Coronavirus - worldwide spread and control

https://twitter.com/user/status/1244736103627849730

 

Data reported from Iceland:

https://www.covid.is/data

1135 confirmed infections;

2 deaths at this time, with 11 currently in ICU.

It appears that the company deCODE has been testing non-hospitalized samples so the stacked charts might give some useful info on overall infection rates.

 

They've significantly ramped up the number of tests they can do in a day and have just started testing everybody who presents with symptoms (but not asymptomatic people though there is talk of possible random testing in the future). Up until now it was only people who'd been overseas or who had had close contact with an infected person that could get tested.
They're doing drive-through testing and on the news they showed very long queues of cars at a testing station. So for now Kiwis seem keen to get tested, at least in a drive-through that doesn't involve unnecessary contact with others.

 

https://twitter.com/user/status/1245249263896010755

 

This is absolute GOLD!

 

My feeling is that we really don´t understand the situation.

It is absolute necessary to have for further assessment:

• mortality of all diseases - and comparing it to years in the past
• mortality of pneumonia - and comparing it to years in the past
• percentage of people in the population who have been in contact with the virus

My feeling is also that the lockdown is not effective. From countries that have been/are doing a lockdown only China shows success.

• Japan does not too bad - no lockdown
• Singapore does not too bad - no lockdown
• Korea does good - no lockdown
• Sweden doesn´t do anything - until now at least not worse than other countries

Sweden as well as Iceland did have cases end of february (please correct me, if I am wrong).


Can it be said that the lockdown is effective in:

• Italy
• Spain
• France

Other countries have not already reached a lockdown for two weeks, and cannot be assessed - though the incubation time is not necessary two weeks, it also can be only 5 or 6 days.

It would be interesting to know since when the Italian started to wear masks.

It is not clear if the decline is due to other factors, the season, pollution or simply that people who have been vulnerable to die from pneumonia or to die at all from any disease within a one or two years time now have died. [And/or that the mortality rate was low in the past one-two years.] How is the situation in Spain?

Hopefully you note that I am not saying that there shouldn´t be an improved care. I am talking about the assessment of the whole situation with regard of timelines of months and years.

It would be cynical to weight economy against health (instead we all could stick together). But the health system will need an economy for being able to exist (I personally don´t see that we are being able to do in a complete new manner). In addition a shutdown of life will do harm as well, I can´t share any optimism that this will not be the case.


My feeling is that something with this virus is special, maybe its vulnerability from transmission under certain circumstances, or maybe in terms of the number of viruses that are transmitted.

 

For some time I lived in the south of Germany. Occasionally sand from the Sahar was coming over the Alpes, and even manifested itself on cars asf.

This might be a factor, I speculate.


[Italy and Spain are in close reach to the Sahra].

 

China pivots to tackle 'silent' Covid-19 carriers as US says a quarter of cases may have no symptoms

Authorities in China will release tally of asymptomatic patients and order them into quarantine for 14 days as infections rise again

https://www.theguardian.com/world/2...-says-a-quarter-of-cases-may-have-no-symptoms

 

I just don’t think doctors in the UK will do this. I would have thought that if they were going to, they would have done it already. They’ve been forced to work without protective equipment and with just flimsy aprons and short gloves, been told this is the right standard despite being against the WHO standard and we have seen how doctors in other countries with outbreaks before us, are wearing the right equipment.

and yes once in a while you hear on the TV that they still don’t have equipment and need to crowdfund, and 1 in 4 NHS workers are currently off sick or in self isolation which seems an extraordinarily high number of doctors getting infected, putting themselves and their families at risk, unbelievable almost, yet they still do continue to work without threatening to quit or sue. It may be because they also, seem to be gagged.

https://news.sky.com/story/coronavirus-one-in-four-nhs-doctors-sick-or-in-isolation-11965886

https://www.independent.co.uk/news/health/coronavirus-nhs-uk-doctors-gagged-england-a9433171.html

Coronavirus: NHS doctors ‘gagged’ over protective equipment shortages


Frontline doctors have told The Independent they have been gagged from speaking out about shortages of protective equipment as they treat coronavirus patients – with some claiming managers have threatened their careers.

