Coronavirus - worldwide spread and control

We're finding out in real-time how those second and third waves happened with the Spanish flu. The worst thing about history repeating itself is watching it unfold and not being able to do anything about it. Fake news have deadly consequences. Always have, but now more than ever.

And now that it's extra important to trust in experts we also have to deal with the fact that experts and medical authorities in many countries will be telling COVID-affected people dealing with long-term illness "whatever just think happy thoughts and do some yoga and you'll be fine and if you don't well it's your fault, now go away there is no disease only negative thoughts" and I'm sure this will go swimmingly with that whole trust in experts thing.

Science is a process. This is why it's worthy of trust. If you break that process the trust is also broken.

 

I agree with this. And I also think the support isn't as big as is being portrayed, but that like with the immigrant communities, the voices of those critical aren't being seen in the media. Like the chronically ill and vulnerable elderly.

I think he's right about Sweden's history causing a lack of unity in this crisis, and also a lacking in swift and decisive political decisions. When I was at uni I read a course on social politics, and how differences between Norwegian and Swedish political traditions stem from the countries' respective history. That Norway's occupation during WWII and relatively recent indepence, compared to Sweden's "neutrality" during that time, has resulted in a more expedient way of political decisionmaking in Norway. Compared to Sweden where there's a tradition of appointing committees and start investigations that last for years before a decision is eventually made. Sweden's slow responses to the pandemic could partly be seen in this light, I believe. We are not used to dealing with urgencies.

Personally I think there's a lot of cognitive dissonance going on now, when the high death rates doesn't seem to correspond with higher levels of immunity. A new study from the Swedish Public Health Authority showed only about 7% of people in Region Stockholm had antibodies. (they talk about the study in the podcast, link below. No details have been released yet) So all these lives being 'sacrificed' and we're still very far from 'herd immunity'. Not what was expected, so what do we do now? Either you challenge if what you're currently doing really is working, or you cling to it even harder, desperate to defend your choices. Tegnell seems to be doing the latter, and he often argues that getting infected is inevitable, so these deaths would have occurred sooner or later anyway. But what if he's wrong?

I listened to an interesting podcast from SvD today with two professors in mathematics and political science, where they discussed this study and it's implications, among other things. They said it's more likely that the Swedish strategy will perhaps change slightly, in a sneaky way, without ever acknowledging that the strategy has changed per se. They also discussed the lack of transparency about what the strategy really is and what the underlying assumptions behind are.

https://www.svd.se/immunitetsstudien-och-tegnells-paradox

"Today's episode of the Editorial Board discusses the new immunity study that came from the Public Health Authority yesterday.

More than 1,000 people had been tested and immunity in Stockholm was estimated at 7.3 percent last week in April. In most people's ears, that sounded much lower than the figures that the Public Health Authority and mathematics professor Tom Britton had told Stockholm just a few weeks ago.

When the results of the study became known, their stories suddenly drifted apart. While Tom Britton in Aktuellt said that both he and the Public Health Authority have something wrong in their models and that they have to go back to the drawing board and see why it doesn't make sense, Anders Tegnell said at his press conference that the 7.3 percent was a little low but that they were still within the scope of the modeling that had previously been done at the authority."

Since then, the debate has raged, in social media and on debate sites. The reason why it plays such a big role, is that you have hoped that immunity will slow down the spread of infection. This is an important building block in the Swedish strategy."

 

Since then, the debate has raged, in social media and on debate sites. The reason why it plays such a big role, is that you have hoped that immunity will slow down the spread of infection. This is an important building block in the Swedish strategy."

There is something vey strange here because of course herd immunity cannot slow down the epidemic, at least not until it is mostly finished. It is a bit like putting the avalanche barriers below the village rather than above it.

An error in modelling the expected infection rate is a slightly less gross stupidity but it is still pretty extraordinary since the 7% figure is very much in line with what someone with common sense would have predicted on the basis of reading the newspapers reporting from China. You do not need modelling if you actually have results from this outbreak.

