Coronavirus - worldwide spread and control

[lunarainbows]

Controlling spread at airports / international travellers

I simply do not understand how this decision can be defended anymore. Especially when compared to what other countries are doing.

London coronavirus: Matt Hancock defends decision not to test for Covid-19 at airports as Heathrow and Gatwick remain open

https://www.mylondon.news/news/heal...m_campaign=sharebar&__twitter_impression=true

“Around 15,000 passengers are still entering the country every day, and no routine testing for Covid-19 is being carried out.

Speaking on Good Morning Britain on Thursday (April 16), Health Secretary Matt Hancock explained that airport testing has not been made available due to the "low amount" of people entering the country

When asked how many people have flown into UK airports this week, Mr Hancock said: "It's about 15,000 a day at the moment."

He added: "It matters that we reduce the rate of transmission. At the current rate of transmission here, the scientists say that the epidemiological impact of keeping the travel open is very small because of the already large transmission””

Many countries now have enforced quarantine for arrivals into the country. Yet here flights from hotspot areas at the time - were never restricted, and still continue, and now there are no isolation rules at all.

Then, there’s this:
Exclusive: 'Test passengers now!' Plea from Heathrow Border Control officer who says staff don't have enough protection

https://www.itv.com/news/london/202...-who-says-staff-don-t-have-enough-protection/

“ITV News London can reveal that staff at Heathrow have serious concerns that the airport is not safe and lives are being put at risk.

There is currently no coronavirus testing of passengers arriving from overseas. One Border Force officer also says workers at Heathrow don't have enough safety equipment to protect them.”

 

[Jonathan Edwards]

To me it seems that it´s the elimination strategy that is more academic like.

On the contrary, the elimination strategy is the only possible one for a disease that is not tolerable on an endemic basis - which applies to TB, measles, meningitis, typhoid, cholera, edolaand a hundred others. In all these cases the elimination strategy is then we use. It may not be completely successful in every country but that does not change the fact that it is the only workable strategy. We do not use herd immunity based on infection for any disease of this sort.

 

[spinoza577]

On the contrary, the elimination strategy is the only possible one for a disease that is not tolerable on an endemic basis - which applies to ...

I havn´t much knowledge on the pathogens, I think TB remains mostly silent and is found in one 3rd of the world population, for measles there is an vaccine, ebola is very deadly. For sure I agree that there are a lot of pathogens that need urgently to be restricted and the best would be to eradicate them (if it only were possible enough).

I think with corona the situation is still unclear. Potential symptoms are unpleasant and take a lot of and a long effort to get treated. Obviously in some areas hospitals are overwhelmed (though this apparently happens also from the flu).

On the other hand, only statistics and forensics will tell what´s going on. Just to test people who are likely enough to have the virus, and to count all deaths positive for corona will hardly give an adequate picture.

I am not already convinced that we see a real catastrophe compared to the normal situation, though it might be so. Whatever it will turn out to be (and I would think that in two weeks we will have a picture), the idea that the virus will be able to be eradicated in today´s world seems to me like playing with tin soldiers.

 

[Jonathan Edwards]

I am not already convinced that we see a real catastrophe compared to the normal situation

I have no idea why not. Loved ones are dying left right and centre. Health care workers are dying. The health care systems are completely non-functionaland people are dying foremother conditions unnecessarily or just not getting essential treatment. The economic costs are catastrophic. What more could you be waiting for?

It is perfectly clear that a significant number of people die from this virus long before their due time and many others have a terrifying illness. Almost certainly the long term complications will become a major healthcare burden - maybe as big problems diabetes or rheumatoid disease. From what we hear many of those who have survived are still seriously compromised.

There is absolutely no way that this can be considered an illness that we can tolerate as endemic.

I find it very peculiar that just because a few ill-informed people suggested at the beginning that Covid1§9 is a mild thing a bit like a cold that people are still thinking that a credible viewpoint.

