Coronavirus - worldwide spread and control

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I realise I have missed about thousand posts so these points may have been covered before.

However, here are some thoughts and, more importantly, a question about the best way forward.

Some assumptions:
1. It is not possible to put the genie back in the bottle, it is about how best to manage the epidemic.
2. The only effective way to curtail spread of the virus involves social distancing, which has a high economic and social cost.
3. At some point, these restrictions need to be relaxed at which point things will kick off again.
4. China is just starting this process. Will the number of cases explode or can they be managed to a low level?

See this graph of Spanish flu cases, showing how the second much bigger peak occurred when Restrictions were relaxed. This seems to be used as evidence that containment isn't possible.
0B9B5871-0D41-4A1B-9AFD-7B1EA0B998A7.jpeg
5. There probably won't be a vaccine until next year.
6. Health services have no spare capacity in the winter so it is easier to manage cases outside that time.
7. If health systems have enough capacity, mortality rates might be around 1%. If they don't, it is more likely to be 3% or higher.

It is unlikely that any health system will be able to acquire large numbers of extra respirators, which appeared to be the key bit of kit to save lives.
7. Very little is known about the virus and how it will behave – including if herd immunity is possible or what proportion of the population must get the virus to achieve it.

As far as I can tell, there seemed to be two broad strategies to handle things, which might be described as the China approach and the UK approach. Though I might not have described either approach right.

A. "China approach" keep the lid on things until a vaccine is available.

Is it possible to relax things enough so the economy can get going again and people can get on with their lives to some extent while still stopping a massive outbreak of the virus? And can this be sustained until a vaccine is available?

B. "UK approach" assumes the "China approach" can't be done and so the best approach is to slow the virus down to have a reduced, more manageable and broader peak to make it easier for the NHS to cope and also to get it all over with before winter hits

The aim is also to achieve herd immunity with the assumption this means that at least 60% of people contracting the virus and also the assumption it won't be higher than 80%.

As far as I can tell, even with the broader peak, the NHS won't have anything like enough capacity to handle sending people getting infected. As a result, a lot of people will die.

However, if the U.K government is right, and it isn't possible to keep a lid on things, this might still be a better option than delaying the outbreak so that it runs into the winter (i.e. a lot of people die anyway).

The "UK approach" also has the least economic pain because things will be over a bit much more quickly than trying to keep a lid on everything. And most of people who die are economically inactive (and impose costs on the State by being alive and claiming benefits/pensions/using health services a lot).

So, am I right in thinking those are the two broad strategies being pursued. And do we have any evidence as to which is right?
 
Lucibee said:
There was this paper from 2009...
Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up.
https://www.ncbi.nlm.nih.gov/pubmed/20008700/
Click to expand...

They were also assessed for the presence of chronic fatigue by using (1) the modified criteria for chronic fatigue syndrome (CFS) according to the Centers for Disease Control and Prevention (CDC) (1994 version),15 in which the exclusion criteria for psychiatric disorders were omitted, and (2) a self- reported Chinese version of the Chalder Fatigue Questionnaire16 (the questionnaire was translated from English to Chinese then back from Chinese to English).
Click to expand...

Unfortunately they use the Reeves definition

This was interesting though

Given the commonness of chronic fatigue symptoms among SARS survivors and its occurrence independently of the psychiatric morbidities, the etiology and pathophysiologic mechanisms should be investigated. In this regard, there has been postulation about the possible involvement of cortisol status and chronic fatigue.19 Among SARS survivors, most were treated with high doses of corticosteroids during the acute infection phase of the disease, and some of them continued to be treated with steroid replacement therapy during the recovery phase. Hypocortisolism was reported in almost 40% of SARS survivors 1 year after the infection.
Click to expand...


I suspect there is a greater number of people with chronic fatigue in SARS patients, but wether it's me/cfs or not, I would wait for a better definition to be used before making that judgment. Btw - I don't think it would bode well for us at all, I'm not sure anyone with post-SARS fatigue is getting a lot of help. I suspect if even a good number of people with covid got chronic fatigue or me/cfs they would be waiting decades for help and recognition.
 
