response to covid-19
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1932 (Published 15 May 2020)

https://www.bmj.com/content/369/bmj.m1932

1. Gabriel Scally, visiting professor of public health1,
2. Bobbie Jacobson, senior associate2,
3. Kamran Abbasi, executive editor3

I haven’t read all of it but looks like a really good article so far:

“Membership of SAGE and its national committees reflects England’s marginalised public health infrastructure. Reorganisation of public health in England, largely resulting from the Health and Social Care Act 2012, led to a critical loss of senior posts and staff.22 The Health Protection Agency, regional public health teams, and regional public health observatories were abolished, and the remnants incorporated into a slimmed down Department of Health agency, Public Health England. This new agency lacks an independent voice and clear public health leadership. England’s chief medical officer is no longer seen as the leader of public health. With these reforms, England’s new public health system was born critically flawed.

By the start of the coronavirus pandemic only one of the UK’s four territories had a trained public health physician as its chief medical officer. At a local level in England, many public health responsibilities were sensibly transferred back to local authorities with the 2012 act. But since then, close to £1bn (€1.1bn; $1.2bn) has been cut from public health budgets and the position made worse by cuts to other local authority services such as environmental health.2324

Public health approach
The UK government’s decimation of public health during years of austerity, and its impact on vulnerable groups, is for a public inquiry to investigate, although any inquiry report will be hollow without legislative change. The system failings are being exposed brutally by covid-19. For now, the focus must be on a strategy to minimise harm from ill advised relaxation of physical distancing in ways that will trigger further epidemic spikes with prospects of a vaccine or treatment still distant.

Firstly, SAGE must exclude political advisers and recruit more public health experts. Secondly, a clear population strategy based on case finding, testing, contact tracing, and isolation is required for each of the four nations to inform and justify future decisions about how the lockdown can be safely relaxed. The plans for case finding, testing, and community contact tracing must be adequately resourced, decentralised, and led by local public health teams who know their communities and the nature of the outbreaks in their localities. Public Health England and the NHS must fully support these plans. And implementation of testing, data monitoring, and reporting must be optimised from all sources: hospital, primary, and social care.

In time, findings from the first population surveillance study will help effective targeting.25Meaningless political soundbites promising to recruit 18 000 contact tracers, test 200 000 people a day, or invest in unjustified contact tracing apps, divert focus and could lead to more deaths.26 These headline grabbing schemes should be replaced by locality led strategies rooted in communicable disease control.“

 

Yes, but the term “shielding” and “cocooning” has only ever come into play in countries which didn’t go for a strong elimination strategy. So staying at home, because you feel more at risk, isn’t called “shielding” in other countries. I don’t know what people do in China or South Korea but it doesn’t look like the elderly or vulnerable had a specific policy or were mandated to stay at home (or even if that many chose to), while others went about close to normal.

When they had lockdown, they used lockdown for the entire population- not for certain sections of the population. When they needed tracing or testing, again they used it for the whole population. Possibly some, but I’m sure not all, elderly and/or chronically ill people decided to stay at home at times when the govt didn’t mandate it as a form of lockdown - but that’s not been called shielding. “Shielding“ and “cocooning“ seems to be very much a western concept and has been used in a specific context - it’s this policy that Prof Sridhar isn’t keen on.

 

South Korea never fully locked down as their test trace and isolate policy did not require it.
Harder to implement when cases are at our level, but not an excuse not to do it.
Only this will open the economy up.

Sadly this is lost on many people.

 

Yes, Now it’s too late in a lot of the country, we don’t have much choice at all except to stay put. Prof Devi Sridhar is advising the Scottish govt, and if they move quickly, and set up a good testing and tracing system, while keeping lockdown for longer, they could potentially get into a better situation soon - I think perhaps that’s her hope.

I found this interesting from the article which is relevant:

“Professor Sridhar would like to see a policy which gives the elderly or the supposedly vulnerable a greater say in deciding their fate.