Maybe ask the UK Prime Minister how he feels about the illness?

 

[Hoopoe]

Another county that thought it was above a pandemic seems to realize it made a mistake.

Sweden: 22 Scientists Say Coronavirus Strategy Has Failed As Deaths Top 1,000

https://www.forbes.com/sites/davidnikel/2020/04/14/sweden-22-scientists-say-coronavirus-strategy-has-failed-as-deaths-top-1000/

 

[spinoza577]

@strategist Sweden might actually say something other, we´ll see.

The following boards might be more accurate than the ones on the worldometer (I don´t know if they have been issued by Johms Hopkins Univ.), as there was very low deaths over eastern.

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Sweden
Note: Data is compiled by Folkhälsomyndigheten at 11:30 (UTC+02:00) each day. Reports of new cases and deaths to Folkhälsomyndigheten might be delayed by up to several days, especially around weekends, possibly introducing delays in reported number of cases for the last few days.[13]

 

[large donner]

I think with corona the situation is still unclear. Potential symptoms are unpleasant and take a lot of and a long effort to get treated. Obviously in some areas hospitals are overwhelmed (though this apparently happens also from the flu).

Yes and also there is the reports of hospitals being practically empty and pretty much shut down for all other business whilst many elderly people incare homes etc and also already in hospital are being aggressively asked to sign DNRs. No surprise then that people on end of life care are dying in slightly higher number s than usual then.

On the other hand, only statistics and forensics will tell what´s going on. Just to test people who are likely enough to have the virus, and to count all deaths positive for corona will hardly give an adequate picture.

Bingo and its ludicrous to try to make like for like, year on year comparisons meaningful in a given category for cause of death when we keep getting told x amount of people died WITH coronavirus today. That's like saying X amount of people died WITH a hospital gown on.

To go the next stage and count people who died and did not have a test for coronavirus as a death from/with coronavirus as it seems some services may be doing if the person had some generic symptoms is absolutely the height of stupidity especially when there are two or three other proven causes of death like cancer or COPD as the cause.

I am not already convinced that we see a real catastrophe compared to the normal situation, though it might be so. Whatever it will turn out to be (and I would think that in two weeks we will have a picture), the idea that the virus will be able to be eradicated in today´s world seems to me like playing with tin soldiers.

 

[spinoza577]

Here new deaths from Iran, plateauing since mid of march.

If I understood rightly, the Iranian government recommended to stay at home begin of march. Schools have closed since march 8th? Some areas might have been locked, and offices might be open only am.

should be the same, but until yesterday

 

[Sly Saint]

It is perfectly clear that a significant number of people die from this virus long before their due time and many others have a terrifying illness.

and yet when announcing todays figures the BBC were saying that the govt were stressing that the majority of fatalities were older people with multiple underlying conditions.

 

[spinoza577]

I have no idea why not. Loved ones are dying left right and centre. Health care workers are dying. The health care systems are completely non-functionaland people are dying foremother conditions unnecessarily or just not getting essential treatment. The economic costs are catastrophic. What more could you be waiting for?

Yes left and all around, deadly clusters seen in care homes - if so - may be a real hint that the disease may be a serious problem.

The death of health care workers should have been avoidable - and are statistical-wise accidents (but will probably not change the statistics). It is not unknown that viral loads may determine the resulting diesease, it is also common knowledge that not paying attention to a viral infection - e.g. doing sports - is not a good idea.

Indirect damages, of course, cannot be attributed to the virus, but is due to mis-preparation. In fact the mortality in Italy is considered to be partly due to this point, and this needs to have a look indeed.

It is perfectly clear that a significant number of people die from this virus long before their due time and many others have a terrifying illness. Almost certainly the long term complications will become a major healthcare burden - maybe as big problems diabetes or rheumatoid disease. From what we hear many of those who have survived are still seriously compromised.

