Coronavirus - worldwide spread and control

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Jonathan Edwards said:
Edit: There is an excellent article circulating called 'Hammer and Dance' that explains the detail of this.
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Thanks for posting that (here's the link). It's the most terrifying and most hopeful thing I've seen, and it's very clearly written and actually a good read - the 'hammer and the dance' title for the idea is both a simple explanation of the concept and very memorable.

It's got me convinced about the way forward but my concern is that the author doesn't have the credentials to lend it the necessary weight, and I think it needs epidemiologists to sign up to it and lend their credentials to it, if they agree with it. One already has, for exactly that reason, at the top of the comments section.

It's an astonishing resource to have produced in so short a space of time. We owe the author a big debt of thanks.

@Jonathan Edwards, what do you think is the best way to support this paper and the strategy in it? Are medics already using it to apply pressure to the government? Should we be sending it to our MPs?

I'm watching the BBC News now and we still have no strong action to get the country into proper physical isolation from each other. It's all still just a suggestion, and I think we're heading for disaster.
 
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Sasha said:
@Jonathan Edwards, what do you think is the best way to support this paper and the strategy in it? Are medics already using it to apply pressure to the government? Should we be sending it to our MPs?
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I have no idea really. Although the Hammer and Dance piece is well researched there is nothing in it that any immunologist with common sense would not have worked out buy the second week of February if not before. The maths does not need modelling. It can be done in the head with adequate accuracy to cover pessimistic scenarios - which we are now in the middle of.
 
"The Hammer and the dance" article by Tomas Pueyo is rightly getting plaudits so I thought I'd summarise the key points.

hammerdance.png

The Hammer is the initial hard crackdown of strict social distancing needed to rescue countries that have lost control (also seen in Wuhan).

The author argues it shouldn't take that long to regain control, not if you do it properly (no sign of that happening in the UK). Perhaps 3-7 weeks.

The Dance is the follow-up when controls are intelligently relaxed, focusing on the things that really work. More like South Korea, which didn't resort to extreme social distancing.

In some ways this is similar to the Imperial College model, but with the inclusion of contact tracing and quarantining — you know, what WHO has recommended all along. And which doesn't seem to have been considered at all in the Imperial College model.

The central point about in the article is the importance of buying time.

Pueyo’s idea is that if we can dramatically slow things down, there will be a learning curve which means we will find much better ways to treat the illness and also find the best ways to control contagion.

Better ways to treat it include time to get more ICU beds and respirators, more/better protection equipment so that more frontline medical staff can stay on the job, and better protocols. More radical would be effective drugs.

There are currently at least five clinical trials in progress for hydroquinone, a drug that is known to work on other viruses including other coronaviruses.

This Carl Zimmer article in the New York Times today says scientists have found 69 candidate drugs to test. Researchers focused on human proteins that the coronavirus seems to need to enter and replicate in human cells. The team found 24 FDA-approved drugs currently used to treat unrelated diseases such as cancer, Parkinson's disease and hypertension.

They find another 45 drugs that are currently in clinical trials or the subject of early research. 22 of the 69 drugs are currently being tested against a live coronavirus grown in the lab.

Learning how better to stop contagion

We don't properly understand how the virus is spread, or what are the most effective ways are to stop it spreading. Extreme lockdown seems to work, but how much of that is actually needed? Hopefully, answers about that will emerge over the next few months as people try many different approaches around the world.

Overall, Pueyot argues that it should be possible to bring the epidemic under control and manageable within the health system with a Hammer approach to initially get control. Followed by a less extreme Dance approach to containing it at a low level until a vaccine or really good treatment emerges.

Plus the article has a pile of good data and interesting analysis about how the epidemic has developed around the world.
 
Simon M said:
"The Hammer and the dance" article by Tomas Pueyo is rightly getting plaudits so I thought I'd summarise the key points.

View attachment 10263

The Hammer is the initial hard crackdown of strict social distancing needed to rescue countries that have lost control (also seen in Wuhan).

The author argues it shouldn't take that long to regain control, not if you do it properly (no sign of that happening in the UK). Perhaps 3-7 weeks.

The Dance is the follow-up when controls are intelligently relaxed, focusing on the things that really work. More like South Korea, which didn't resort to extreme social distancing.

In some ways this is similar to the Imperial College model, but with the inclusion of contact tracing and quarantining — you know, what WHO has recommended all along. And which doesn't seem to have been considered at all in the Imperial College model.

The central point about in the article is the importance of buying time.

Pueyo’s idea is that if we can dramatically slow things down, there will be a learning curve which means we will find much better ways to treat the illness and also find the best ways to control contagion.

Better ways to treat it include time to get more ICU beds and respirators, more/better protection equipment so that more frontline medical staff can stay on the job, and better protocols. More radical would be effective drugs.

There are currently at least five clinical trials in progress for hydroquinone, a drug that is known to work on other viruses including other coronaviruses.

