Coronavirus - worldwide spread and control

Could you say which episode of The Week in Virology this is from? There have been a lot of episodes this week…

 

Harley Street clinic has sold 2k coronavirus home test kits at £375 to celebs

https://www.mirror.co.uk/news/uk-news/coronavirus-harley-street-clinic-sold-21711100

 

This is a very important thread, in my view, putting forward the idea that suppression can be better sustained if we move to a programme of massive testing (though not testing everyone).



The author calls this "the Apollo challenge of our time".



Basically, a massive if expansion of testing and contact tracing (presumably after a massive short term lockdown to be clear on who isn't infected). And also massive antibody testing to establish who has already been infected and so can get back to work to keep the economy and society moving.



Possibly also a huge expansion of contact tracing, including using anonymous mobile phone GPS data to alert people who might of being exposed, so they can get quarantined and organise a test.



The author is proposing this — it can't be done yet, but might be a better long term solution than the current plan. Worth considering, anyway.

 

I think it was the one with Ralph Baric: http://www.microbe.tv/twiv/twiv-591/
but it's a long one.

I'll edit this post when I get a timestamp.

edit 1: OK. At 47mins, Baric discusses history of coronaviruses, immunity, cross-immunity - suggests that immunity acquired in childhood *is* protective. But we just don't know yet.

The CD4 data I saw was from severe cases, so may indicate that those who recover from severe disease are less protected against reinfection?
https://twitter.com/user/status/1239259641965658115


Still trying to track down the bit about immunity waning after a month... it might just be in severe cases.

edit 2: OK. It's at 15 mins in. I'll try to do a transcript so that those whose immunology is better than mine can tell me where I have misunderstood it!

 

People have been questioning why celebrities are getting access to coronavirus tests when even frontline healthcare workers aren’t.

Then there’s also the fact that MPs also got tested (even under the old rules - which meant you had to have had contact with a confirmed case, or had returned from an “infected region” within 14 days), when they didn’t fulfil either criteria to get tested.

 

Do we even know what the current plan is? I am unclear on it. Sometimes I feel we are still in herd immunity. (And some twitter commentators like Devi Sridhar and the times journalist I posted above seem to agree). Sometimes I think we are under suppression. Sometimes I think we are under mitigation.

 

1% seems very high. Do you happen to have a link for this?

Don't know if this article has been discussed yet, I think it's quite interesting: "Coronavirus: Why it’s so deadly in Italy" - Andreas Backhaus, 13 march 2020.

It argues that the death rate in Italy is soo high because a lot of the confirmed cases are old people. That could be because the outbreak in Italy has mainly spread among older segments of the population or because testing is restricted so that younger persons who tend to have milder complications are not picked up.

The interesting part of the article is when the author presents data from South-Korea, another country that has been greatly affected but that tested much wider than Italy. In contrast to the situation in Italy, the age-distribution of confirmed cases in Korea is quite similar to the general population. So their case fatality rate (around 1%) is probably a more accurate estimate of what would happen if the virus were to spread among the general population in a more controlled manner.

Although, even in South-Korea, I think there will be a significant selection bias where those infected with the virus and develop significant symptoms are much more likely to be picked up than those who don't. So I wouldn't be surprised if the CFR (EDIT: I meant the infection fatality rate (IFR) here) for a modern healthcare system that is not overloaded as is currently the case in Italy, would be significantly lower than 1%, probably somewhere between 0.1% and 1%. Any thoughts on this?

 

Our chief scientific adviser / chief medical officer, Whitty & Vallance on Sky news just now, after being asked about the lack of PPE and tests on NHS:

“Only science-y questions please, not on the NHS and things like that”

@Jonathan Edwards

So who is responsible for this then, if it is not them? They are the ones advising the govt.

 

Top doctors here are now saying to keep stores closed and self isolate for 3+ weeks.

 

Data on comorbidities in the deceased from Italy retrieved from this news article.

From what I understand around 99% had pre-existing conditions like heart disease, diabetes and high blood pressure, often 2 or three (see table 1).

