Coronavirus - worldwide spread and control

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I also went outside today. I live in a small town so there are no empty streets that had previously been filled. It is unusually quiet however, aside from some children playing and someone gardening.

Very little car traffic by the sounds of it, even an normally fairly busy street. I avoided the main road, opting for a path passing near trees and gardens.

The grocer had customers shopping. I avoided coming even near it. I think it's likely to be a major source of infection. The owner's son has had a cough for a week now but he is young and is unlikely to get anything worse than this. Not long ago the owner herself was saying that this new coronavirus is just a flu. We desperately need tests so that we can tell who actually has this new virus.

We're allowed to leave the house for walks like this, as long as we stay away from other people. Close contact is now only allowed when absolutely necessary.
 
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As well as the letters I shared yesterday, another letter, this time from other researchers, health workers and consultants too, to the UK govt.

https://docs.google.com/forms/d/e/1...fKtkXwCIJXAXKAsJfGYKF2w/viewform?vc=0&c=0&w=1

“Our country’s public health response to Covid-19 is demonstrably different to most other countries’ responses globally and in Europe. As the government has outlined, it is imperative to delay and ‘flatten’ the epidemic curve to ensure the NHS can cope. This is particularly essential for the UK, which according to OECD data, has 2.5 hospital beds per 1,000 population--behind Italy (3.2), France (6.0) and the USA (2.8). There is also no clear indication that the UK’s response is being informed by experiences of other countries in containing the spread of Covid-19. For the above reasons, we request that the government urgently and openly shares the scientific evidence, data and models it is using to inform its decisions on the Covid-19 public health interventions in the UK. This transparency is essential to retain the scientific community, healthcare community, and the public’s understanding, cooperation and trust".

I do wonder why this letter wasn’t reported on the news. It would have been good to put it on, especially as there’s quite a few epidemiologists etc on it.
 
lunarainbows said:
I asked a question on here earlier about if Switzerland / Germany have the same policy as the UK.
I came across this earlier so it seems I’ve answered my own question (about Switzerland at least).

https://www.bloomberg.com/news/arti...o-contain-coronavirus-singapore-minister-says
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In Germany it's a little difficult to make nation wide decisions, so the different states decide on their own.

Each state has closed schools, kindergardens etc. so far. Many bigger cities (Cologne, Berlin etc.) have closed places where people gather (clubs, bars, movie theatres) but keep restaurants and Cafés open because they too have the function of feeding some people.

Gatherings >1000 are forbidden and it's strongly adviced not to have any at all regardless of the number.

We're also recommended to reduce social contact with family etc.

Germany has closed borders with some countries and others have closed theirs with us. So borderwise we're un-Schengened ;-)

Public transport has been somewhat reduced.

Edit: Strategy is still to identify every case and trace contacts to quarentine. Don't know if that's actually still possible. Mortality rate still very low.
 
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Cheesus said:
Leaked Public Health England document shows they expect the crisis to last until Spring 2021 and for the virus to infect 80% of the UK population.

https://www.theguardian.com/world/2...il-spring-2021-and-could-see-79m-hospitalised
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Hmm.

To me, suspicious timing. In the sense over the past weekend there’s been a bit furore over the herd immunity plan and how 60% of people infected could mean X number of deaths.

Then yesterday we get a “leak” to Robert Peston. Then Hancock writes an article in the telegraph. Then an article in the Sun appears. Then today we were told we would get more news but we didn’t.

Now, another leak saying 80% of people will get infected anyway (and in my view, perhaps makes it so people don’t question the fact the govt wants the virus to infect 60% of us now through herd immunity).

I would like to hear from the govt directly on what they’re doing and why. Not these leaks to newspapers and to unaccountable journalists.
 
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?
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@Simon M @Jonathan Edwards
The recommendation from the WHO* is to detect and trace i.e. to break the transmission.

I think the other thing is that you can stop transmission but you must detect and trace - the UK isn't carrying out a mass testing program - you only get tested if you are being admitted to hospital - how many people would not be tested --- 90% of cases?

The WHO advice is 'Don't let this fire burn' - is the UK governments approach to 'Let this fire burn'?

*
https://www.weforum.org/agenda/2020/03/world-health-organization-latest-coronavirus-covid19-news/
 
FMMM1 said:
The WHO advice is 'Don't let this fire burn' - is the UK governments approach to 'Let this fire burn'?
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I am afraid it is.
I have. done my own mathematical modelling and my calculation is that an infection rate that the NHS could just about cope with in the way that Italy has (i.e. not really coping and utter misery) would take about ten years to play out. Anything shorter and thousands of youngish adults will die unnecessarily. The good news is that this will become apparent within a week or so and we will fall in line. The current advisors should be sacked. Whether they will be or not is another matter.