This Carl Zimmer article in the New York Times today says scientists have found 69 candidate drugs to test. Researchers focused on human proteins that the coronavirus seems to need to enter and replicate in human cells. The team found 24 FDA-approved drugs currently used to treat unrelated diseases such as cancer, Parkinson's disease and hypertension.

They find another 45 drugs that are currently in clinical trials or the subject of early research. 22 of the 69 drugs are currently being tested against a live coronavirus grown in the lab.

Learning how better to stop contagion

We don't properly understand how the virus is spread, or what are the most effective ways are to stop it spreading. Extreme lockdown seems to work, but how much of that is actually needed? Hopefully, answers about that will emerge over the next few months as people try many different approaches around the world.

Overall, Pueyot argues that it should be possible to bring the epidemic under control and manageable within the health system with a Hammer approach to initially get control. Followed by a less extreme Dance approach to containing it at a low level until a vaccine or really good treatment emerges.

Plus the article has a pile of good data and interesting analysis about how the epidemic has developed around the world.
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As I've said before, this is not unlike an industrial process control scenario. If a seriously large rapid onset disturbance occurs, such as to result in a rapidly changing deviation from where things are supposed to be, then the controller kicks in with a rapid and large correction, to pull it back. In this sort of scenario a key control component is derivative action, which links rate of change of disturbance to speed and amplitude of corrective action. Basically if a disturbance shows rapid change then it anticipates that it will progress rapidly into a large disturbance. So the correction is massive and rapid to preempt that. Unlike the government's response.

The graph of processes experiencing such a disturbance, and with such corrective control, is often remarkably like the Hammer and Dance one shown; it's a form of process control. More than anything, it is common sense.
 
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Where does all this leave us now? Given that we lost the window of containment several weeks ago, the only feasible path forward seems to be to put in stringent physical distancing measures to delay the spread of the virus. But these alone will not be enough. We also need to backtrack and start doing the mass testing, tracing and isolating that are integral to breaking chains of transmission. Putting these measures in place does not mean that we will immediately solve NHS capacity challenges, or that we will not see a massive rise in patients dying. They will, however, help to slow down the spread. We must also continue to push for the protection of the health workforce and frontline responders who are exposed to high viral loads. And we must race to make up for the time lost during two months of passivity.
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https://www.theguardian.com/commentisfree/2020/mar/23/britain-covid-19-head-start-squandered
 
I still get the feeling that those who are critical, like the Guardian and even Pueyot, are thinking in terms of slowing rather than eradicating. I just don't think this is an option. If virus is circulating you cannot return to anything like normal life and you will have to limit commerce for years. If the virus is eradicated country by country the whole thing could be over by summer. The economic impact will be far less. TB was very nearly eradicated from the UK in the 1970s. The problem was continual importation from Asia and Africa. But even with that case trails were eradicated, not slowed down. Testing, contact tracing and isolation were the main tools of management. For a rapidly transmissible virus eradication cannot work usefully with international travel but there is no prospect of that for a good while anyway now.

The past experience with viruses of this sort is eradication - SARS and MERS. Eradication is how we have handled almost all infections other than those with animal reservoirs. Vaccines are an important tool in that but treatments are not - once someone needs treatment it is too late to stop the spread to others.
 
Some statistics on the 213 Corona deaths in the Netherlands so far.
At least half of corona deaths had an underlying condition, two thirds are men.


https://nos.nl/artikel/2328082-zeke...derliggende-aandoening-twee-derde-is-man.html


Google Translate:
At least half of the number of people who died of coronavirus effects in recent weeks had underlying conditions. This is evident from detailed information from GGDs and hospitals that RIVM has made public.

In total, there are now 213 deaths in the Netherlands, at least 111 of whom had underlying suffering. The conditions made the persons already in vulnerable health at the time of infection with the coronavirus.

The most common conditions are cardiovascular disease or high blood pressure. This applies to a quarter of the deaths, or 52 persons.

Less reserve

"These conditions are known to be associated with a higher risk of serious illness and death," says virologist Eric van Gorp of Erasmus MC. "A corona infection can lead to a serious lung infection. If you already have cardiovascular disease, the body has less reserve to endure this serious infection. We also see this in the flu."

The other underlying conditions of the corona victims are: diabetes (30 deaths), chronic lung disease (24), kidney disease (13), malignancy or cancer (12), muscle diseases (7) and liver disease (1). In 50 people, the underlying condition is categorized as "other."

The other disorders are mainly that they weaken the functioning of the immune system, says Van Gorp. "And so you are more susceptible to developing an infection."

In 5 percent of the people who died of the coronavirus, there was no underlying condition. It is unknown for more than 40 percent of the deceased persons whether they had an underlying condition.

More men

The figures also show that approximately as many men as women are infected. Still, many more men die in the end: the male-female ratio is two thirds male and one third female. The age of the dead is between 55 and 97, with the average age being 82.

