Coronavirus - worldwide spread and control

That's not looking good. How long have that had their social distancing policies in place now?

Carl Henegan & co have just released a new review of social distancing during pandemics: https://www.cebm.net/what-is-the-ev...ndemics-a-rapid-summary-of-current-knowledge/

 

That’s a scary thought. I’m watching and waiting every day for the govt to announce some proper measures at press conference - but am not seeing it.

I think London is not 3 weeks behind Italy. From a scientist I follow, they said London is 7-10 days behind Italy.

 

Just saw a tweet with image titled "The Case Fatality Rate Varies by Country" dated 16th March 2020. I'll just copy the image here in case some folks have trouble with embedded twitter.

Code:

https://twitter.com/DrEricDing/status/1240669044300296192

 

Quite a lot has changed since then (for the UK definitely). Deaths are ~140 I think today, and ~3300 cases.

 

Sorry if it was too old, thought it was worth passing on.

 

I think this only kicks in when the system is overwhelmed. Is that the case already?

 

This thread also describes China's procedures.


https://twitter.com/user/status/1240494951177302016

 

Still interesting to know.

 

Yes. Chair of BMA said on the news today that patients from London hospitals were being moved to hospitals outside, as they didn’t even have enough beds.

 

Very sad.

https://twitter.com/user/status/1240781787976085506

 

"The coronavirus is killing far more men than women"
The Washington Post

https://www.thehour.com/news/article/The-coronavirus-is-killing-far-more-men-than-women-15143405.php

and one from Israel

https://www.haaretz.com/world-news/...ronavirus-kills-more-men-than-women-1.8688767

 

I was being slightly flippant; probably entirely inappropriate in the circumstances. I assume that we would have heard if there was no access to ventilators.

I was speaking to a friend, who is a doctor, who described having to hand ventilate a patient overnight before a bed could be found (in another country i.e. no beds in UK!) - that was before coronavirus. We really are starting from low numbers of ventilators; I find it very hard to accept the statement "we are ordering them" - they need to be in place now, not one year + from now.

 

These heroic people should already have healthy food available without any effort from them.

https://twitter.com/user/status/1240687667265843202


"The recording was played this morning to Britain’s Health Secretary Matt Hancock, who told the BBC’s Today programme that his heart went out to people like Dawn.

He said that people should follow the guidance which has aleady been set out but the government “would do whatever it takes” if necessary."

 

I think there are some fundamental misunderstandings regarding "herd immunity" being propagated.

Although the Science Media Centre provides some good explanations about what it is (https://www.sciencemediacentre.org/expert-comments-about-herd-immunity/), very little is actually known about the dynamics of SARS-CoV2 precisely because it is a new virus.

The assumption that the epidemic will start to "burn out" at about 60% is just that, an assumption (based on what the likely R0 might be). It is also an assumption that reaching that point will convey lasting "herd immunity" or anything like it. Herd immunity is usually reached after vaccination programmes, because vaccination can often confer much better and longer-lasting host immunity than exposure and recovery from the virus itself (this is particularly true in the case of measles, and we are only just beginning to learn why that is the case). But it also requires constant maintenance to keep levels of protection up. That's why we have vaccination programmes to make sure that new entrants into the population are covered. If immunity to SARS-CoV2 wanes after a few months in some people, any protective herd immunity could easily drop below the required level and the epidemic start up again. This is how virus infections either establish seasonality or even become endemic.

So when talking about "herd immunity", be aware that it is something that it is likely to be transient, it may not even be achievable at all, and it is unlikely to be desirable to achieve, given the mortality/morbidity associated with COVID19.

 

There is some great data from Italy on this. Apologies to whoever posted it earlier in the thread (tweet of a newspaper article, I think, and PDF with data - all in Italian), can't find the source now. But here are the key figures. It's all about age and health.

https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_17_marzo-v2.pdf

2004 cases, mostly from Northern Italy
355 deaths
Document dated 17 March 2020 (but I think this is only 10% of total deaths)

Median age at diagnosis: 63
Median age at death: 81

So it appears that the high death rate in Italy is primarily driven by an older age at infection, By contrast, a day or so ago Germany had 30 deaths from 10k cases: they had no data on age but anecdotally most people tested were young.

Health also matters. Here's the number of existing health issues - mostly cardiovascular

0: 1%
1 pathology: 25%
2 pathologies: 26%
3 or more: 48%

So co-morbidities are hugely important. Would be good to analyse the interaction of age and co-morbidities (there was no data on that).

There's more data but I don't speak any Italian.

UPDATE: more data on Italy from this tweet
https://twitter.com/user/status/1240680887479648259


Lombardia and Emilia Romagna are the 2 regions with most of the deaths in the first analysis as well



@Michiel Tack

 

Head of Chinese Red Cross visited Italy and was very critical, said their lockdown is not good enough. Said public transport is still going, people are still gathering, economic activities still going on..

Sounds very much like what the UK is trying to do.

https://twitter.com/user/status/1240889102804889600