Coronavirus - worldwide spread and control

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Just a little real life illustration:

My daughter has caught ‘something’, and is in day 3 social isolation in her student flat. 7 other people live there. Of course she hasn’t been tested.

So far it seems like a mild cold with predominately nasal symptoms and what may have been a low temperature of on the first morning. She’s using an ear thermometer which I don’t entirely trust.

Today she has developed a hoarse voice and a bit of a cough which she says is producing a little phlegm. She’s asthmatic, and still slightly symptomatic from a cold last month. Let’s hope it’s that!

So what is going on? All we can do is wait and see. It’s stressful!

Testing and isolation period recommendations are inadequate. She was advised to isolate for 7 days as per NHS111 advice. The fact she is isolating at all is due to us being more cautious than official UK advice re her symptoms, which I find alarming. We’re discussing extending beyond the NHS guidelines now that she is coping better with her anxiety.

Fortunately she has a kettle, a stash of easy food and her own bathroom and is not leaving her room. Her boyfriend collected her prescription meds and a bit more shopping for her.

Her flat mates are going here there and everywhere, not isolating for 14 days as per the UK advice. Most intend leaving for family homes this week ( including the first year medical and dental students). Most of them aren’t following the advice to self isolate.

Last night one of the flat mates (in spite of everyone else’s protests) had a little party in the flat until one in the morning.

Similar scenarios will be being played out across campuses in the UK, as many students are still on campus.

There’s so much wrong with this scenario.

I can’t say what I really think as I would probably be moderated.
 
Lucibee said:
We really don't know yet whether that is the case. On TWiV this week they seemed to think otherwise, and it was possible that immunity could wane quite quickly - but I guess only time will tell.
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I agree we do not have evidence, so do not know, but I still think we can be 99% sure on the basis of what we know of how viral infection and recovery works. The only real exception I am aware of is the norovirus group which infects gut mucosa and gut immunity is importantly different from other domains.
 
Simon M said:
The big problem is that the government was messing around the several weeks and, as a result, the NHS is likely to be overwhelmed pretty soon, though will hopefully gain back control.
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The NHS is already overwhelmed. I hope it gets back in control but I think there is a real chance that medical professionals will be so pissed off and frightened that they will walk out, as the teachers did this week in very large numbers. There was no communal decision to down tools. People just decided for themselves. The 'behavioural' advisors seem to have got this very wrong.

I also think the figures from Italy may suggest that once you get above a certain rate of spreading the illness becomes much more dangerous. It may be worth remembering that the real problem with plague is that when transmission rates get high it converts from bubonic to pneumonic form and becomes far more dangerous.

But again, the good news is that with proper isolation the situation remains reversible tomorrow if people take it seriously.
 
Jonathan Edwards said:
I thought Ioannidis was woolly and ill-informed
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I thought he did make a good point that we don't know the CFR or actual spread of the virus. Someone should really test a representative sample of the general population.

It could be that a lot more people have the virus but don't end up having significant symptoms and so don't get picked up. That's crucial to know what the consequences are if the virus were to spread to, say, 60% of the general population. I assume that's the question everyone wants answered.

He does write: "We don’t know if we are failing to capture infections by a factor of three or 300." Hmmm..., I think we do know we're not off by a factor of 300 and that the virus isn't as banal as he sketches it to be. Hospitals in Lombardy wouldn't be flooded with patients if it was. This doesn't happen with the flu. I would suggest watching the news once in a while instead of only looking at data in scientific publications.
 
Jonathan Edwards said:
I interpreted this as indicating that numbers were rising in new areas where lockdown was not yet being teen seriously. From what I had heard the regions that have been in lock down for a while have greatly reduced cases. But this may be wrong.
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That could well be the case. I didn't check localised numbers, not even sure if this is available.
It's hard to remember what happened when but Italy has only been in lockdown since 9th Mar.
 
Richard Horton writing in the Guardian, https://www.theguardian.com/commentisfree/2020/mar/18/coronavirus-uk-expert-advice-wrong
Something has gone badly wrong in the way the UK has handled Covid-19. I know Chris Whitty, the chief medical officer, and Patrick Vallance. I have the utmost respect for both. They have had the services of some of the most talented researchers in the world to draw on. But somehow there was a collective failure among politicians and perhaps even government experts to recognise the signals that Chinese and Italian scientists were sending. We had the opportunity and the time to learn from the experience of other countries. For reasons that are not entirely clear, the UK missed those signals. We missed those opportunities.

In due time, there must be a reckoning. I sat with the director general of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, in Geneva in February. He was in despair. Tedros had been criticised for not calling a public health emergency of international concern sooner. But when he did and when he asked for the modest sum of $675m to help the WHO combat the growing global pandemic his pleas were ignored.