Oh dear. Robert peston’s at it again.

What is it with Robert Peston and his weird role of being an unofficial breaking-news-spokesperson for Boris, before Boris actually says it in public? Like he’s testing the ground to see if the public like it? This has been released after the Open Letter by scientists I posted above. I presume it’s in response to the open letter.

https://www.itv.com/news/2020-03-14...ime-style-mobilisation-to-combat-coronavirus/

...What do you think? It’s too late. “Sometime after next week”. “For a few weeks”. “Temporary”.

There’s no “timetable” for things. China had school closures for months. I don’t understand this government and it’s focus on things being at the right time and for the right length of time.
 
Simon M said:
So, am I right in thinking those are the two broad strategies being pursued. And do we have any evidence as to which is right?
Click to expand...

Actually I think almost all those points are based on false premises, @Simon M.
I think stopping the epidemic is entirely possible. At least as possible as winning a world war. It just requires courage and level headedness. The economic impact of this is going to be the same whatever strategy is used. The structure of commerce as we know it will be wiped clean and have to start again - just as in the last world war. That being the case the ethical imperative is to reduce cases as much as possible. I am increasingly convinced that this is not actually too difficult. You just go in to lockdown and the virus dies. You close all borders. Countries that cannot achieve adequate lockdown will suffer larger numbers of cases but in the end the virus will die out.

I have talked to a lot of people in the field over the last few days. The only sensible analysis is that the UK policy is the worst possible bungle. And I do not say that out of vested interest because it would actually be very convenient for me if the epidemic got finished with while I am hiding away in the country. My daughter would get it and could nurse us if we did get ill.

Edit: And as far as we know seasons are not relevant.
 
Simon M said:
I realise I have missed about thousand posts so these points may have been covered before.

However, here are some thoughts and, more importantly, a question about the best way forward.

Some assumptions:
1. It is not possible to put the genie back in the bottle, it is about how best to manage the epidemic.
2. The only effective way to curtail spread of the virus involves social distancing, which has a high economic and social cost.
3. At some point, these restrictions need to be relaxed at which point things will kick off again.
4. China is just starting this process. Will the number of cases explode or can they be managed to a low level?

See this graph of Spanish flu cases, showing how the second much bigger peak occurred when Restrictions were relaxed. This seems to be used as evidence that containment isn't possible.
View attachment 10160
5. There probably won't be a vaccine until next year.
6. Health services have no spare capacity in the winter so it is easier to manage cases outside that time.
7. If health systems have enough capacity, mortality rates might be around 1%. If they don't, it is more likely to be 3% or higher.

It is unlikely that any health system will be able to acquire large numbers of extra respirators, which appeared to be the key bit of kit to save lives.
7. Very little is known about the virus and how it will behave – including if herd immunity is possible or what proportion of the population must get the virus to achieve it.

As far as I can tell, there seemed to be two broad strategies to handle things, which might be described as the China approach and the UK approach. Though I might not have described either approach right.

A. "China approach" keep the lid on things until a vaccine is available.

Is it possible to relax things enough so the economy can get going again and people can get on with their lives to some extent while still stopping a massive outbreak of the virus? And can this be sustained until a vaccine is available?

B. "UK approach" assumes the "China approach" can't be done and so the best approach is to slow the virus down to have a reduced, more manageable and broader peak to make it easier for the NHS to cope and also to get it all over with before winter hits

The aim is also to achieve herd immunity with the assumption this means that at least 60% of people contracting the virus and also the assumption it won't be higher than 80%.

As far as I can tell, even with the broader peak, the NHS won't have anything like enough capacity to handle sending people getting infected. As a result, a lot of people will die.

However, if the U.K government is right, and it isn't possible to keep a lid on things, this might still be a better option than delaying the outbreak so that it runs into the winter (i.e. a lot of people die anyway).