“We have to listen to people who want to make an informed choice,” she said. “The thing we are really missing and which I think could be transformative is local-level data. If people knew in their neighbourhood, whether in Glasgow or in Edinburgh, or if they are in a rural area, what the rates of transmission were, that would help.

“You could have some kind of rating, where red means you have active community transmission, green means very few cases, or transmission is almost non-existent. Then I think people could make choices about how much they want to circulate. If you know transmission is high you will be more cautious, if it’s just a handful then it’s OK.””

And this way - it wouldn’t be a blanket “shielding” policy. This red, green etc policy is similar to something China has as well. But for this to happen, so much needs to be change, as that BMJ article above talks about. It is very frustrating that we don’t already have local data and tracing, cordon sanitaires to protect areas that have little or no transmission from areas that have lots of transmission, local decisions...

 

Tweet and link within tweet

https://twitter.com/user/status/1261654674123509762



https://davidalton.net/2020/05/16/t...urbing-reading/amp/?__twitter_impression=true

 

This is interesting given that the main argument against lockdown is an economic one. At least in Scandianavian culture it may be a lot less relevant than commonly thought.

My take:

Lockdown requirements don't make much difference to most people's behaviour, they just stay home anyway because it's the sensible thing to do, rules or no rules, and consequently spend less.

Lockdown requirements do make a difference to a few people's behaviour, if allowed to they go out if they want to or feel they need to. As a result there was a little bit of extra spending going on in Sweden - and a lot of extra virus-spreading.

From: Pandemic, Shutdown and Consumer Spending: Lessons from Scandinavian Policy Responses to COVID-19
https://arxiv.org/pdf/2005.04630.pdf

 

Opinion piece in Svenska Dagbladet about Sweden being left out when other Nordic and European countries are starting to open their borders. The Swedish Foreign Minister is frustrated and claims Sweden's strategy has been misunderstood.


https://www.svd.se/nar-europa-oppnar-granser-ligger-sverige-daligt-till

"When Europe opens borders, Sweden is poorly positioned
The Nordic neighboring countries are considering discriminating against Sweden when borders around Europe begin to re-open. It's no wonder. High death rates and a shoddy strategy discourage."

"In Denmark several parties wants to open to Germany and Norway, but not to Sweden. Intensive negotiations are ongoing and our Nordic Minister Anna Hallberg tells Sydsvenskan that it would be unfortunate if this would happen. Unfortunate, yes. But not a coincidence. Finland has also opened up for Sweden to be treated differently. What the countries that open to each other have in common is a confidence in the other country's corona strategy. Ann Linde is frustrated: "Me and my colleagues have been very careful in saying that one should discriminate against various countries when trying to open now." But Sweden has nothing to oppose from a legal standpoint. "

" Internal borders should be opened between countries with the same epidemiological situation. It is said that it should be done in a non-discriminatory way, that is, if one country opens to another with a certain spread of infection, it should be opened to everyone with a corresponding situation .

In practice, it could mean that Denmark can open to Germany before opening to Sweden, unless we can credibly show that we have the same control over the infection. But our death tolls are causing headlines all over the world and give reasons for keeping closed. Yesterday, Sweden ranked 8th on Worldometer's list of the most deaths per million inhabitants in the world. 365 people per million, dead in Covid-19. Denmark was ranked 24th with 94 dead per million inhabitants. Germany came close in place 23."

" The Swedish corona strategy has been so unclear and fuzzy on the edges that our Foreign Minister must begin her negotiations with convincing the outside world that we are not at all investing in herd immunity and that we certainly care about keeping the spread of infection down just like other countries. Even if we accept the idea that this is a communication problem - that the outside world has only gotten our strategy backwards- that in itself is a major failure.

In the short term, the government has managed to avoid major interferences with individual freedom, and been proud of that. But the gains might be lost if it turns out that our reputation has become so damaged and our death tolls so high that we are shut out when the rest of Europe opens again."