Seems similiar to the data from China before.

 

There are other stories of getting ventilators from outpatient and veterinary clinics as well as military and "obsolete" stockpiles.


https://twitter.com/user/status/1240076083707490304

 

Mr Johnson is responsible at present. Previously Mr Hunt, Mr Hancock, Mr Lansley... also Mr Milburn in his way. The NHS has been restructured such that nobody is responsible because nobody has enough resources.

This lunchtime Whitty is still talking of flattening a peak. Either this is a deliberate obfuscation strategy to make it look as if the policy has been right all along on the basis that now is not the right moment to admit that it was four legs bad, not two (referring to Animal Farm), or they really are that dim that they do not realise what they have to try to achieve.

The BBC seem to be sticking to government message as much as possible yet at the same time are undermining the plan by constant clips of people having trouble working at home saying they cannot cope and wondering whether we will be able to survive lockdown with 'no escape route'. The reality of course is that this is a war situation and it is up to people to bite the bullet, unless they are happy for people to die like flies from all the conditions that won't get treated, as well as the virus.

 

I think the South Korean data is probably as good as it gets i.e. they did mass testing including those without symptoms, who had been in contact with someone with coronavirus, (I think!). I take your point i.e. we don't know the true fatality rate and I assume will not - unless we had a statistically significant sample of people tested for antibodies (establishing total number exposed and recovered).

 

I don't quite see why it cannot be done yet. Or at least for everything to be done to get it started - i.e. stringent lockdown and as much testing as feasible. At least it should be possible to test people known to have been in close contact with positive cases and people with cough and fever.

 

OK. I've done a quick transcript [apols for any errors - I haven't gone through it thoroughly] - from 15 mins 32 secs in:

They then continued to talk about herd immunity as if none of the above had been said. So I'm confused!

 

To Beat COVID-19, Social Distancing is a Must - https://directorsblog.nih.gov/2020/03/19/to-beat-covid-19-social-distancing-is-a-must/

Opinion: The common factor to Asia's success against Covid-19 - https://www.odt.co.nz/opinion/opinion-common-factor-asias-success-against-covid-19

 

Thanks for that @Lucibee, very useful.
It seems that there is some evidence for antibody titres dropping rather early with coronaviruses. I am not sure that it is easy to interpret that. Humoral immune memory is complex and we don't have a model that really explains what we find. Tests may be predominantly picking up antibodies from short-lived scenic plasma cells that are not actually critical to protection, and not so sensitive to critical antibodies from bone marrow based plasma cells or something like that. There may also be enough high affinity memory B cells capable of generating plasma cells rapidly during a re-infection.

What sounds rather plausible is that this may belong to a group of viruses that stimulates adequate immunity but at a level that allows low grade replication after re-infection and recurrent grumbling symptoms. That of course is OK if everyone has had the virus but not so good if the idea is to keep vulnerable people free of virus because the virus may go on circulating at a subclinical level indefinitely. That is an important caveat, although it seems likely that second time round bouts of the virus are very unlikely to be life-threatening. That might not be true for people severely immunocompromised but then they are at risk of things they have seen before anyway.

Edit: I thought the answer to the comment that maybe numbers dropped in Wuhan because everyone was infected seemed a bit flabby - although I know how easy it is to try to sound in agreement for politeness. My understanding is that even now no more than one person in a thousand or so in Wuhan has been ill. Maybe 999 out of a thousand are asymptomatic but that does not seem to be what we are hearing from elsewhere.

 

https://twitter.com/user/status/1240369314638815234

 

I don't know anything about that. But it reminded me of news reports from a few weeks ago saying that the virus found in Washington state had been circulating for about six weeks.

Article dated March 2nd:
https://www.theverge.com/2020/3/2/2...ath-life-care-washington-testing-surveillance

The website https://nextstrain.org/ncov is way beyond my abilities but I'm sure some folks on here can understand it. Or perhaps understand the twitter thread (second link in the quote above).