The "UK approach" also has the least economic pain because things will be over a bit much more quickly than trying to keep a lid on everything. And most of people who die are economically inactive (and impose costs on the State by being alive and claiming benefits/pensions/using health services a lot).

So, am I right in thinking those are the two broad strategies being pursued. And do we have any evidence as to which is right?
Click to expand...

Im not sure if you read my earlier post about the open letter signed by many scientists in the UK about the approach -



There was also an open letter from behavioural scientists too - 100 of them - expressing deep concern with the UK.

https://sites.google.com/view/covidopenletter/home
 
Sounds like the UK government is doing an U-turn, or was this what they intended all along but just communicated poorly?

https://www.itv.com/news/2020-03-14...ime-style-mobilisation-to-combat-coronavirus/

But only quarantining the elderly might not be enough. A not insignificant portion of cases is under 70. In Italy there are increasingly cases between 25 and 40 (a minority, but I think not so rare that an unchecked spread wouldn't overwhelm the healtcare system). It seems that the older people are hit first and worst and then you see more younger ones.
 
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strategist said:
Sounds like the UK government is doing an U-turn, or was this what they intended all along but just communicated poorly?

https://www.itv.com/news/2020-03-14...ime-style-mobilisation-to-combat-coronavirus/

But only quarantining the elderly might not be enough. A not insignificant portion of cases is under 70. In Italy there are increasingly cases between 25 and 40 (a minority, but I think not so rare that an unchecked spread wouldn't overwhelm the healtcare system). It seems that the older people are hit first and worst and then you see more younger ones.
Click to expand...

Yes I just posted my thoughts above. I think it’s actually in response to the open letter done by scientists, that’s why it was released less than an hour after the letter. I mean; just 2 days ago he was saying “we absolutely will not close schools now”, “it’s not the right time”, “business as usual”, it was all about just washing hands and 7 days of self isolating. and then suddenly an article about this 2 days later.

Edit I agree with you on your thoughts on quarantining the elderly. They are still continuing with herd immunity by the looks of it, just with also the “cocooning” of the elderly.

It seems to coincide with this, which is still the herd immunity theory.
 
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Simon M said:
So, am I right in thinking those are the two broad strategies being pursued. And do we have any evidence as to which is right?
Click to expand...

I think that your view on the different strategies sounds about right, but with the addition of the UK strategy being influenced by the view that people will 'fatigue' of social isolation after a few weeks, so that policy should only be applied when it appears that infections are peaking.

As for your starting assumptions, I don't know about them.

re evidence: It looks like China successfully cut down new infections, but we can't yet know if they'll shoot up again in the future.
 
Simon M said:
See this graph of Spanish flu cases, showing how the second much bigger peak occurred when Restrictions were relaxed. This seems to be used as evidence that containment isn't possible.
0b9b5871-0d41-4a1b-9afd-7b1ea0b998a7-jpeg.10160
Click to expand...

I note this has been doing the rounds over the past few days. However...
Second wave of Spanish flu was likely due to a mutated strain of the influenza virus (and it's unclear whether it was related to the first wave, which may have just been seasonal flu), rather than a second peak of the nature that is being described in the case of COVID-19. See this paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477554/ and here https://www.history.com/news/spanish-flu-second-wave-resurgence
 
Simon M said:
I realise I have missed about thousand posts so these points may have been covered before.

However, here are some thoughts and, more importantly, a question about the best way forward.

Some assumptions:
1. It is not possible to put the genie back in the bottle, it is about how best to manage the epidemic.
2. The only effective way to curtail spread of the virus involves social distancing, which has a high economic and social cost.
3. At some point, these restrictions need to be relaxed at which point things will kick off again.
4. China is just starting this process. Will the number of cases explode or can they be managed to a low level?

See this graph of Spanish flu cases, showing how the second much bigger peak occurred when Restrictions were relaxed. This seems to be used as evidence that containment isn't possible.
View attachment 10160
5. There probably won't be a vaccine until next year.
6. Health services have no spare capacity in the winter so it is easier to manage cases outside that time.
7. If health systems have enough capacity, mortality rates might be around 1%. If they don't, it is more likely to be 3% or higher.

