Coronavirus - worldwide spread and control

[Sid]

The high death rates in northern Italy could also be in part due to high air pollution levels. It's a densely populated and industrialized area.

 

[lunarainbows]

This is pretty scary. From Robert Peston. If we are not being tested how many coronavirus cases are actually there in the UK? The govt haven’t given a proper rationale for not testing.

 

[Simon M]

Full text of imperial paper here https://www.imperial.ac.uk/media/im...-College-COVID19-NPI-modelling-16-03-2020.pdf

Note that the simulation had already been published and shared with UK/US governments

Summary

The global impact of COVID-19 has been profound, and the public health threat it represents is the most serious seen in a respiratory virus since the 1918 H1N1 influenza pandemic. Here we present the results of epidemiological modelling which has informed policymaking in the UK and other countries in recent weeks. In the absence of a COVID-19 vaccine, we assess the potential role of a number of public health measures – so-called non-pharmaceutical interventions (NPIs) – aimed at reducing contact rates in the population and thereby reducing transmission of the virus. In the results presented here, we apply a previously published microsimulation model to two countries: the UK (Great Britain specifically) and the US. We conclude that the effectiveness of any one intervention in isolation is likely to be limited, requiring multiple interventions to be combined to have a substantial impact on transmission.

Two fundamental strategies are possible: (a) mitigation, which focuses on slowing but not necessarily stopping epidemic spread – reducing peak healthcare demand while protecting those most at risk of severe disease from infection, and (b) suppression, which aims to reverse epidemic growth, reducing case numbers to low levels and maintaining that situation indefinitely. Each policy has major challenges. We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over. For countries able to achieve it, this leaves suppression as the preferred policy option.

We show that in the UK and US context, suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members. This may need to be supplemented by school and university closures, though it should be recognised that such closures may have negative impacts on health systems due to increased absenteeism. The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed. We show that intermittent social distancing – triggered by trends in disease surveillance – may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound. Last, while experience in China and now South Korea show that suppression is possible in the short term, it remains to be seen whether it is possible long-term, and whether the social and economic costs of the interventions adopted thus far can be reduced.

 

[Perrier]

Seems a preliminary vaccine is already being tested in humans (in Seattle, USA): https://neurosciencenews.com/covid-19-vaccine-trial-15921/

here's another article: https://nypost.com/2020/03/16/first...bbjaGCmECLofUGl7TL-aWJOj_pOSk3-w08otP82j4dttY

 

[FMMM1]

The high death rates in northern Italy could also be in part due to high air pollution levels. It's a densely populated and industrialized area.

A virus like this doesn't need pollution; it causes respiratory problems which kill - even many of those treated using a ventilator (approx 80% of those treated with a ventilator survive?).

I don't see any reason to focus on air pollution + one of the impacts of the lockdown is lower pollution levels!

Don't worry about air quality - the virus will get you first!

 

[FMMM1]

Full text of imperial paper here https://www.imperial.ac.uk/media/im...-College-COVID19-NPI-modelling-16-03-2020.pdf

Note that the simulation had already been published and shared with UK/US governments

Summary

----We show that intermittent social distancing – triggered by trends in disease surveillance – may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound. Last, while experience in China and now South Korea show that suppression is possible in the short term, it remains to be seen whether it is possible long-term, and whether the social and economic costs of the interventions adopted thus far can be reduced.

This looks like the Goldilocks approach @Jonathan Edwards highlighted i.e. there is a sweet spot where the number of cases can be managed with "only" 1% fatalities. OK pity about the 1% but there's even worse news; if you don't manage the number of cases just right then the death rate increases to 5%. The number of potential cases is huge (36 million in the UK?) and the number of ventilators is ludicrously low -- Goldilocks spot my a-s you can't control the transmission rate to that extent.

Test, test, test and trace - WHO advice - that way you just might manage the demand on ventilators.

How come these folks are right and WHO is wrong --- maybe there's another explanation.

 

[lunarainbows]

They haven’t learnt.

 

[lunarainbows]

Can people in other countries confirm what their doctors and medical staff are wearing when coming into contact with Covid-19 patients? Especially in Italy? I’ve seen pictures of doctors in Italy with full gear on.

Look what’s happening in the UK:

https://www.independent.co.uk/voice...n-italy-china-ventilators-masks-a9404836.html

“The crisis has not yet truly hit and already, we are running out of face masks. This week, Public Health England (PHE) downgraded its guidance for those treating coronavirus patients from a full respirator mask to only a surgical mask, unless we are doing an invasive procedure or administering CPR. This isn’t because PHE decided staff were at any less risk than previously thought – simply because it realised the NHS lacks the necessary respirator masks.

https://www.theguardian.com/world/2...in-the-leadership-a-doctors-story-coronavirus


I work on the infectious diseases ward of a major UK hospital. This has now become a coronavirus ward. It’s a “red zone” – one of the most infectious areas. We have all the patients here who have tested positive, apart from the ones so severely ill they need intensive care. We know that some of our patients will die.

I treat patients who are proven to have coronavirus. One week ago, I was wearing full PPE [personal protective equipment]. That consists of a proper FFP3 mask [offering high respiratory protection], a visor, a surgical gown, and two pairs of gloves.

Now we’ve been told not to bother with any of that. They’ve told us “just treat it as though it’s seasonal flu”. Now we are expected to wear just a normal surgical mask, a pair of ordinary short gloves, and a plastic apron that doesn’t cover all of you like a surgical gown does. I would see other patients around the hospital in the same scrubs, and the scrubs could have coronavirus on them.

But this advice contradicts WHO and European guidance. This guidance says to use full PPE if you are exposed to patients with coronavirus.”



This is terrifying. So many doctors are going to fall ill and at risk of death in the UK. And will then pass it onto patients.

