Coronavirus - worldwide spread and control

https://www.bbc.co.uk/news/stories-...ews/uk&link_location=live-reporting-story

 

What a week over here. I suppose this is the exact wrong time for this all to boil over into nationwide demonstrations. On the other hand, I'm guessing the protests and rioting will have little impact on Covid in the US since we have been destined to default to the Sweden approach anyway.

 

https://www.bmj.com/content/369/bmj...RxFu6qgRuInSWjRthKOosPJF3Kl_aNxw-QU9_xp7xKQ7c

Contact tracing.... not very surprising I suppose, but concerning nevertheless

 

An important factor with this trial off contact tracing is that it was totally unofficial. So people would not necessarily be expected to adhere to advice. What I think it usefully shows is that you can establish how many peopler adhering - which is all you need if you have an official process with teeth. If employers tell people not to quarantine then they get fined or their franchises removed - easy.

 

I think in the end all countries will have to realise the Swedish approach can’t work in the long term.. especially when things start to open back up properly..

just some countries will come to it a lot later, and with lots of loss of life.

 

With the contact tracing. ONS keeps saying ~8000 new cases a day, yet only picking up 1500-2000 cases on tests. So the rest won’t be traced. My mum told me what was said in the press conference. They seem to be focusing on the R number not being above 1. So it’s all perfectly fine as long as it’s 0.9. (I don’t believe though that the last weeks events & the people all being out and about hasn’t affected that R). But even with that R number so many people will keep dying every day. I wonder how much longer they’re going to continue the mitigation strategy despite pretty much every other country in Europe not doing this?

Isn’t it better to get the R to something like 0.2 or 0.1, then it will just die down quicker. What is the actual point of keeping is at 0.9 and telling us if we “follow the rules” it won’t tip the balance. They don’t seem to have any intent to bring case numbers down any further? What do they think is going to happen in the care homes, or in hospitals and to vulnerable sections of society? Let alone the backlog of hospital admissions for other things.

Maybe if all other European countries + New Zealand + Australia did this:


https://uk.finance.yahoo.com/news/coronavirus-spain-bans-british-holidays-135535763.html?

Spanish health minister bans British holidaymakers 'until UK's coronavirus situation improves

Maybe then they’ll do something about it?

 

The low rate of case identification is a different issue from contact tracing (it is case tracing if you like). You improve case tracing by better population surveillance through GPs, public health personnel, police, army, whatever takes. Contact tracing then follows after interviewing all the cases. It is routine for notifiable diseases. The problem in Sheffield seemed to be that the contacts were not keen to isolate. I don['t know if they set out to optimise case identification rates.

 

Yes I see - how would that work in the U.K. specifically? To identify all the cases? Has Matt Hancock said anything about having set up / setting up such a surveillance programme to find cases? I don’t remember him saying anything about it.

But would this still require a positive test or can this just be done using symptoms. I would think symptoms & suspected COVID is better due to the high rate of false negatives (guardian article earlier in the thread). But then how do you identify asymptomatic people - wouldn’t you need tests for that - the low number of tests done won’t be helping with that?

 

As so many people appear to be asymptomatic, it would be difficult to achieve without a massive testing effort – far beyond the capacity available at the moment. A home kit similar to a pregnancy test would make it a lot easier, though it would presumably be hugely expensive to offer mass testing. But health and care settings do seem to be particularly effective at spreading the virus, so at the very least we should probably be testing all staff and all patients/residents regularly.

One of the strategies I've heard about for identifying localised clusters is testing of sewage, as the virus is shed fairly prolifically in faeces. However, that's at community level, not individual cases, and could only show up hotspots at best. It might be useful in tracking the progress of any flare-ups that occur once schools open and more people start returning to work, though?

 

I think there is too much working against the possibility of any other approach here. We will be stuck with Covid19 until there is an effective vaccine or if 'natural' heard immunity materializes.

Extended restrictions are already unacceptable to a substantial segment of the population; meanwhile, a critical mass of federal politicians have made it clear that they will not continue to spend money to keep non-essential workers and small businesses solvent. So people will have little choice but to call for going back to work to get a paycheck.

It is said that us Americans will do the right thing... once we have exhausted all other options. In this case i suspect the time-sensitive nature of the outbreak has caused us to miss all the best boats. I believe an effective lockdown was politically possible in Jan/Feb but is has not been since, and never will be. As such I doubt it is in the public interest to try at a later date.

The best we can hope for is good results on an individual basis at the state, county, and municipal level.

 

Yes, and that’s why I’m concerned that we are only picking up 1500-2000 cases through testing even though there are 8000 cases. Maybe we can say that a proportion of the rest of that 6500 can be identified through “case finding” as mentioned above, although I’m not convinced that the govt seems to have any plan for that, but what happens to the rest? We need much more widespread testing to be able to pick up them up. Especially asymptomatic people too. I agree with you I think widespread routine testing in hospitals and care facilities is something often mentioned by the scientists but it doesn’t look the govt is interested.

And if there are any people that aren’t being picked up, either through case finding or testing, then those people won’t be flagged to the tracing teams - and their contacts won’t be traced. Surely we are looking at a massive outbreak if they don’t sort it out. They’ve been saying “ramping up” testing, don’t see evidence of that.

Edited to add a word

 

There isn't reasonable evidence that there are any "asymptomatic" cases at all. I suggest such assumptions based on poor test specificity.