It is unlikely that any health system will be able to acquire large numbers of extra respirators, which appeared to be the key bit of kit to save lives.
7. Very little is known about the virus and how it will behave – including if herd immunity is possible or what proportion of the population must get the virus to achieve it.

As far as I can tell, there seemed to be two broad strategies to handle things, which might be described as the China approach and the UK approach. Though I might not have described either approach right.

A. "China approach" keep the lid on things until a vaccine is available.

Is it possible to relax things enough so the economy can get going again and people can get on with their lives to some extent while still stopping a massive outbreak of the virus? And can this be sustained until a vaccine is available?

B. "UK approach" assumes the "China approach" can't be done and so the best approach is to slow the virus down to have a reduced, more manageable and broader peak to make it easier for the NHS to cope and also to get it all over with before winter hits

The aim is also to achieve herd immunity with the assumption this means that at least 60% of people contracting the virus and also the assumption it won't be higher than 80%.

As far as I can tell, even with the broader peak, the NHS won't have anything like enough capacity to handle sending people getting infected. As a result, a lot of people will die.

However, if the U.K government is right, and it isn't possible to keep a lid on things, this might still be a better option than delaying the outbreak so that it runs into the winter (i.e. a lot of people die anyway).

The "UK approach" also has the least economic pain because things will be over a bit much more quickly than trying to keep a lid on everything. And most of people who die are economically inactive (and impose costs on the State by being alive and claiming benefits/pensions/using health services a lot).

So, am I right in thinking those are the two broad strategies being pursued. And do we have any evidence as to which is right?
Click to expand...

Yip i.e. I think you are right; i.e. the UK Government seems to be going for herd immunity. You're also correct regarding the respirators; I assume that this is what has happened in Italy - the health system cannot cope (shortage of respirators), so the death toll rises.

Not having capacity, in the health care system in the UK, does not seem like a good idea --- efficient yes but not good when it comes to a health crisis on this scale.
 
Lucibee said:
I note this has been doing the rounds over the past few days. However...
Second wave of Spanish flu was likely due to a mutated strain of the influenza virus (and it's unclear whether it was related to the first wave, which may have just been seasonal flu), rather than a second peak of the nature that is being described in the case of COVID-19. See this paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477554/ and here https://www.history.com/news/spanish-flu-second-wave-resurgence
Click to expand...

That seems fairly significant!

If that's right, then presumably the best thing to do to avoid a 'second wave' would be to do everything possible to contain the virus, prevent it spreading, and reduce the chances of it mutating. The opposite of our current plan.
 
large donner said:
So what you are saying is there was no test for it before the end of 2019?
Click to expand...

No I don't think that applies. SARS stands for severe acute respiratory syndrome if I remember rightly. Until Nov 2019 nobody much had a severe acute respiratory syndrome. Then a cluster of people did and some died. The illness seems to have a typical pattern in a lot of cases - acute fever and dry cough. That is quite unusual. Also there is pneumonia, which is unusual without a findable cause. So there was no SARS2/Covid-19 before Nov 2019, or at least vanishingly few cases.
 
When the test was developed was the efficacy of the test proven by blind testing samples over and over in different labs?

How many people whom have tested positive had multiple of their samples taken at the same time and tested blindly in separate labs?
 
Esther12 said:
That seems fairly significant!

If that's right, then presumably the best thing to do to avoid a 'second wave' would be to do everything possible to contain the virus, prevent it spreading, and reduce the chances of it mutating. The opposite of our current plan.
Click to expand...

SARS-coronaviruses are not necessarily like influenza viruses. As far as we know, they do not mutate at the same rate or in the same way as flu. But we also know next to nothing about how much immunity we generate to them. Containment at the very least buys us time. I can fully understand why so many scientists and disease modellers are jumping up and down (sometimes "hysterically") in frustration at the games our government is prepared to play with the population.
 
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