I note the the prime minister met with the person obviously most important for looking after the British people - the crown prince of Saudi Arabia. The article says 'Both leaders agreed on the need for an internationally co-ordinated response to the outbreak, particularly on developing a vaccine and limiting the economic disruption caused by the pandemic.' That says it all I guess. But Brits are a bit more sensible than the PM realises I think.
 
Jonathan Edwards said:
I am afraid it is.
I have. done my own mathematical modelling and my calculation is that an infection rate that the NHS could just about cope with in the way that Italy has (i.e. not really coping and utter misery) would take about ten years to play out. Anything shorter and thousands of youngish adults will die unnecessarily. The good news is that this will become apparent within a week or so and we will fall in line. The current advisors should be sacked. Whether they will be or not is another matter.

I note the the prime minister met with the person obviously most important for looking after the British people - the crown prince of Saudi Arabia. The article says 'Both leaders agreed on the need for an internationally co-ordinated response to the outbreak, particularly on developing a vaccine and limiting the economic disruption caused by the pandemic.' That says it all I guess. But Brits are a bit more sensible than the PM realises I think.
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Do you have any idea Jonathan Edwards on what kind of modelling that the governments advisers may have done? Knowing the capacity of the NHS and how few beds it has, and the % patients who need intensive care, and the exponential growth, it seems obvious to most that it wouldn’t work. And knowing you’ve done the modelling, that confirms what a lot of us suspect.

Is there any kind of modelling that they could have done, that would have shown a different result? They seem adamant that they could flatten the curve this way. I know nudge unit stuff comes into it but there must still be some mathematical and infectious modelling somewhere. I’ve been trying to find out info on this but have failed. All I can find is references to SAGE ( a scientific advisory group), which works with scientists I think.
 
jI'm not sure that has been posted already.

Don’t “Flatten the Curve”, stop it!

"There will be some countries that do not have the necessary infrastructure to implement severe containment measures, which include widespread testing, quarantines, movement restrictions, travel restrictions, work restrictions, supply chain reorganization, school closures, childcare for people working in critical professions, production and distribution of protective equipment and medical supplies.

This means that some countries will stomp out the virus and others will not. In a few months from now, the world will turn into red zones and green zones, and almost all travel from red zones into green zones will come to a halt, until an effective treatment for COVID-19 is found.

Flattening the curve is not an option for the United States, for the UK or Germany. Don’t tell your friends to flatten the curve. Let’s start containment and stop the curve."
 
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Trish said:
The nudge stuff seems to me to be pseudoscientific twaddle. Nobody in the UK government and its scientific advisers seems to realise you can't nudge a virus.
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Yea it says here "Testing for coronavirus is not needed if you're staying at home" [https://www.nhs.uk/conditions/coronavirus-covid-19/].

Nudge theory might work to e.g. get more people to lift the phone and get tested --- do the right thing. The problem here is that there is no testing available for those staying at home. OK if you live alone, have no visitors and can get by for a week; however, most people will live with someone --- have visitors ---go out. We need systems for diagnosis/isolating those who have the virus and are contagious --- not nudge theory.
 
Phil Hammond: I work in the area of post-viral fatigue, so I’m expecting a spike in cases when this is all gone away – and we know that when you’re frightened and when you pick up a virus infection it can affect your immune system and make the infection symptoms worse and increase your risk of post-viral fatigue afterwards. So there’s clearly a delicate balance between appropriate concern and fear, and we have to make sure that we get that right, because otherwise the psychological consequences of all this – we know that mind and body and environment are inextricably linked –could end up doing a lot of harm in addition to the physical consequences.
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This is irresponsible stuff. His certainty is disturbing.
 
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From what I have seen so far, the best option is hard social distancing, not strict quarantining of those not yet infected, or at raised exposure risk.

Confining those groups to their house is not going to work. People need to get out, at least for short periods. Fresh air and sunlight, and a change of scenery, are definitely good for your general physical and mental health. There shouldn't be much risk in that, as long as we keep at least 2m (6 feet) away from each other, which is easy to do walking down a non-crowded street.
 
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Rosie said:
We can't rely on people doing the right thing and isolating after coming into our country.
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In our state of Victoria, if someone coming into the country does not self isolate for two weeks they face up to a $20,000 fine and imprisonment. I am not sure about the other states.

One unfortunate lady on the news just arrived for a two week holiday.
 
Leila said:
jI'm not sure that has been posted already.

Don’t “Flatten the Curve”, stop it!

"There will be some countries that do not have the necessary infrastructure to implement severe containment measures, which include widespread testing, quarantines, movement restrictions, travel restrictions, work restrictions, supply chain reorganization, school closures, childcare for people working in critical professions, production and distribution of protective equipment and medical supplies.
Click to expand...