I sense a certain sort of arrogance within a science community - similar to that in the UK. It seems that people who do not understand very basic common sense concepts have become the figures of authority in science. And it is no surprise to me since I have seen it happen gradually over decades. It reminds me of The Rise and Fall of Modern Medicine by James LeFanu. I wonder if the existence of the Karolinska (an outstanding institution over many years) and the association with Nobel are relevant. But then one could perhaps expect the same for the Max Planck Institutes but they are more associated with physics and engineering I think.

No doubt politics is also very relevant but what I keep coming back to is how extraordinary it is that scientists should even entertain these ideas when the reality was sitting infant of them.

 

Another thing that has dawned on me is just to what extent deaths in the UK have been Ade worse by health care policy rather than better. My niece who is a casualty based GP got the virus right at the beginning - she was not wearing PPE when she saw a case who had come in not through the `Covid call system but just turned up.

I suspect that a very significant proportion of cases now stem from hospital spread or the care home spread that may also be largely hospital derived or health care professional derived.

Forty years ago none of this would have happened because we had fever hospitals. People with infections went to completely different places from those with other illnesses - for obvious reasons. And we still have isolation units - used for things like Ebola - but they are built within ordinary hospital complexes and if they expand destroy the whole idea of isolation.

I wonder if Germany still has fever hospitals? I wonder if South Korea had them or built them after MERS?
It is also interesting that Africa seems to have had much fewer cases and deaths than expected. Maybe comfortable Westernised health care systems are part of the problem.

 

Terrible that this is still happening months into our epidemic:

https://www.bmj.com/content/369/bmj.m2013

Covid-19: Doctors sound alarm over hospital transmissions


Doctors have told The BMJ they are deeply concerned at the number of patients becoming infected with covid-19 in NHS hospitals in England and have called for more stringent infection control measures to combat its spread.

They cite limited capacity for testing and retesting as a barrier to keeping covid and non-covid patients separated in so called “green” and “red” zones. There also have concerns about the availability of side rooms and cubicles to keep patients separate and believe that poor ventilation in areas other than intensive care units may be contributing to nosocomial infections.

Jan Coebergh, a consultant neurologist in Surrey who has worked on covid wards at several sites since the outbreak began, told The BMJ that he had seen distressing cases of patients becoming infected with the virus from other patients while in hospital and who were likely to die as a result.

No official data
Currently there are no official figures on numbers of patients contracting covid-19 in hospitals. However, the Guardian newspaper reported that the proportion of covid-19 infections acquired in hospital was between 10% and 20%, although NHS sources told the paper that the figures were skewed by poor infection control procedures at one single trust and that the true rate was lower, at around 5% to 7%.2

 

They may also be skewed tenfold the other way by the fact that so few cases have ever been tested unless they are dying in hospital.
My niece never got a test despite being a frontline doctor - it wasn't available.

 

This idea occurred to me, also. I was amazed that they put the Nightingale Hospital in London on pause, rather than using it to move infected patients out of the other hospitals. It just makes sense to isolate them properly. Plus, it could then open up the NHS to at least some of its normal working, rather than letting the queues continue to build for appointments and treatments.

 

I would imagine this has to do with the 'internal market'. Intensive care physicians are paid by specific trusts. There are none spare to staff the Nightingale. You couldn't have a fever hospital trust because for decades it would have no income. Then...

 

I had to go to a major hospital 2 wks ago, for an urgent but minor surgery, and I was staggered, just astonished, to see many many NHS staff milling about not observing any kind of distancing, only a tiny fraction of whom were wearing masks. I saw probably 200people that day & i'd estimate only maybe 10-15 people with masks on despite being in close range with other people, & other than my surgeon & 2 nurses wearing surgical masks, I counted only 2 other health care staff wearing them.