It is certainly possible that it will be significant, and not to pay attention to this possibility is no good. To my extended fantasy it was already a possibility when I heard about china (and, to speak of my own unimportant situation, if I hadn´t to deal with impossible things I would have prepared a tiny bit).

There is absolutely no way that this can be considered an illness that we can tolerate as endemic.

The virus is completely new. Once also the [spanish] flu was completely new and caused a lot of deaths, now nobody bothers. Case fatality nowadays is 0.1%, drawn from excess mortality, as far as I have understood.

I find it very peculiar that just because a few ill-informed people suggested at the beginning that Covid1§9 is a mild thing a bit like a cold that people are still thinking that a credible viewpoint.

I guess, the impression that the virus is "not the most apokalyptic one" (Washington post, quite recently) was already easily available from China, when the Chinese didn´t thought to act soon and only later started to act. It´s again dealing with possibilities, same point as above.

Maybe ask the UK Prime Minister how he feels about the illness?

I do not say, btw, "take it easy" and that the UK would not have made a serious mistake, at least in some sense. Accordingly I do also not say that all the lockdown is not worth to be carried out.

But as might be seen from Sweden, it might not tell what´s going on. We will see. Statistics and forensics are the source of knowledge, not impressions even if the may be outstanding. In two weeks, I guess, we will have a picture.

 

[large donner]

One other issue to take into account is that the average number of deaths per day in a country is averaged over the WHOLE year.

ie/ Total in the whole year divided by 365

But that does not account for the fact that there is always a seasonal peak with a large rise in the curve during winter months for example that dies off heading into summer for example.

It's not unusual to see such a hockey stick curve on a chart in a given three to four month period.

All of these things must be taken into account when trying to establish a deaths caused by figure especially when day by day we are presented with a total deaths yesterday number.

 

[Jonathan Edwards]

and yet when announcing todays figures the BBC were saying that the govt were stressing that the majority of fatalities were older people with multiple underlying conditions.

Yes but I am older and would be classified as having an underlying condition but my life expectancy at this point in time is about sixteen years. So is cotton life short by sixteen years trivial?

Statistics and forensics are the source of knowledge, not impressions even if the may be outstanding.

As the saying goes there are lies, damned lies and statistics. Since there is no controlled experiment possible statistics are unlikely to tell ups much here. And you do not need statistics when outcomes are qualitatively unacceptable whatever way you consider them. No statistics were needed to analyse Hiroshima. Similarly no statistics are needed here. The only possible strategy in the long term is attempting eradication and having failed to set up contact racing at the crucial stage there is no alternative to lockdown until case rates are at least ten fold and probably a hundred fold less than now.

It may well be that a number of features of current lockdown are unnecessary.One issue is that it is indiscriminate but if contact tracing and cordon sanitaire had been employed, as Alyson Pollock pointed out, we would not need indiscriminate lockdown. I suspect wearing masks would do much more than many of the rules in place. But what clearly cannot be done is to loosen controls without knowing what would work better.

Again the analogy with flu is irrelevant. There is a reasonable analogy with Spanish flu, which killed 50 million people, but no analogy with seasonal flu. Seasonal flu almost exclusively contributes to death in those with life expectancy of no more than a few months and of poor quality. Every epidemic of flu is new to a large tranche of the population so not different from Covid in that respect.

 

[Sasha]

Just heard this guy a couple of minutes ago on R4 talking about this - extremely interesting - his team has gathered nearly 300 suggestions:

 

[lunarainbows]

A really informative and interesting article. About Kerala and what they did so differently; also talks about India as a whole.

https://www.technologyreview.com/2020/04/13/999313/kerala-fight-covid-19-india-coronavirus/
What the world can learn from Kerala about how to fight covid-19

The inside story of how one Indian state is flattening the curve through epic levels of contact tracing and social assistance.

