Coronavirus - worldwide spread and control

[Esther12]

Four urgent changes Boris Johnson needs to make to prevent major COVID-19 death toll in winter

http://www.msn.com/en-gb/health/med...-death-toll-in-winter/ar-BB16Jepy?ocid=ASUDHP

That report was from Holgate:

At the request of the Government Office for Science, the Academy of Medical Sciences established in June 2020 an Expert Advisory Group chaired by Professor Stephen Holgate CBE FMedSci to inform...

https://acmedsci.ac.uk/file-download/51353957

During the upcoming winter, the NHS will need to provide ongoing care for those who have had COVID-19 infection and who are suffering from post-viral sequelae. Although there is a paucity of data to accurately estimate the extent of post-COVID-19 sequelae, post-viral syndromes are well documented following other viral infections including severe acute respiratory syndrome (SARS), Chikungunya and Ebola. SARS resulted in chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome.192 Chikungunya leaves 20% of patients with post-viral chronic inflammatory joint disease.193 Ebola resulted in 70% of survivors suffering from musculoskeletal pain.194,195,196,197 About 80% had major limitations in mobility, cognition and vision one year after discharge. Each of these post-viral syndromes have their own set of symptoms – and COVID-19 will probably be different again. In addition, data from the COVID Symptom Study suggest that while most people recover from COVID-19 within two weeks, one in ten people may still have symptoms after three weeks, and some may suffer for months.198,199

Some post-COVID symptoms may have multiple possible aetiologies – particularly mental health, cognitive impairment, chronic pain and chronic fatigue – which will benefit from a multidisciplinary approach for diagnosis, treatment and long-term management to avoid long-term disability.

OT, but this was of interest to me:

Those from BAME backgrounds (especially younger people) tended not to be aware of the disproportionate impact the disease has on these groups. As a whole, this group were less interested in talking about the disease as having an ethnicity-based element – they would rather think about socio-economic drivers, for instance the high numbers of people from ethnic minorities working as lower-paid frontline workers such as taxi drivers, bus drivers and nurses.

This too:

Trust and communications

Scientists were considered a trustworthy source of information but there was a tendency to associate leading scientists with politicians. There was a common perception that a single scientific truth exists around the pandemic and that scientists are the ones promoting and defending it, while politicians are more focussed on protecting the economy. But those who were more interested in the pandemic and knew more about it were also more likely to question the mortality and infection figures, wondering whether they are being massaged or underreported. Among this group, those who distrusted the government transferred this distrust to the scientists leading the response, whose position was seen to be politicised.

Conversely, trust in politicians was lower. Some acknowledged a difficult trade-off between protecting people and the economy (and were unable to suggest an answer) but there was criticism of the government’s handling of the outbreak and its communications, which were felt to have become more complicated since the early days of the pandemic. Those who had been following the pandemic more closely were able to name multiple instances where they felt the government had manipulated figures or not been straightforward in talking to the public.

The groups expressed confusion about the current guidelines, being unsure about how to act under many of the new, less absolute, social distancing measures. Coming shortly ahead of the planned opening of many shops and restaurants in England on the 4th July, there was also a view that many of the newly-opening places would not follow the rules. Some demanded greater clarity on the scientific rationale behind each of the steps that have been taken in the opening up – what the impact of each step was expected to be and the thought process behind permitting it.

The 'expert advisory group' included Matthew Hotopf.

Claire Bithell, who did a lot of the worst Science Media Centre spin, also played a role as Head of Communications at the Academy of Medical Sciences

Mod note: post copied here for discussion not related to Covid-19 spread and control. UK-Preparing for a challenging winter 2020/21, 2020, Academy of Medical Sciences, Holgate

 

[Jonathan Edwards]

Four urgent changes Boris Johnson needs to make to prevent major COVID-19 death toll in winter

http://www.msn.com/en-gb/health/med...-death-toll-in-winter/ar-BB16Jepy?ocid=ASUDHP

This looks to me like a complete lame duck. The four proposals are the basic minimum that nobody even needs to be told about. What we need are some real changes. For instance sending all Covid19 cases to dedicated fever hospitals not ordinary hospitals. Enforced quarantine. Shutting down air traffic. Like the sorts of things they do in New Zealand and Australia. All these establishment cronies are equally culpable. In comparison to Independent SAGE it is little better than a whitewash.