Staff have been warned not to make any comments about shortages on social media, as well as avoiding talking to journalists, while NHS England has taken over the media operations for many NHS hospitals and staff.

The Independent has seen a series of emails and messages warning staff not to speak to the media during the coronavirus outbreak.

One GP has been barred from working in a community hospital in Ludlow after making comments about the lack of equipment, while another in London said they were told to remove protective equipment they had purchased themselves.

One intensive care doctor, who asked to remain anonymous, raised concerns with their managers about a shortage of protective masks after being told they would have to use less safe surgical masks. They claimed they were later warned in a meeting with trust bosses that their social media profiles would be watched.

The doctor said they were told: “If we hear of these concerns going outside these four walls, your career and your position here will not be tenable going forward.”

 

I agree largely, but I would not be surprised if something happens in Southern Europe. I also think it may be a more subtle thing with medical director committees resigning en masse at the threat of 'loosening restrictions. I think the problem is going to be that even if new infections drop to zero the task of nursing all the cases so far back to being fit to discharge (and not to care homes) may be enough to make it impossible to contemplate such loosening. At present the figures for recovery in the UK are about 1%. That is probably nonsense but I suspect a good number of people will not specialist organ support for weeks or months.

 

I was thinking this when watching news coverage about the NHS before.

https://twitter.com/user/status/1245040880035278851

 

It's not as simple as lockdown or no lockdown.
For example as mentioned eaier in this thread Singapore has taken a lot of extra steps to reduce numbers.
Also Sweden seems to have a laissez-faire approach to the whole thing so I wouldn't pay too much attention to their numbers right now.
There is a question mark over Japans figures due to the Olympics, we might see higher figures coming out soon.

Regarding Italy I would say definitely the lockdown is having an effect. They have had no increase in daily figures for the past week and it even looks like they might be reducing now.
Similarly Spain daily new cases are beginning to flatline.

For me lockdown is definitely effective, the tighter the lockdown the better as Wuhan has demonstrated.

 

by Scott Gottlieb, an exit strategy from the lockdown for the US

National coronavirus response: A road map to reopening

"This report provides a road map for navigating through the current COVID-19 pandemic in the United States. It outlines specific directions for adapting our public-health approach away from sweeping mitigation strategies as we limit the epidemic spread of COVID-19, such that we can transition to new tools and approaches to prevent further spread of the disease.

The authors outline the steps that can be taken as epidemic transmission is brought under control in different regions. They also suggest measurable milestones for identifying when we can make these transitions and start reopening America for businesses and families.

In each phase, the authors outline the steps that the federal government, working with the states and public-health and health care partners, should take to inform the response. This will take time, but planning for each phase should begin now so the infrastructure is in place when it is time to transition."

 

Seems to be authored by Scott Gottleib, fresh faced junior trainee is wishful thinking. No doubt he got paid well to sound optimistic.

 

Labs are used to getting large numbers of specimens, I don't see why there should be contamination to give false positives. Handling these are not different from any others.

Scotland has been testing medical personnel for over a fortnight. My daughter drove up in her car to one of the drive thru stations, was swabbed thru the window by a technician in protective gear and then drove away. Next day she was back at work.

The problem with false positives and negatives comes from the nature of the test, not the tester. The new antibody tests are like a pregnancy test stick, you get a line for IgM which shows a current infection, a line for IgG which shows you have had the virus or a line which is the control and tells you if the test worked.

It is based on the cartridges testing for RSV which have been used successfully for years. Usually such a test would be tested for accuracy, how many false positives how many false negatives and so on but everything is being done in a rush. That is where any problems will come from.

 

Echoes of Temple Grandin?

 

Just now there was a very short interview (Radio Canada) with an Italian doctor (who has just published in the New England Journal of Medicine)--sorry could not catch his name as he spoke very quickly with a heavy Italian accent-- stating that from what they have learned it is important to try and keep the sick at home ( even those quite sick) and to have mobile units going to their houses, and also to have separate hospital-like facilities only for the Covid patients. This he says, is one of the most urgent things they have learned from the Italian experience.

 

Currently the spread of the virus is considered to be by droplets i.e. from an infected person or from a surface which the droplets why have settled onto (I've heard comments about virus being viable after 3 days on stainless steel - food cans? - and plastic).

The Sahara?