Coronavirus - worldwide spread and control

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"As bioethicists, we teach medical students, residents and fellows that every clinical encounter involves moral and ethical decision-making. As these three stories illustrate, the pandemic sharply focuses this paradigm and raises the stakes. What can clinicians do when faced with these kinds of moral dilemmas?



The answers are both undeniably simple and frighteningly difficult. Ask questions and speak up. Be brave. Stick your neck out."


 
Hi @Simon M thank you for writing up an analysis of the study. I found it really helpful.

Do you know who was responsible for writing the original paper / model - the one which the UK used to go ahead with their mitigation model? And do you know where to get a copy of it?

I would’ve thought it’s the same team (including Neil Ferguson). But today i heard that Neil Ferguson was the person responsible for telling Trump he needed to bring in social distancing measures otherwise in America lots of people would die. And as a result a Trump has taken steps which are actually stronger than the steps taken in the UK (although some of that may be down more to the federal system in the US too). So I’m confused how he could be the author of the original paper, which would have recommending a very lax mitigation strategy in the UK which thought herd immunity as desirable, at the same time as telling Trump it’s a serious matter? Or am I getting it wrong?
 
Testing in the UK - from a Times journalist. Recently Vallance said we would be able to test 25,000 a day - but in only a months time (no set date given). I’m sure before we were told it would happen a lot earlier than that, and it hasn’t happened. We currently have “capacity” to test 5,000 a day, but the median number of tests so far in March is 1,600. https://www.wired.co.uk/article/coronavirus-testing-uk





I have also noted that Vallance and Whitty continuously talk about the antibody test, and say the PCR test is not so helpful as it only tells you if you’re infected or not. Not if you’ve had a past infection. That’s also part of the justification given for not needing to test the community and doctors. But so what?! Isn’t the PCR test the very test that China and South Korea and every other country is using to try to beat the virus.. so why does the UK feel that they are exceptional in this regard and the antibody test is the only one they can/should use?

https://www.itv.com/news/2020-03-18...reveal-whos-had-the-disease-with-no-symptoms/
 
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Rosie said:
'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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According to the latest Imperial College paper, over 70% of patients over 80 require critical care, presumably an ICU placement. We see higher death rates reported on, but demand for critical care goes up radically as age advances. I would guess this is also true for patients in higher risk groups.

So if numbers rise then older patients will rapidly take up all ICU and respirator usage and the death rate in older patients who cannot get treatment is likely to be very high.

The turning point seems to be about age 50 when need for critical care doubles over the adult rate, from about 6% going to about 12%.

I would love to know how this correlates with a range of biomarkers, but I guess we wont know about much of that for many months at least.

https://www.imperial.ac.uk/media/im...-College-COVID19-NPI-modelling-16-03-2020.pdf
 
A family member had to go to A&E yesterday and then was sent on to another department in the hospital for a vital scan. She said the waiting room was rammed, and she was stuck there for three hours. When the consultant came in to call somebody, she heard him mutter to the receptionist that people were supposed to be a metre apart.

So this in a hospital...
 
Sasha said:
Does anyone know how being able to test only 25,000 people a day in a population of 66 million is going to help? Presumably it would be some sort of targeted testing?

Don't we need to be testing everyone?
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From what I’ve gathered, in the UK they are still not thats interested in testing the community.

They said they will use that 25,000 tests to test people in hospitals and also medical staff, but only because then they can be sure whether it’s coronavirus or not, so they can get back to work if it’s not.

The govt are very focused on developing an antibody test (there’s a link in the post I wrote above). Because that way they’ll know if people have had the coronavirus yet - so if they have, they don’t need to bother to self isolate if they get symptoms as it won’t be the coronavirus again; and they can get back to work.

So really.. it all comes down to getting us back to work.

Edit: and like the screenshot I posted before too, the govt certainly has the resources to test many many more people. Even if not everyone, certainly a substantial proportion if not all people who have symptoms.
 
Sasha said:
Don't we need to be testing everyone?
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Trouble is, we'd all need to be tested repeatedly in case we've caught the virus since the last test. I think the worst thing is that health workers are not being tested, so if anyone in their household gets any sort of symptom that might be covid-19, they all have to isolate for 2 weeks. And that could happen repeatedly in households with several people. We need healthy health workers to be able to go to work.
 
Sasha said:
Does anyone know how being able to test only 25,000 people a day in a population of 66 million is going to help? Presumably it would be some sort of targeted testing?
Click to expand...

If everyone is doing their best to keep themselves to themselves testing asymptomatic people is probably not helpful, unless there is a contact line. The problem at the moment is that at least in London they have allowed mixing so much that almost anyone is likely to have a contact history.

I have a feeling that the only sensible strategy is to lockdown as hard as possible and wait for at least ten days. Anyone with symptoms needs testing but since no different advice would be given to asymptomatic people they would not need testing.
 
Trish said:
Trouble is, we'd all need to be tested repeatedly in case we've caught the virus since the last test. I think the worst thing is that health workers are not being tested, so if anyone in their household gets any sort of symptom that might be covid-19, they all have to isolate for 2 weeks. And that could happen repeatedly in households with several people. We need healthy health workers to be able to go to work.
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The UK is not adopting the strategy recommended by WHO; i.e. protect your health care workers, test, trace ---.

The Republic of Ireland has access to testing even for the public, takes about 3 days to arrange ---. I assume Health Care workers have priority.
 
lunarainbows said:
From what I’ve gathered, in the UK they are still not thats interested in testing the community.

They said they will use that 25,000 tests to test people in hospitals and also medical staff, but only because then they can be sure whether it’s coronavirus or not, so they can get back to work if it’s not.

The govt are very focused on developing an antibody test (there’s a link in the post I wrote above). Because that way they’ll know if people have had the coronavirus yet - so if they have, they don’t need to bother to self isolate if they get symptoms as it won’t be the coronavirus again; and they can get back to work.

So really.. it all comes down to getting us back to work.

Edit: and like the screenshot I posted before too, the govt certainly has the resources to test many many more people. Even if not everyone, certainly a substantial proportion if not all people who have symptoms.
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Yea the Government could e.g. turn the veterinary laboratories used to test for foot and mouth to coronavirus testing - there are laboratories doing lower priority work using the same technology!

I've noticed that they have advertised for students, who have DNA extraction experience, to volunteer.
 
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