 

[chrisb]

We'll brook no criticism of the Senescent And Geriatric Elimination advisers.

 

[anciendaze]

Whatever you do in the U.K. make sure it is different from what Florida has done. Today's news just showed the state reported 10,161 new cases and 112 deaths. The deaths were naturally caused by infections that typically started weeks ago. There is usually a weekly dip in reporting new cases. I expect the case numbers to rise by Friday.

Arguments about lower mortality rates are mostly based on hypotheses. Some are deliberate deception, like confusing the infection mortality rate with the case mortality rate. The bulk of cases in our current surge remain unresolved, and that tends to distort statistics. Politicians touting current statistics are hoping nobody will remember what they said a month from now. In far too many cases that has worked in the past.

I've only started analyzing data on hospitalizations first available last Friday. I'm not even certain it is still possible to isolate patients in special hospitals, because those previously treating such cases are full.

 

[Jonathan Edwards]

I'm not even certain it is still possible to isolate patients in special hospitals, because those previously treating such cases are full.

It is perfectly possible, if like some countries have done, you build the hospitals afresh. The absurd thing about the UK is that we built the Nightingale hospitals and then did not use them. This is a measure of just how scatterbrained the approach has been.

 

[Sly Saint]

It is perfectly possible, if like some countries have done, you build the hospitals afresh. The absurd thing about the UK is that we built the Nightingale hospitals and then did not use them. This is a measure of just how scatterbrained the approach has been.

Yes and it is proudly proclaimed that the NHS was not 'overrun', and that they therefore hardly used the Nightingale hospitals; but this was only achieved at the expense of a lot of non-covid patients not being treated.

 

[Jonathan Edwards]

Yes and it is proudly proclaimed that the NHS was not 'overrun', and that they therefore hardly used the Nightingale hospitals; but this was only achieved at the expense of a lot of non-covid patients not being treated.

And a vastly greater number of people with ordinary serious illnesses not being treated.

 

[Amw66]

Yes and it is proudly proclaimed that the NHS was not 'overrun', and that they therefore hardly used the Nightingale hospitals; but this was only achieved at the expense of a lot of non-covid patients not being treated.

I had thought part of the reason for the Nightingale hospitals being underutilised was that hospitals were to send their own staff ?

Would have been ideal facilities to discharge the elderly to instead of care homes

 

[Amw66]

https://www.nytimes.com/2020/07/15/...&nl=coronavirus-briefing&emc=edit_cb_20200715

 

[Sly Saint]

 

[Snow Leopard]

At the current rate, the USA is going to overtake Sweden, Spain, Italy and France in deaths per million in a matter of 2-3 months!

 

[rvallee]

Extremely concerning

Fortunately it should make little difference, everyone was already relying on the Johns Hopkins data, who already bypassed the CDC because they were failing at it from the start.

I'm sure this will have some repercussions but at least the raw data are still available, the CDC was already irrelevant in this matter.

 

[Trish]

I assume that the surge of cases now in mid summer in the southern states of the USA knocks on the head any idea that Covid-19 is a seasonal winter infection.

 

[Wits_End]

I assume that the surge of cases now in mid summer in the southern states of the USA knocks on the head any idea that Covid-19 is a seasonal winter infection.

And, as they said on the news the other night, that hot weather/sunlight kills the thing off


Meanwhile, Contact tracing won't curb COVID-19 spread if testing is too slow

http://www.msn.com/en-gb/health/med...s-too-slow/ar-BB16PSDO?li=BBoPWjQ&ocid=ASUDHP

Contact tracing is a key strategy for controlling the spread of COVID-19, but a new study finds that delays in COVID-19 testing will significantly hamper this process.


The study researchers found that even the best contact-tracing strategy — where all contacts of an infected person are identified and alerted — won't reduce the spread of the virus if there is a delay of three or more days between when a person shows symptoms and when they are tested for COVID-19 (and get test results).

 

[ahimsa]

At the current rate, the USA is going to overtake Sweden, Spain, Italy and France in deaths per million in a matter of 2-3 months!

Yes. I'm also worried about India.