While we were waiting in the large foyer/main entrance area - waiting while my carer argued that the staff at the clinic had told us that she must take me up & come in with me, rather than sending her away & getting a porter to take me up - I counted roughly 10 physiotherapists all sitting in a circle obviously having a meeting over coffee, with their chairs all pushed together as close as they could get. No masks. There were nurses & orderlies & security staff all standing close to one another talking, without masks, walking & talking & laughing together in groups of 2,3,4, just 'as normal'.... it's like they had all completely given up trying to stop the spread.

The only differences i could see from pre-covid-era hospital visits, were less people overall, & that a group of 3 people standing less than 2 ft apart from each other & trying to come closer to us, carer wheeled me back & away at one point, were standing arguing with us about whether someone who obviously needed a carer, could be allowed to have her take her up, the clinic had instructed, or whether I would have to be dumped on a porter because 'no unnecessary visitors' allowed... despite the fact we were both wearing properly fitted N95 masks! (which I had in cupboard from 2yrs ago mould remediation emergency).

The only hand sanitiser I saw was at the parking pay point.

I felt seriously at risk of infection in that place. It's been 11 days now so am hopeful that our masks & extreme hygiene vigilance protected us. But I wouldn't be at all surprised if a main route of transmission was in hospitals, I cant see how it could possibly be avoided with their ridiculously lax attitude.

 

But, surely they were there and being paid whilst patients were being taken there? Could not that same system be used to continue caring for patients there, since they spent all that money setting them up?

 

Briefly it seems staff from trusts were drafted in to do extra hours. But I suspect that rapidly ran out of steam and the hassle of billing or deciding who should pay probably contributed to that. otherwise, as others have pointed out, the logical thing to do would be to second staff to the Nightingales for a period of months and transfer all suspected Covid cases there. The impression is that whoever is co-ordinating has no concept of how to manage effective medical care. Which is not surprising if their main job over the last couple of decades has been to avoid spending any money on medical care wherever possible.

 

https://twitter.com/user/status/1264694805101076480

https://twitter.com/user/status/1264696014583128064

 

@JemPD I am absolutely horrified

Thank heavens you both were wearing those N95 masks. I absolutely love your carer. She sounds like a marvelous person.

 

An interesting report on how coronavirus spread through a hospital in South Africa from the first sufferer who went through their doors.

Study tells ‘remarkable story’ about COVID-19’s deadly rampage through a South African hospital

And the report the above article was based on.

Report into a nosocomial outbreak of coronavirus disease 2019 (COVID‐19) at Netcare St. Augustine’s Hospital

https://www.krisp.org.za/manuscript...tbreakInvestigation_FinalReport_15may2020.pdf

Sorry, for some reason I couldn't make the second one link properly.

 

Somerset hospital closed to new patients to halt spread of coronavirus

https://www.theguardian.com/world/2...l-closed-new-patients-halt-spread-coronavirus

 

Surprised not to have heard anything about this (perhaps the Dominic Cummings thing has driven everything else off the UK news):

https://twitter.com/user/status/1265232235705270272

 

Sikora seems always seems to have something convenient to say for the establishment.
I cannot see that models are of any use. What will happen will depend entirely on how people behave, and that looks to be significantly more up in the air the last week. There may not be a second wave in the sense that we are still in the first wave and it will just flip upwards again. If airports open I suspect it will take off like a jump jet.
I wonder if Sikora stops to ask himself whether his tweets are helpful or not. Judging by the hordes of people milling around yesterday everyone thinks it is all over.

 

Other countries eg Greece could potentially suppress a second wave because they have a tracing system in place combined with very few cases now. Countries like New Zealand are being careful by easing lockdown slowly with a contact tracing system in place. Lots of countries now have very low numbers of cases and I imagine many will suppress the virus if they are careful with people coming in.

But there are countries like the U.K., where I think things are going to get worse. Lockdown is from what I can see, very much over, even with thousands of new cases a day. And officially schools opening and all shops opening very soon. This is without the proper tracing in place and nothing linked to local communities or primary care, and with hardly any local data. It is just herd immunity all over again.

Oh, and on the govts page they’ve even stopped recording the number of people who are being tested - it says “unavailable” for 3 days now..