 

New Times article

https://www.thetimes.co.uk/article/...-scientists-picked-the-wrong-remedy-nmk8lsrr7

Coronavirus: fixated on the flu and shrouded in secrecy, Britain’s scientists picked the wrong remedy

How the U.K. response was based on flu
Interestingly, mentions the code that prof Neil Ferguson released and they say that it had different outputs when run on different computers!

“The history is revealing. UK thinking was shaped by the Asian and Hong Kong flu pandemics of 1957 and 1968. Sars and Mers — both coronaviruses — barely registered. Exercise Cygnus, a simulation carried out in 2016, was based on flu. In early 2020 the UK was still preparing for pandemic flu, stockpiling Tamiflu and Relenza. Even as community transmission of Covid-19 was detected, the recommended protective equipment was in line with flu. When an updated document on school closures was submitted in February 2020, it said: “For the purpose of this paper, we assumed that children have a role in transmission similar to that of influenza.”

Looking back on the seminal press conferences of early March, you can see flu hovering like an apparition. The logic of “Contain, delay, research, mitigate” is based on flu. The trade-off that dominated UK thinking — namely, the balance between suppressing the first wave and reducing susceptibility to a second — assumed that containment was not feasible. It was the prism of flu — not evidence emerging from Asia — that led Chris Whitty, the chief medical officer, to assert on March 12 that containment was pointless. It is why Jennie Harries, his deputy, said on the same day that community testing was “not appropriate”. It is why there was so little urgency to build testing capacity in that crucial window.

In a fine analysis last week, the historian Sir Lawrence Freedman pointed out that UK policy was based on a “mature conceptual framework”. But the problem is that the framework had matured through a covert process of conceptual narrowing, and was shrouded in secrecy. Many scientists disagreed with the cessation of community testing, but they couldn’t look at the reasoning because it was confidential. Experts were also surprised when the Imperial model was finally published, a program with 13-year-old code. A group at Edinburgh University found that the model gave different outputs when fed the same inputs, and different results when run on different computers.”

 

A good infographic.
Bad news for Sweden, the U.K., and others. But many other countries are doing really well.

https://twitter.com/user/status/1262212738190848000


https://www.endcoronavirus.org/

 

Yes - he is also the founding president of the New England Complex Systems Institute - which produced an analysis paper about the Imperial model, which we talked about on this thread earlier, - how they missed out modelling contact tracing and testing, ignored super spreader events, etc:

https://necsi.edu/review-of-ferguson-et-al-impact-of-non-pharmaceutical-interventions?rq=Imperial

 

On worldometer, the UK, on deaths per million of population, is on track for a bronze medal in the 'how to handle a pandemic as badly as possible' olympics.

https://www.worldometers.info/coronavirus/?utm_campaign=homeAdUOA?Si

Only Spain and Italy are above us, on official figures (and there is every reason to doubt these in the case of the UK).

The US, and Brazil, are not in the same league as us, their performance in killing off their own populations through incompetence is quite frankly underwhelming, when compared to the results achieved by the UK.

It's really saying something when our Government is even less competent, than the US administration.

Both Italy, and Spain to some extent, have the excuse that they got caught off guard, and overwhelmed, but what excuse do we have?

We knew it was coming, even to the extent of saying how many weeks behind various countries we were. Our health system was not overwhelmed so, we are told, that no one in the UK went untreated and died, for lack of staff or respirators.

Best scientific advice my dodgy right foot.

 

Here’s the page for looking at countries from outside of Europe as well:

https://www.endcoronavirus.org/countries

 

I thought it ‘interesting’ that a Sydney Aged Care facility is spending AU $21,000 a day to provide Personal Protective Equipment during a current outbreak.

https://www.google.com.au/amp/s/amp...ing-and-equipment-crises-20200515-p54tbm.html

 

Good news, although there are still issues with the testing and getting results itself (bbc says as much in the article), & it’s still being done as a centralised system:

Coronavirus: All over-fives in UK now eligible for test

https://www.bbc.co.uk/news/amp/uk-52713127?