Edited to add today's graph from https://coronavirus.jhu.edu/data/new-cases

 

[anciendaze]

Another report from Florida, where officials apparently don't realize the virus is out of control. Predictably, Florida had 13,965 new cases today. Unfortunately, we also set a record of 156 reported deaths in a day. Here in Orange County (Orlando/Disney World) we had 1,390 new cases. Australia would be appalled by this if it applied to their entire continent.

Why do I say this was predictable? Because a number of good models predicted it. There are big variations caused by delays in reporting (cases from one day land on another, there is a dip followed by a spike,) but the 7-day average is fairly smooth. My favorite at the moment is by PolicyLab at Children's Hospital of Philadelphia which collects data, and makes weekly predictions for select counties. They use anonymized data from mobile phones to estimate mobility and social interactions. (This data can be bought for marketing purposes.) They also take weather into account. Here's an account of their methods. I wish the predictions were updated daily.

At the state level I recommend the site Rt-live, which uses a very different algorithm to estimate an R value, (as in SIR or SEIR models,) with the code available on Github. I wish their estimates were available for counties, or other countries. R values have tended to be leading indicators of surges.

Aside: If you take the R value, subtract 1.0, and multiply by 100, you get the percentage increase in each case reproduction period. Think of this as compound interest, with a period under a week. This is what will happen if nothing else changes. When epidemics are out of control, things do change, and with competent decision makers they change for the better.

The momentary R for Orange County is 1.59, which I expect to drop to about 1.3 as people realize things are not normal. This still leaves us with the equivalent of 30% interest in cases compounded in less than a week.

Aggregate statistics for entire nations or states can mask a local outbreak until it becomes large enough to dominate the total. We have had multiple politicians in many countries try to deny the reality of outbreaks, and several means of delaying upsetting numbers have been employed. If no action is taken promptly the local outbreak will become a spreading center for a larger outbreak.

What I find outrageous is that modern technology for testing for the virus has been used to delay reported numbers by about a week, saying this is to validate those numbers. No daily count of symptomatic individuals or excess deaths is available. We had to fight to get numbers hospitalized. We seem to have gone backwards since 1918.

I've attached two graphs, one showing Florida cases by week, another showing Orange County cases by day. This is what a surge looks like. A third graph shows the PolicyLab prediction several days ago.

 

[Snow Leopard]

Another report from Florida, where officials apparently don't realize the virus is out of control. Predictably, Florida had 13,965 new cases today.

At that rate (per day), they'll achieve herd immunity in 4 years!

 

[anciendaze]

A purely anecdotal report:

Orange County, Florida is still trying to reopen schools with face-to-face classes and no masks.
(Why? Because no money has been allocated for anything else. This also applies to Jonathan Edward's proposal to build new hospitals. )

There was a contentious school board meeting Tuesday which failed to settle the matter. Another meeting is scheduled Friday. After the last meeting a teacher I know decided to retire rather than risk her health. She went to file her retirement papers on-line, but found this down. She needed to arrange an in-person meeting with county school officials. It turned out the virus had run through that floor of the office building, and many people were in isolation or quarantine.

She is still trying to file her retirement papers.

Knowing this person the way I do, I don't think those officials realize the hornet's nest they have blundered into.

 

[anciendaze]

At that rate (per day), they'll achieve herd immunity in 4 years!

You mean the survivors will. Don't worry, the numbers will go up. This is the magic of exponential increase.

The problem is that mortality will also go up, and that is delayed by weeks. Before successful immunization or fully effective treatment, we will have about 1% mortality if hospitals are not overwhelmed. I've provided private estimates to local people I know of what that means. All have said this is politically unacceptable.

Locally, we are in fair shape with 20% available ICU capacity. South Florida is not in such great shape. Here's a report from a hospital CEO who is also a registered nurse, and is working two jobs.

 

[Sean]

Knowing this person the way I do, I don't think those officials realize the hornet's nest they have blundered into.

Add into that the fact that millions of parents will now have had experience of trying to home school during the lock downs, and hence are likely to be more sympathetic to the lot of teachers.

You mean the survivors will. Don't worry, the numbers will go up. This is the magic of exponential increase.

The problem is that mortality will also go up, and that is delayed by weeks. Before successful immunization or fully effective treatment, we will have about 1% mortality if hospitals are not overwhelmed.

Plus the increased long-term morbidity for (at least some) survivors.