“On March 11, the who declared the covid-19 outbreak a pandemic. The next day, India reported its first death. Even so, Modi—perhaps concerned by the impact on the already lackluster economy—refused to issue public advisories and didn’t address the media. His biggest concern seemed to be a plan to redesign the heart of the Indian capital, including parliament, at a cost equal to $2.6 billion.

In Kerala, a different style of leadership was on display. With 15 cases now confirmed across the state, Pinarayi Vijayan, the chief minister, ordered a lockdown, shutting schools, banning large gatherings, and advising against visiting places of worship. He held daily media briefings, got internet service providers to boost capacity to meet the demands of those now working from home, stepped up production of hand sanitizer and face masks, had food delivered to schoolchildren reliant on free meals, and set up a mental health help line. His actions assuaged the public’s fears and built trust.

“There was so much confidence in the state government,” says Latha George Pottenkulam, a clothing designer in the port city of Kochi, “that there was no resistance to modifying one’s behavior by staying in.”

There were other reasons why Kerala was better equipped to deal with the crisis than most places. It is small and densely populated, but relatively well-off. It has a 94% literacy rate, the highest in India, and a vibrant local media. Elsewhere in the country, people were taking WhatsApp rumors at face value—for example, spreading messages claiming that exposure to sunlight could protect against the virus. But in Kerala, most people realized the seriousness of the situation.

Manju Sara Rajan, the editor of an online design magazine in the district of Kottayam, told me she felt safer living in Kerala than anywhere else in India. “We have been considering the possibilities for far longer,” she said. Everyone around her knew the number to call if they developed symptoms, and they weren’t acting heedlessly by rushing to the hospital at the first sign of a dry cough.

.....

Nooh was still contact tracing, testing, and isolating, his team chasing down every potential patient. There were now more than 162,000 people in self-isolation in his district, as well as more than 60 community kitchens, eight relief camps to house and feed migrant workers unable to return to their home states, and a two-member documentation team taking notes in the event that the situation repeats itself.”

 

[lunarainbows]

I just read the article about Kerala through twice..I think it’s amazing. it is so nice to read things like this. Something else struck me, that when they asked people to go into isolation, they did monitor them through police and surveillance etc but also they called them each day to make sure they were ok, to check symptoms but also that they were staying at home, and also made sure everyone who was self isolating had food. That must be so important, in order to ensure compliance.

Kerala has a lot to teach all of our countries I think. I think it also has a lot to teach the central govt in India and the way they’ve handled the crisis there.

 

[Barry]

Yes but I am older and would be classified as having an underlying condition but my life expectancy at this point in time is about sixteen years. So is cotton life short by sixteen years trivial?

Yes, a useful metric might be looking at average life expectancy curtailments, and comparing those.

 

[Ravn]

To me it seems that it´s the elimination strategy that is more academic like. I find it highly unlikely that it should prevail. You would need only one inaccuracy and you had to start again, furthermore, you would need to accurately tighten the borders with quarantine or an 100% accurate test. Maybe in a world where everyone could behave completely patiently and very accurately, this might be possible. In my view, with this virus, it is in a way naiv to think that the try will come out as supposed, indeed academic like, I would say. Things are not that easy done than thought.

To my knowledge, the only infectious disease that has been eradicated is small pox.

I wonder if we aren't talking slightly past each other here? It's worth noting that when it comes to viruses there's a difference between eradication and elimination.

Eradication refers to the virus being gone - completely and everywhere - it doesn't exist anymore. Eradication is extremely rare.

Elimination means the virus has been eliminated locally but occasional sporadic but short-lived outbreaks can still happen, mostly through reintroduction from outside areas or where the virus can survive and hide out in an animal population. Elimination is still very difficult but it - or something close to it - is doable.

An elimination strategy is slightly different again. It accepts that total elimination may not be possible but still treats it as the goal because following that strategy - even if not 100% successful - remains the best way to minimise both health and economic costs.

