Coronavirus - worldwide spread and control

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https://twitter.com/user/status/1243791521729712128

 

Yes that is what is happening in Italy too. And on TV they are saying that the true number of cases is much higher than what the statistics show.

The Veneto province has 750.000 IgG/IgM tests available from tomorrow which will be used to also get a better epidemiological picture.

 

But surely even with total closure of borders, you cannot fully come out of lockdown before there is sufficient herd immunity in the population; until a vaccine is available the human costs of attaining that herd immunity would be appallingly and unacceptably high.

There is a long list of workers who cannot work from home if essential infrastructure is to remain intact, health workers, emergency services, food and essential household supplies, transport, sewage treatment, water supply, gas and electric, communication systems hardware, etc, etc. The virus will still be circulating within this community I assume.

So I imagine it would be impossible to fully eradicate the virus purely via lockdown, because you simply cannot achieve 100% lockdown. And without 100% lockdown it is presumably impossible to destroy 100% of the virus circulating in the population, until a vaccine becomes available? A great many of those locked down will have escaped CV19 by virtue of being locked down, but on coming out of lockdown some would become exposed again.

I can only think that what will happen in practice is to keep us all locked down until adequate testing becomes available, and we get to know who has likely gained immunity and who not. Maybe then the lockdown will be rolled back progressively, with only those known to be immune and not infectious coming out of lockdown first?

To be clear these are just the idle thoughts of someone completely unqualified on the subject!

 

Saw this Italian article: «The real death toll for Covid-19 is at least 4 times the official numbers». If I understand correctly it was submitted by Claudio Cancelli, the Mayor of Nembro a municipality in the Province of Bergamo.

It reads:

I think it's a good idea to look at the death statistics from previous years and compare it to this year, to get another perspective on what's happening.

 

In the university hospital of Brussels, they've been giving every patient that comes into the hospital for a regular (non-COVID-19) appointment a CT scan of the lungs, to check if they have been infected without knowing it. Thus far they've done this for only 50 patients and 5 (10%) were thought to be infected.

Based on this data, our main virologist, Marc van Ranst said in the media that 10% of Belgians might be infected with the virus without even knowing it. I personally think it's a bit soon to be making such declarations given the poor sample size and risk of selection bias.

Here's a short article about this: https://www.hln.be/nieuws/binnenlan...oronavirus-zonder-dat-zelf-te-weten~aa4c30fe/

 

The Wuhan experience indicates that you can. Even now I suspect less than 1 person in a five hundred in Wuhan was infected. This is why herd immunity is so ridiculous because it would take five hundred times the period of misery so far to reach it.

If you isolate and trace you can control infections without herd immunity. That is what has been done for tuberculosis for a couple of decades in the west. Unfortunately the kowtowing to penny-pinching and political correctness has meant that in the last five years the organism has had field day.

 

I think we have remember that about the only people going to hospitals now are people with Covid symptoms or people who take so little notice of reality that they are likely infected. Any sensible person is staying away from hospital whatever is wrong with them - maybe in some cases with dire consequences.

 

Stealing a link to the Washington Post https://www.washingtonpost.com/heal...a-b148-e4ce3fbd85b5_story.html?outputType=amp

and thinking that this assessment is reasonable:

 

Despite the word coming out of China that frontline health care workers don't even want it and instead demand basic resources be prioritized because opportunity cost is a real damn important principle that fools can't seem to integrate. Primary needs that are demanded by those experiencing the crisis are far and above imaginary needs of those with a supply of imaginary solutions to non-issues. This is the same with us. We need food, shelter, security, not aphorisms and doctorsplaining.

Those guys are like the comedy sketch about the homeopathic emergency department and don't even realize it.

 

I am afraid not everyone in the society is as much steadfast and circumspect as you like to think. I am not talking about the needs of health carers, who are so at least enough.

A good example might even be the non-issuers themselves, and there are more issuers. Albeit they all might well be not as evil in their first minding than we PwME uses to experience.


From this doubtful perspective arises the second question: What does the crisis mean for our organizations of producing food asf. What will happen when the market is out of function. More likely - if you ask me - that the democracy will be corrupted than that we all look into each other´s eyes and say, Yes we will.

There are many sketches around greeting the sun each day. I think "even" a lot of politicians don´t grasp the horizon. Though I admit this crisis may gives chances of different kind as well.

 

Today Dr harries, the Deputy Chief Medical Officer for the Ik says:

“If we are successful, we will have squashed the top of that curve, which is brilliant, but we must not then suddenly revert to our normal way of living,” she said. “That would be quite dangerous. If we stop, then all of our efforts will be wasted and we could potentially see a second peak.”