This was my optimistic expectation weeks ago, when they were still containing it with contact tracing and selective quarantines. Of course some people simply ignored common sense and well, we are where we are now now.
 
alex3619 said:
In our state of Victoria, if someone coming into the country does not self isolate for two weeks they face up to a $20,000 fine and imprisonment. I am not sure about the other states.

One unfortunate lady on the news just arrived for a two week holiday.
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Good to hear your state is laying it down like that. I don't think our government has gone as far as fining yet.

Two young tourists who arrived here in NZ this morning told a reporter they weren't going to isolate and were going to travel the country. I imagine they will be found and deported after this being on the news this morning.

Another man who arrived from overseas had taken a Covid-19 test in his country before he left! - and while sitting at a café here in NZ he found out that the test was positive. Some people just don't care and there could be many like that.
 
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Snow Leopard said:
This was my optimistic expectation weeks ago, when they were still containing it with contact tracing and selective quarantines. Of course some people simply ignored common sense and well, we are where we are now now.
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It all depends on how infectious this is. What is the doubling period in the early phases? I hope its low. (PS low not in number, but in it takes a long time to double ... so high, I guess, doh)

Worst case scenario I have seen so far is that the doubling period for infection is only two days. This was a comment by some doctor or other, I think in the UK, and I do not want anyone to thing it is accurate. It is probably much less infectious, but then again it might even be worse. That is for the epidemiologists to figure out.

I want to make a comment on numbers, and numbers in the community. This commentary is purely illustrative, I don't want anyone to think its an accurate representation. The numbers chosen are just selected, not necessarily factual. This is purely to demonstrate the issue with pandemic exponential growth, and while strict early containment is critical, and any delay can lead to total failure.

Suppose one person, just infected, arrived in your area. Suppose a doubling period of 2 days, and incubation period of 14 days, which is the time they have chosen for quarantines. By the time that one person reaches their 14 days, during which they might still not be particularly symptomatic (or could have died), there would be about 128 infected people (actually 129, doh, but I am looking at increase not total numbers). Yet only some will be symptomatic, so the total numbers apparent should be much lower .. maybe even one.

During the next 14 days this could increase by 16,384 people, but maybe only 128 are symptomatic. The next 14 days could see 2,097,152 new people infected. The next two weeks could lead to another 268,435,456. I am not going to do the full math, could not be bothered in an hypothetical, but that last two hundred million odd might lead to over 8 million deaths.

So in two months most countries on Earth would be mostly infected with millions dead. That is exponential growth. It is also a reason why the doubling period is much longer than 2 days, we do not see those numbers yet, nor anything close.

Now infection rates change this equation. Lower the infection rate and you massively slow growth. This could be because the natural infection rate leads to much lower growth with a much longer doubling period, isolation and separation, cleaning of hands and surfaces, or any other measure. Slow the rate, you slow the growth.

Now lots of people have talked in various places about treatment or vaccine. There is ongoing work on this. However there is another big issue, discussed a bit, which is herd immunity. Viruses can burn their infection out because the infection rate declines as more and more people have already had it. This is how viruses die out in natural infections. This is unacceptable here though because the death toll might be so high.

These are all strategies of vector denial.

I keep coming across a guesstimate of about 80% peak infection rate. I have no idea if that is right. It sounds too high to me. However if we presume a 3% death rate that could lead to over 160 million dead before the end of the year.

We need to reduce the rate of infection by all means necessary, while we wait for treatment and cure. We need to do this aggressively.

For those panic buying, in the huge crowds, and most likely not ME patients, they may be infecting themselves. The virus is global now. We need to improve home delivery services for essential goods, not cram into stores to buy food, non-essential goods, and of all things, guns (the latest panic buy in the US).
 
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Rosie said:
Another man who arrived from overseas had taken a Covid-19 test in his country before he left! - and while sitting at a café here in NZ he found out that the test was positive. Some people just don't care and there could be many like that.
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In that case, what I read was that the man had returned to Australia from France and was tested as a matter of course because he had travelled from Europe. He felt fine and he already had a flight booked to see his son in NZ. I think it's a bit understandable that he thought he was ok to travel; he didn't feel unwell before travelling. Even now, after receiving the information that the test was positive and in isolation in his hotel room, the report said that he feels fine.

Things are changing so fast and the messages haven't been clear; I don't think this man didn't care. I think what that story illustrates, and the South Korean experience tells us too, is that mass testing is really important. If that man had not been routinely tested (i.e. if he had only been tested when he reported symptoms) then he would have continued on happily, potentially infecting people. The requirements for self-isolation now in place here and in Australia will help, but I imagine that people who know they have the infection will be much stricter about self-isolating than many of those who don't.
 
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