Coronavirus - worldwide spread and control

Just a follow up to what I said. I don’t know much about modelling so I may be getting the wrong end of the stick. But the modelling seems quite simple to me and also in particular

“Our model rests on the assumption that only a very small proportion of the population is at risk of hospitalisable illness”. But this assumption hasn’t been proven?

Don’t you first need to make sure as assumption is true before making models and releasing a paper on it? Or is that not how epidemiology works?

 

I agree @Adam pwme we need serology testing to know.

But I also wish instead of the govt spending so much time on talking about antibody testing for the past two months whenever they’re asked a question about testing, maybe we could actually first start testing people who already are presenting with symptoms of Covid-19, who are unable to get tested, who are being turned back home from hospital and not tested, doctors and nurses who are getting exposed but not tested, and so can be passing it onto other vulnerable patients. Instead I constantly see a focus on testing the population to check for degree of herd immunity. Surely that is secondary and some things are far more important.

Today this paper has generated A LOT of interest on Twitter with people saying it will have policy implications and Gupta saying she disagrees with the revised Imperial paper. I’m sure it will interest our govt as well. I’m also worried as to how people who already might not have taken coronavirus seriously, may behave now, on the basis of a paper which uses unproven assumptions, (edited to add: especially when they are told less than 1 in a thousand infected people get hospitalised according to the model).

I’m worried about both social and policy implications: with the govt putting forward an even greater focus on antibody testing rather than PCR testing for the infected, and people thinking it’s not serious so they don’t need to social distance. The paper and Gupta recommend “urgent” need for serology antibody testing of the population now. The research group has released a tweet saying they did this to stimulate discussion about “immunity”. Honestly? I’m really getting fed up of hearing about immunity, herd or otherwise, while people are dying and ill in the UK without testing, and their contacts aren’t being traced either.

https://twitter.com/user/status/1242528016485490689

 

The latest data is indicating that the mortality rate is higher in men.

 

Could there be a genetic predisposition?

Presumably they will likely need many more than 4000?

 

Here is a summary of the conference yesterday: https://www.politico.com/news/2020/03/23/trump-coronavirus-lockdown-skepticism-143800

As I understand it now, policy would include federal aid, including building hospitals in "hotspots", and possibly a vague form of tracing, but no lockdown and 'restarting the economy' by easter. With regards to the tracing, something was only mumbled vaguely about it on post-code type basis. There were heavy allusions to herd immunity and Trump would be ok with that - here's a quote

It seems to be the economic cost of this will be far worse. We are far behind Italy with far lighter restrictions.

 

I had a brief look. I don't think this is consistent with what we know. The curves we have seen would be different if we are getting near to population saturation. My impression is that these modellers are completely incompetent. The understand maths but not how to apply it to reality. This is an extremely common problem with complex system dynamics in science.

In other words forget it. I doubt it will have a lasting effect on the politics. By next week we will know it was wrong.

 

I note a number of journalists from major news outlets have asked to interview Gupta about this, I am concerned and I expect a flurry of news tomorrow about this.

https://twitter.com/user/status/1242566660432760832

 

Rushed reply.

Good idea i.e. rather than the Government owning up i.e. South Korea has put in place mass testing (for virus - PCR) and we haven't. The Government are "re-directing/re-focusing" the discussion to a test which doesn't currently exist i.e. an antibody test that confirms exposure and recovery.

George Orwell's work was broadcast on the BBC (Radio 4 etc.) recently ---"battles which were reported and never happened" and "battles where hundreds died and were never reported".

 

I agree it seems unlikely.

On 19/03 the UK only had about 100 confirmed deaths, similar to South-Korea now (as of 24/03 they report 120 deaths). In South-Korea they have tested 348,582 people of whom 9,037 tested positive. So that's 2,6%. I assume there are all sorts of ways I which this estimate will be biased (not everyone who has been infected will have a positive PCR test for example) but the difference with 50% of the population seems too large.

I also find it a bit strange. What exactly is this model trying to do? If you assume only a very small proportion of the population is at risk of hospitalisable illness, yes then you'll need less Intensive care units - obviously.

Predicting how many people have been in contact with the virus based on an assumption of how many people are at risk of being hospitalised seems like things upside down. Wouldn't one normally estimate the infection and fatality rate first based on the available data and then use a model of how this might impact things in the future under different scenario's?

Trying to read and understand these papers hasn't exactly made me a fan of 'modelling studies'...

 

Just saw that Farid Zakaria on CNN is interviewing the PM of singapore next Sunday if anyone is interested.

https://twitter.com/user/status/1241475359075381249

 

He talks fast, I bet he does everything fast. He reminds me of 'Mr Wolfe' out of Pulp Fiction!

 

You're correct, Singapore is not on lockdown. My best friend lives there.

 

https://twitter.com/user/status/1242574865489711105

 

https://twitter.com/user/status/1242716481785397248


Now where have we encountered that attitude before...

 

This is very interesting. Staff in China dealing with COVID didn’t want psychological intervention, they asked for more rest without interruption and enough protective supplies.

Well, who could have predicted that! Amazing!

 

Lipkin has been diagnosed with Covid-19
https://www.mediaite.com/tv/infecti...onavirus-if-it-can-hit-me-it-can-hit-anybody/

 

I'll be much less insightful than @Adrian and talk longer to say it!

Basically I agree with what you are saying @Michiel Tack first what is the purpose of your model/predictions? In this case to examine strategies and outcomes e.g. South Korea tested, tested, tested (i.e. to identify people who were ill and infectious) and then traced their contacts and the outcome was --- (reduce R naught, don't overwhelm your ventilator capacity, lower % deaths) best we've seen.

Italy appears to have allowed the virus to become established (the South Korean's didn't) and it had an older population. It's healthcare system has been overwhelmed and the % of fatalities exceed those in South Korea (since there are insufficient ventilators).

So basically you input the variables (rate of transmission R naught) and the limiting resource (ventilators) and you examine various strategies. As for not using the best available data; that is mind boggling! As for publishing a study which does not use the best available data ---.

I agree about the combination of poor modelling and a poorly informed audience (us) --- not good (unless you are content with the outcome--- defend the indefensible!).

 

I wish they would make it clear to people that even if they 'feel fine' that they might still be infected and subsequently passing the virus onto other people by not taking the appropriate measures.

When I think of the AIDS tv public health announcements back in the 80's that scared the hell out of everyone...........this on tv last night from the CMO just didn't do it

https://www.youtube.com/watch?v=_cK02XwUogM