 

[Invisible Woman]

A virus like this doesn't need pollution; it causes respiratory problems which kill - even many of those treated using a ventilator (approx 80% of those treated with a ventilator survive?).

I don't see any reason to focus on air pollution + one of the impacts of the lockdown is lower pollution levels!

Don't worry about air quality - the virus will get you first!

If you live in an area of high air pollution then it is possible you are more likely to already have slightly reduced lung capacity or irritation to the lungs?

If you have any lung issues, having contracted the virus, then breathing in more polluted air will exacerbate the problem.

 

[lunarainbows]

@Jonathan Edwards

Vallance being questioned by Jeremy Hunt in Parliament and giving non answers to all questions including whether any doctors and nurses had been tested for coronavirus Or whether any were in intensive care.

Also he is lying to the questioners as far as I can see. For his rationale on not testing, he says that the tests don’t pick up asymptomatic cases, so they’re not very useful. That’s not true is it?

In South Korea they tested the community and picked up lots of asymptomatic patients. Lots of people tested positive when asymptomatic and that’s how they were identified (I remember cases of one Chinese women taking it out of Wuhan into other provinces).

 

[lunarainbows]

@Jonathan Edwards

Oh and on the question of why doctors in hospitals are now just wearing surgical masks and short gloves, he answers “that’s a case for the NHS”, and “we need to be looking at the proportionality” of any measures they introduce - so apparently if they go too far in any one direction it will hamper other things.

Cannot believe we have a Chief Scientific Adviser who happily says this.

 

[Marco]

This would seem to clarify that it was part of their strategy.

https://www.bbc.co.uk/news/health-51915302

I did say immediate strategy. Herd immunity can only be a long term aspiration as it can only be a benefit if there are future waves.

 

[Marco]

The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed.

We show that intermittent social distancing – triggered by trends in disease surveillance – may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound.

Last, while experience in China and now South Korea show that suppression is possible in the short term, it remains to be seen whether it is possible long-term, and whether the social and economic costs of the interventions adopted thus far can be reduced.

And this is the least risky option?

As I asked previously - when are populations going to be told that lockdown is for 18 months minimum?

 

[Andy]

I did say immediate strategy. Herd immunity can only be a long term aspiration as it can only be a benefit if there are future waves.

I, and I think most people, would read that quote as showing that part of their immediate strategy was to let more people become infected than other countries in order to build up herd immunity. It wouldn't have an immediate effect, as you say, but it certainly was part of their immediate strategy at the time.

 

[Marco]

I, and I think most people, would read that quote as showing that part of their immediate strategy was to let more people become infected than other countries in order to build up herd immunity. It wouldn't have an immediate effect, as you say, but it certainly was part of their immediate strategy at the time.

Of course you would.

 

[FMMM1]

@Jonathan Edwards

Vallance being questioned by Jeremy Hunt in Parliament and giving non answers to all questions including whether any doctors and nurses had been tested for coronavirus Or whether any were in intensive care.

Also he is lying to the questioners as far as I can see. For his rationale on not testing, he says that the tests don’t pick up asymptomatic cases, so they’re not very useful. That’s not true is it?

In South Korea they tested the community and picked up lots of asymptomatic patients. Lots of people tested positive when asymptomatic and that’s how they were identified (I remember cases of one Chinese women taking it out of Wuhan into other provinces).

Keep coming back to WHO advice --- TEST, TEST, TEST

I haven't looked but I think the South Korean's found a lot of people in their 20s who were infectious but not symptomatic. Yes, they tested positive for the virus; so they are identifiable; also they are contagious. I would have thought this was a good reason to test all medical staff (routinely) and everyone who has been in contacted with an infected person (regardless of symptoms). As the WHO have advised, if you can't see a fire, you can't fight it.

Does anyone know how the petition, for testing for medical staff, operates; is there a charge for supporting it? If there's a charge then I suggest skipping it. There's a WHO caronavirus appeal I could donate to instead!

As at @Jonathan Edwards said maybe the UK Government should consider that people, who don't speak English at breakfast, may still have something useful to impart!

Distancing the Government from decisions, e.g. the NHS decides what protective wear is available, is just buck passing --- the Government can advise/direct.

 

[Andy]

As I asked previously - when are populations going to be told that lockdown is for 18 months minimum?

I'm not sure why you are asking us.

However, their modelling report says

Our projections show that to be able to reduce R to close to 1 or below, a combination of case isolation, social distancing of the entire population and either household quarantine or school and university closure are required (Figure 3, Table 4). Measures are assumed to be in place for a 5-month duration.

 

[Andy]

Of course you would.

Yes, because most reasonable people would.

 

[lunarainbows]

Keep coming back to WHO advice --- TEST, TEST, TEST

I haven't looked but I think the South Korean's found a lot of people in their 20s who were infectious but not symptomatic. Yes, they tested positive for the virus; so they are identifiable; also they are contagious. I would have thought this was a good reason to test all medical staff (routinely) and everyone who has been in contacted with an infected person (regardless of symptoms). As the WHO have advised, if you can't see a fire, you can't fight it.

Can anyone send a link to the online petition for testing for front line medical staff - crazy that you have to petition for that!

As at @Jonathan Edwards said maybe the UK Government should consider that people, who don't speak English at breakfast, may still have something useful to impart!

Distancing the Government from decisions, e.g. the NHS decides what protective wear is available, is just buck passing --- the Government can advise/direct.

Change petition: http://chng.it/cSbWNtx4DX

I know. I would’ve thought the WHO conference would’ve got through to the UK at least a little bit. Apparently not. Frankly it’s unbelievable we are in this situation.

 

[lunarainbows]

@Marco did you miss the fact that the govt’s entire theory has been discredited and shown to be a sham last night, and the fact it’s been all over every news channel today?