This indicates to me that she has no idea what the plan is and that leads me to suspect that nobody knows what the plan is.

There is bound to be a second peak unless the virus is eradicated. That is not squashing a curve. It is eradicating the virus. If, as implied, the idea is to keep any further recurrences lower than this coming peak then unless the virus is eradicated we are talking about restrictions for ten years, not six months.

I suppose the most optimistic interpretation is that these people do understand but want to keep 'on message' to make it look as if their policy made has made sense all along. Maybe they actually think that bullshitting reassures people. The problem is that there is already enough commentary to make it perfectly obvious that it is bullshit.

On the other hand my experience of the majority of people in biomedical science is that they are quite capable of the sort of double think that allows them to believe what they say makes sense when they at the same time know that it doesn't. At the end of the day my bet is that neither Dr Harries nor any of the others actually realises they are talking through their armpits.

 

Are you saying you believe that in Wuhan they have eradicated all traces of the virus, and so there is nothing that could initiate another outbreak? Or do you mean there is still a residue of the virus in Wuhan, but such that it can be controlled?

 

I am saying that it looks as if they have eradicated all replicable virus. There may be some lurking that will need further surveillance to deal with and there will be a major risk of re-introduction if movement is re-opened. But the fact that cases have dwindled more or less to zero means that you can reduce the R number to much less than 1 and if you do that you end up with no virus at some point, just as if R is greater than one you end up with an exponential increase.

After all that is what happened with SARS and MERS. It was on the cards in the UK that this would be achieved until the policy of contact tracing was abandoned and those returning from known source areas were not forced to quarantine properly. Ebola came to the UK and was eradicated. This is more difficult but largely because people are lazy and have vested interests which they do not realise are being far more damaged by the laziness than they would have been with a proper policy like in China.

 

I think what Jonathan is highlighting is that the authorities have, in effect, eradicated the virus in Wuhan. I.e. even though the % people infected was possibly 0.2% of the population. The virus would die out naturally when the approx 70% of the population were infected (herd immunity). However, the Chinese government tested and isolated those infected/infectious, and traced their contacts (isolated where necessary) --- breaking transmission.

So it's a model of how to deal with the virus until you have a vaccine/at least not overwhelming your hospitals.

Until there's a vaccine you cannot eradicate entirely (small pox) i.e. on a global scale; therefore, I assume this is in effect closer to "can be controlled".

 

I am not sure about that. Previous eradications can be instructive but each virus has a different dynamics. And smallpox had been eradicated in Western countries for a long time before it was finally eradicated in rural Africa. When I was a boy smallpox was still present in pockets in Africa but nobody in the UK believed that there was any chance of catching it at home - and they were right. All sorts of things have changed since 1977, including the infrastructure that could achieve eradication almost anywhere with motivation I suspect.

So I am not talking about can be controlled. I am talking about eradication. If that means nobody visiting India or Africa for five years so be it.

Also, if controlling with social distancing simply does not work in certain communities these communities will within six months have infection of the entire population and have herd immunity. So the virus will die out. The problem with smallpox may have been that in rural areas it spread only occasionally from community to community so that it cycled round populations with new infants ready to be infected and keep the virus alive. SARS-2 Covid does not have the same clinical pattern.

 

The very same numbskull it seems.

 

There is a manipulative aspect to what is being said by the medical experts being put forward by the government that it makes it difficult to know if anything they say should be trusted. Their early messaging on herd immunity, etc is not just going to be forgotten.

They might get away with this approach for a while but cynicism can spread pretty rapidly, even when they keep the mainstream media on side. Will they be looking at another contagion with exponential growth?

 

It had struck me before that the best way to induce 'rule fatigue' so beloved of the nudge-a-behaviourbabble chaps was to lock down, unlock, lock down, unlock and so on. Nobody would beige it really mattered.

What I think they may have to think even harder about is what the health care professionals are going to think about relaxation of rules and whether they will be prepared to work again under the conditions at present. And what about all the people with cancer who are not being treated at present? Do they get the chance to be treated before mayhem recurs and their treatment is put off until too late?

They seem to be dim enough to think there is a way out of this other than eradication.

 

At present millions of people are being paid to do nothing. And hundreds of thousands are being asked to volunteer to help the NHS for free. Might it not be a better plan to ay people to work for the NHS? After all, that is what we have been needing the government to do for a decade. Now we can see why it was needed. But for some reason it is better to pay people to be ready to go back to providing inessential services whenever the time allows.