There can be pre-symptomatic cases if tested right before the patient realises they are developing symptoms. Similarly, survey questions can be limited (eg focused on fever) and people can lie about their symptoms on questionnaires for various reasons.

If someone wishes to claim that there are 8000 total cases per day, yet only 1500-2000 official cases, it necessarily means many people are hiding out in their homes and not being tested. Which begs the question as to why they aren't being tested (lack of access, perceived discomfort, difficulty travelling, reluctance to isolate etc. - are these sufficient reasons to lead to only a quarter of cases are being tested?)

 

From the University of Oxford (29th May):

Iran and Nicaragua have the worst score (0.2) in terms of readiness to exit lockdown. Next worst are the UK, Moldova, Afghanistan, Benin, South Sudan, Kyrgyz Republic, Syria and Algeria with a score of 0.3. (Good to know that the UK is on a par with some of the poorest and most war-torn countries in the world)

At the other end of the scale, doing well and coming in at second place (with a score of 0.9) are the following countries: Cypress, Rwanda, Taiwan, Seychelles, Gambia, Trinidad and Tobago, Spain, Vietnam, Brunei and Australia.

But at the top of the table and coming in at first place is New Zealand. They are the only country to achieve full marks with a score of 1. Well done New Zealand!

https://www.bsg.ox.ac.uk/sites/default/files/2020-06/Lockdown Rollback Checklist v3.0.pdf

 

From The Guardian:

https://www.theguardian.com/world/2...ld-double-if-2-metre-rule-reduced-study-finds

Paper here:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext

 

Sir David Norgrove [UK Statistics Authority] response to Matt Hancock regarding the Government’s COVID-19 testing data

https://www.statisticsauthority.gov...arding-the-governments-covid-19-testing-data/

 

Case identification should work the way it normally does using public health personnel- the way it worked in Brighton originally for Covid19 and the way it worked Korea. Hancock's planner case identifications the app that never got going. The first stage of operation was people volunteering that they felt unwell. That seems very unlikely to be reliable. The second stage- capturing contacts by Bluetooth, was clever but also full of flaws.

The basic method starts with identifying a population at risk. For TB in Barnet that is a school. The whole school, teachers and pupils, are personally screened. For the initial outbreak in Brtighton all likely routes were screened and all contacts were identified and the spread was halted. The system is known and it is there. The only problem is that now the population at risk is 60 million UK residents. But all you need to do is recruit about 50,000 intelligent people with a biology background to follow procedures. Senior medical students might be a good group to use because their studies have been interrupted anyway. That would probably provide several thousand for starters.

There is much too much emphasis and reliance tests. We do not really need tests. I suspect that there are rather few people feeling feverish at present who not have Covid19. Normally one knows if there is 'a bug around' any virus that causes enough trouble to put people off work becomes part of daily conversation. With my daughter as a teacher we had strings of infections in the house but only about every two months and I suspect there are few if any going around now with lockdown.

So it is simple - assume that anyone feverish has Covid19. If there are pressing reasons to be able to exclude Covid19 so that someone can get back to work then test. But trying to pick up cases by testing is a complete waste of time. It will only pick up those in a short presymptomatic window and a negative test today does not mean you do not need one tomorrow. People would have to be tested daily.

Yes you will miss some asymptomatic cases but I suspect these are no more than quarter at most. The discrepancy between 1500 and 8000 is not asymptomatic cases. Its is that people have not been told to get tested if they feel ill - just isolate, which would be reasonable advice if everything else was in place.
Missing some cases does not matter because you can pick up the trail again next time theirs is passed on. Once you get to grips with trails you can work out how they extend both back and forward. Experience with tracing when it was up and running indicated that it worked - trails were terminated.

What needs to happen is for there to bean intelligent biologically trained person allocated to each cohort of 500-1000 people in the country. They need to be given the resources to keep that cohort free of virus by case identification, contact tracing and policing of quarantine however seems fit for the circumstances. For rural populations it is likely to be very different from metropolitan ones.

I have recently been in the middle of a TB tracing exercise. It took too long because of inadequate resources but it got sorted. An obvious feature of practice is that those involved do anything they think might improve their information base. There are rules for the basic plan of action but on top of that all sorts of double checks and sideways investigations are set up on the basis that they might clarify. An outsourced commercial service will not do that.

My prediction remains that infection rates will climb in June and that by July it will finally be accepted that things have to be done properly. I am beginning to think it may be nearer August.

 

Merged thread

Article : Lockdown Lunacy: the thinking person's guide

Discussion in 'Epidemics (including Covid-19)' started by Arnie Pye, 35 minutes ago.


This is a blog post - a very long one.

Author : J. B. Handley

Link : https://jbhandleyblog.com/home/lockdownlunacy

 

The blogger does not understand the basics. Lockdown was essential only because adequate procedures, which would have included closing all airports and gathering venues, were not put in place when it should. But once the infection rate was high lockdown was essential because originally appropriate policy could not have coped.

The blogger gets lots of things wrong. Asymptomatic cases can spread the virus. Outdoor gatherings are very likely to spread virus. I don't know what Farr's law is.

The irony is that it is the same people who are anti-restrictions who are most cross about all the economic damage that has occurred because restrictions were used too late. This is the unthinking person's guide.