The UK is now taking the right actions to defeat this new epidemic. But we have lost valuable time. There will be deaths that were preventable. The system failed. I don’t know why. But, when we have suppressed this epidemic, when life returns to some semblance of normality, difficult questions will have to be asked and answered. Because we can’t afford to fail again. We may not have a second chance.
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Jonathan Edwards said:
I agree we do not have evidence, so do not know, but I still think we can be 99% sure on the basis of what we know of how viral infection and recovery works. The only real exception I am aware of is the norovirus group which infects gut mucosa and gut immunity is importantly different from other domains.
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They were talking specifically about what is known about coronaviruses, and the suggestion was that immunity wanes after about a month. Given that there is also recent evidence that SARS-nCoV2 clobbers memory T cells, that would sort of make sense.
 
Jonathan Edwards said:
The 'behavioural' advisors seem to have got this very wrong.
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Maybe, just maybe, this time the powers that be will understand what a sham and danger to us all the current generation of behavioural advisors and the current state of their 'science' really are.

Richard Horton:

The system failed. I don’t know why.
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*sticks hand up*

Maybe, just maybe, dear Richard, it happened in no small part because for decades people just like you, in positions of serious power, recklessly over promoted and protected from proper scrutiny the very behaviouralists now giving dodgy advice to the government?
 
Leila said:
There this infographic from JAMA regarding age etc but not comorbidities.
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I've just been looking at the cases by age range and I wonder what the worlds population is by these age ranges and does it make any difference to the percentages. How many are over 50 and how many of the worlds population falls in to the 20-50 age range and then the 0-19 age range.

'If' the world has a top heavy older age group (far greater than under fifties) that could be a reason why more are dying? Is there anything to this?
 
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An article criticising the governments approach comments on the evidence presented on 'behavioural fatigue' (including the Wessely paper I mentioned earlier).

https://unherd.com/2020/03/the-scientific-case-against-herd-immunity/

The main bit on fatigue:

In addition, the government initially claimed that the population would encounter “fatigue” if countermeasures are implemented early, and would get tired of self-quarantining, and that “nudges” to encourage people to wash their hands more frequently were sufficient. At the time this piece was published, over 500 behavioural scientists had signed an open letter urging the government to publish their evidence for this claim, stating that they are “not convinced that enough is known about ‘behavioural fatigue’ or to what extent these insights apply to the current exceptional circumstances.”

The evidence that emerged was surprising. On Friday, one of the government’s advisors explained that the idea of social fatigue, which was used as a rationale to delay quarantine, was based on a literature review of the psychological impacts of quarantine.

But crucially, the literature review made no mention or recommendations of how early quarantines should be implemented. It also stated explicitly that only a few of the papers it included directly compared quarantined versus unquarantined patients, which makes it difficult to establish whether quarantine would cause more panic and social fatigue in an epidemic than the absence of quarantine.

The other paper cited as “influential” in the government’s strategy was in fact a working paper that was published a single day before the government’s delays to quarantines were announced. As with the previous paper, it made no recommendations as to when quarantines should be implemented.

There may be real and substantial psychological, medical and economic side effects of quarantine measures, and of a pandemic more generally, regardless of whether individuals are quarantined or not. But given the exponential nature of the disease’s spread, these effects should be mitigated alongside countermeasures, not traded off for them. If the government believed that individuals would feel fatigued by taking self-isolation procedures and social distancing measures, they should have provided top-down assistance and coordination to alleviate this.

And if these papers represent the basis for the government’s strategy to delay quarantine, they should be seriously questioned. Substantial social distancing measures are recommended by WHO and the CDC to be implemented as soon as possible if there is evidence for local community transmission of COVID-19.
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I agree that the papers presented publicly didn't say much, so it's important to find out what the government was being told privately by their behavioural science advisors. We've previously seen how Wessely can go well beyond the evidence when he thinks he's speaking privately to politicians or civil servants, and it will be interesting to see what basis there was for the behavioural assumptions that shaped government policies.
 
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On the radio, some scientists were quoted as saying that air pollution makes the virus more dangerous. That could be an important factor in why things got so bad in Wuhan and Lombardy.

Authorities in Italy now also want to tighten the lockdown rules further.

Re. behavioural science, I think this and the modeling fiasco are showing that people should pay more attention to the real world and less to models and other experiments conducted in different contexts. It seems to me that to understand behaviour you have to understand the person's circumstances, not so much their psychology (whatever that even is).

I can definitely see healthcare personal in the UK revolting because they're not even given protective equipment from what I head. And that is also a terrible idea because hospitals can easily spread the virus and are probably an important source of contagion.

Edit: Italy also has high rates of antibiotic resistance because of overuse. That could increase the risk of an untreatable secondary infection developing in the lungs.
 
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