According to virologist Van Gorp, the differences may be explained by a difference in smoking behavior "Men smoke more often, which makes their lungs more sensitive and vulnerable. The difference in the number of cardiovascular diseases can also be an explanation. But whether this is also a reason is for earlier death, needs further investigation. "

Hospital admissions

Information has also been published about the 1,230 persons who were or have been hospitalized with a corona infection. 17 percent of them appear to be under 55 years of age. None of them died.

Eight children up to the age of 10 have been hospitalized with the coronavirus. In addition, it concerns 4 teenagers, 19 in their twenties, 30 in their thirties and 73 in their forties.

A quarter of the total number of 4749 people who tested positive have been or have been hospitalized. RIVM emphasizes that the actual number of infections is higher, because not everyone is tested.
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Also here the curve seems to flatten a bit, later this week it should be clearer since most measures started 16 March.


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dreampop said:
I'm wondering how this crisis could impact me/cfs research. We were benefitting from stable research in other fields, making me/cfs an attractive "new" field for researchers to enter. Will their attention be turned to viral pandemics? Will the scraps we got go elsewhere? Will research stall over the next two years? I assume the NIH inhouse study is on hiatus. When will it get back on track?
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Yes, dream pop, this is on my mind too. We have not heard a word from ME researchers. Dr Tompkins' little statement really distressed me: the bottom line was, well, folks will have some understanding of ME and confinement now. He's not the darn empathy enforcer. What we all want to know is, how can ME research benefit from this, and can ME researchers get a bit more fire under their seats to move things along. ME is not some peaceful little illness; folks are bed bound for 10 and 20 years, and unable to help themselves and in great discomfort day after day, many opting to end their lives.
 
A very good 3-part summary into the UK’s decisions and analysis of the SAGE documents that have recently been released.


Part One
The Politicised Science that Nudged the Johnson Government to Safeguard the Economy over British Lives

https://bylinetimes.com/2020/03/23/...-to-safeguard-the-economy-over-british-lives/

“A scientific analysis by the New England Complex Systems Institute at New York University has found the Imperial College model to be deeply flawed. Although the authors praise the Imperial study for recognising the disastrous consequences of the Government’s previous “mitigation” approach, they identify a number of inexplicable failings.

One of the most egregious is the stubborn belief that the outbreak of the virus cannot be stopped. This belief can be traced partly to how the Government interpreted a range of modelling results produced by British scientists advising it, as part of its Scientific Advisory Group for Emergencies (SAGE). “

Part Two
Government Documents Reveal Concern for ‘Economic’ and ‘Business’ Impacts Prevented Early Action

https://bylinetimes.com/2020/03/23/...-and-business-impacts-prevented-early-action/

“The Government has based its response decisions on advice provided by three advisory networks in SAGE: the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), the Scientific Pandemic Influenza Group on Modelling (SPI-M), and the Independent Scientific Pandemic Influenza Group on Behaviours (SPI-B).

The Government’s overall strategy was developed by achieving ‘consensus’ within and between these three bodies.

Analysis of the SAGE corpus suggests that inputs from the third group on behavioural science ended up consistently watering down scientific calls for more urgent social distancing action.

....
 
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Post copied to the Covid-19 Biology thread

Dr Tardif of the Institute of Cardiology of Montreal announced today that his group will be treating 6000 people suffering from Covid-19 with an anti-inflammatory called, "Koshesyn." That is not the correct spelling but I cannot find this med online so I have written it phonetically. He says that they hope to dampen and shorten the symptoms, so that patients do not risk going into full blown pneumonia.

The cases in Quebec are mushrooming, and though Prime minister Legault is fabulous in his daily briefings--level headed, organised, reassuring-- some folks are not listening to his request for confinement, for avoiding contact (even with relatives). Tonight all the stores are going to shut down, except for grocery stores and pharmacies and take out food outlets.
 
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I feel calmer now. Except as soon as I started feeling a bit calmer, a few worries have entered my head

1) what about the tube: we’ve seen scenes of the tube this past week absolutely packed with people, as they had cut the no of tube stops

2)what about supermarkets: it’s absolute chaos in supermarkets at the moment with a very high density of people, no rules on density of people and how many in a shop etc, unlike in places like Italy

3) what does “essential work” mean? I’ve heard this past week of many people who are not on the key workers list, even people with desk jobs, being forced to go to work by their employers. There’s no rules to stop that happening.

4) how is the “going out once a day for exercise” going to be enforced? I just have a feeling, looking at the behaviour of the British public this past week, that lots of people will exploit this. Although I hope they don’t. We have far less police than other countries eg Italy, to enforce this, due to police cuts.

5) have we heard anything on mass testing, contact tracing, isolation, testing of doctors and nurses, PPE? Doctors and nurses are still hugely at risk and why is this not being rectified.

6) The lockdown will be reviewed and possibly “relaxed” in 3 weeks!
 
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