For now the only place I know of that has (possibly) succeeded in eliminating the corona virus is Greenland. That's provisional of course, pending further testing. But as of 16 April they haven't had any positive tests for 12 days in a row. They've tested nearly 2% of their population and are continuing with their testing. Restrictions are continuing, too, for now. They only had 11 cases, all recovered, but given their population of about 56,000 that's still quite high and, importantly, not all the cases were linked to travel. It will be interesting to see how they get on. (Note that the worldometer figures for Greenland are out of date).

 

[TiredSam]

Here's a new idea from a Swiss clinic which has just been posted in our German language forum:

https://infekt.ch/2020/04/exitstrategie-lockdown/

It starts as follows:

The Federal Council's measures to contain Covid-19 are taking effect: The infection rates have fallen below the critical value of 1 and a collapse of the health system has been avoided. But where do we go from here? Two strategies are under discussion: either the attempt is made to keep the resurgence of infection rates as low as possible despite the relaxation of the measures and to wait until a drug or vaccine is available; or the attempt is made to contain the spread of the virus even without a vaccine by creating herd immunity. There is a third possibility - a combination of the two approaches: The establishment of a population immunity is cautiously allowed in the younger, less vulnerable population, while in the older population and in the risk groups the infection rates should be kept as low as possible.

Translated with www.DeepL.com/Translator (free version)

Unfortunately it's only in German, and appears to be an opinion piece by a single author, although he's the head doctor of infectiology in his clinic.

For anyone interested, I find the best way to translate articles is to copy and paste them into DeepL:

https://www.deepl.com/translator

 

[JaneL]

European Commission presents EU coronavirus exit strategy

3. CRITERIA

Three sets of criteria are relevant to assess whether the time has come to begin to relax the confinement:

1. Epidemiological criteria showing that the spread of the disease has significantly decreased and stabilised for a sustained period of time. This can, for example, be indicated by a sustained reduction in the number of new infections, hospitalisations and patients in intensive care.

2. Sufficient health system capacity, in terms of, for instance, occupancy rate for Intensive Care Units, adequate number of hospital beds, access to pharmaceutical products required in intensive care units, the reconstitution of stocks of equipment, access to care in particular for vulnerable groups, the availability of primary care structures as well as sufficient staff with appropriate skills to care for patients discharged from hospitals or maintained at home and to engage in measures to lift confinement (testing for example). This criterion is essential as it indicates that the different national health care systems can cope with future increases in cases after lifting of the measures. At the same time, hospitals are increasingly likely to face a backlog of elective interventions that had been temporarily postponed during the pandemic’s peak so Member States’ health systems should have recovered sufficient capacity in general, and not only related to the management of COVID-19.

3. Appropriate monitoring capacity, including large-scale testing capacity to detect and monitor the spread of the virus combined with contact tracing and possibilities to isolate people in case of reappearance and further spread of infections. Antibody detection capacities, when confirmed specifically for COVID-19, will provide complementary data on the share of the population that has successfully overcome the disease and eventually measure the acquired immunity.

It is up to the Member States, depending on their own structures, to decide at what level compliance with the criteria above should be assessed.

https://unric.org/en/european-commission-presents-eu-coronavirus-exit-strategy/

https://ec.europa.eu/info/sites/inf...ifting_coronavirus_containment_measures_0.pdf

 

[Jonathan Edwards]

Here's a new idea from a Swiss clinic which has just been posted in our German language forum:

I think this has been an implicit component of herd immunity strategies already. The trouble is it does not work. Following spread a 60% immunity rate can be quite useful.However, for it to be safe in the longer term for higher risk (older etc) groups to live normally I think it would need to be nearer 85%. It depends a bit on whether or not the virus can hang around either in people or in other animals that may become new reservoirs. It is hard to see how you get 85% of young people infected without a large number of vulnerable people getting infected too.

What may also be forgotten is that younger people who have 'recovered' may in fact have suffered serious permanent damage to their cardiovascular system that may not become apparent for years.