COVID-19 Coronavirus Containment Efforts

[russ_watters]

Any reason for the periodicity? It shows up in US data as well. It seems to peak in the Thursday-Friday range.

Analysis date as far as I understand, and fewer tests analyzed at the weekend. Plus some reporting lag, so tests from one day can appear in the statistics of the next day. More discussion here and details in its German source.

In my area, the peak-trough pattern was clear before the peak, but the timing is not consistent and does not align with weekends. I'm guessing some testing or reporting happens in batches, which aren't necessarily scheduled according to the work-week.

Since the peak, which was just before Easter here, the data has gotten very chaotic for some reason. I expected it to regain some consistency after an initial Easter testing lull, but it hasn't. So it is very hard to tell what the case decrease rate is.

 

[russ_watters]

Analyzing what practical measures could have maybe helped at the beginning, with an eye on what would be the best actions before possible new similar situations, we all know (taking seriously China's reports) how effective the internal lock-down in China was, but international airplane travel from China, including Wuhan, was continued if I'm not mistaken, all through the months of January and most of February which is the time window where the virus seems to have spread worldwide and especially in Europe, including up to 6 regular flights per week from Wuhan to Paris and similar frequencies to Rome and London. Would it have been practical to halt the epidemic spread interrupting those international flights from China to the rest of the world? Could China have done it?

Of course China could have done it, but why protect others from them?

In the US we instituted a travel ban from China on February 2, which I think was reasonably early, but Europe didn't (not sure when they did their own) and we didn't implement one from Europe until March 14, which was way too late since as you said, the virus was already widespread in several countries such as Italy. A significant fraction of the East Coast outbreak has origins from Europe.

 

[DennisN]

An article on Reuters today about the race for a vaccine:

LONDON/ROME (Reuters) - Scientists in Britain began clinical trials of a potential COVID-19 vaccine on Thursday as other vaccine developers across Europe also stepped up work on experimental shots against the disease caused by the new coronavirus.

A team at Britain’s Oxford University dosed the first volunteers in a trial of their vaccine - called “ChAdOx1 nCoV-19” - while Italy’s ReiThera, Germany’s Leukocare and Belgium’s Univercells said they were working together on another potential shot and aimed to start trials in a few months.

...

As many as 100 potential COVID-19 candidate vaccines are now under development by biotech and research teams around the world, and at least five of these are in preliminary testing in people in what are known as Phase 1 clinical trials.

Source: European firms step up COVID-19 vaccines work, UK team starts human trials (Reuters, April 23, 2020)

 

[Vanadium 50]

So, while the data are valuable, they are by no means definitive and should be taken in context with other seroprevalence studies underway in other areas of the world.

There is now a released study from USC (Google the PI "Neeraj Sood" to find popular press descriptions of the study - I failed to find the preprint of the scientific article) that gets an antibody rate of 2.8 to 5.6%. The first (Santa Clara County) study came up with 2.58 to 5.70%.

 

[kadiot]

An article on Reuters today about the race for a vaccine:Source: European firms step up COVID-19 vaccines work, UK team starts human trials (Reuters, April 23, 2020)

Yuhoo! Another step closer to a vaccine for COVID19 virus SARSCoV2's other cousin, MERS (Middle East Respiratory Syndrome) coronavirus.

 

[Jarvis323]

Any reason for the periodicity? It shows up in US data as well. It seems to peak in the Thursday-Friday range.

At least one source (for deaths) is that they periodically tally up deaths of people who died outside of hospitals. That was the cause of a recent increase in NYC deaths a few days ago (actually the number of new deaths went down).

 

[anorlunda]

This sounds ominous.

ERs seeing less heart attack, stroke patients during COVID-19

If people die of other diseases because they fear doctors and hospitals, do the statistics count that as a COVID-19 death? Perhaps it should be recorded as cause of death --journalism.

Also, regarding phone apps for virus tracking. I did not read all the posts here about tracking versus privacy. But I did read that the proposed Google+Apple app does not use your actual location. It requires enough proximity to sense the bluetooth ID of another nearby phone. Only proximity is relevant, not location. Of course proximity can have privacy implications too.

I also read that about 20% of smart phones still in use do not have the hardware needed to scan for nearby bluetooth while using low power. Those phones will not be able to use the app. That reduces the effectiveness of the app.

 

[ChemAir]

I suspect they could do that with a scary level of accuracy via location tracking alone.

While I'd agree this is likely true for those with the most modern devices that are fully connected, I don't believe enough people (of all ages) in the country have smartphones that are current enough to be effective at managing this.

3 thoughts (without solutions)--I'll probably have others, but these come to mind:

1) I operate my phone with GPS/wifi/bluetooth disabled. I find ads based on location intrusive and unhelpful, unless I am asking for information. People like me will not have close enough tracking, especially if you work in different facilities like I do, where cameras (and phones with them) are prohibited, and left in vehicles or offices in the workday. Based on my phone use, contact tracking will be useless for me.

2) As resistant to tracking by the government the average person is, criminals don't intend to have a trackable smartphone. States have released detainees for many crimes, many of whom have no such cell phone. Most will find it a little more than offensive if they are arrested for not having a cell phone (that they pay for) while detainees are being released for the detainees' safety, while not having a registered cell phone, and they'll have a point.

Thought 2 is mostly there to state that the general public would not appreciate no-trial imprisonment, or it's equivalent (ankle bracelet), while current detainees are given free reign following arrest for cause, without the same consideration.

3) A large number of cellphones are not in the names of the people that carry them. Many are business owned, and tracking a phone number that gets transferred between people over years will be problematic. Likewise, phone numbers for children in the name of the parent will be difficult to parse.

The logical answer for anyone not wanting this intrusion is to stop paying their cell phone bill, which could torpedo this idea. I guess the government could try to either issue us all cell phones, or force us to pay bills for phones we would have to carry lest we be arrested, but I suspect that won't go very well, even if the government could afford it.

On the other hand, if you wanted to use your phone to help yourself mitigate risk, that is certainly possible, but could only made fully effective if everyone did it.

 

[OmCheeto]

The articles states that Rhode Island has the highest per capita testing rate of the 50 states. I have not independently verified.
...

This is true.

But it's somewhat trivial, so I'd rather not discuss it further.

... By March 1, as New York confirmed its first case, the numbers there may already have surpassed 10,000.

https://www.nytimes.com/2020/04/23/us/coronavirus-early-outbreaks-cities.html

...

Yay!

Feb 19, 2020

In my simulation, nearly 10,000 people were infected by the time the first person died. I find that difficult to believe.

[ref]

Though, I'm guessing my 10,000 was more luck than science.
It's been two months, and I still don't fully understand the model.

Anyone else watch the Frontline Coronavirus Pandemic show on Tuesday?
I found the interview with a Dr. Riedo the most interesting
[transcript]

18:45 Francis Riedo, MD, Evergreen Health, Medical Director of Infection Control​

​

Remember, this was flu season and we’d already had a peak of influenza B in December, and now we were going through the peak of influenza A. And so, the unit was full of individuals with severe respiratory infections.​

​

In the meantime, in the background, we’re watching these events unfold with increasing alarm, not only in Wuhan, but now spreading across the globe and wondering when our turn was coming.​

...​

My initial honest response was skepticism. I thought, the odds of both tests in two randomly selected individuals being positive, with no history of travel, no history of exposure to anybody, was fairly astronomical.​

​

This was a huge shift. Incident command was activated, and we made a quick decision to test nine additional people that night. Eight of those nine were positive.​

​

​

 

[Ygggdrasil]

There is now a released study from USC (Google the PI "Neeraj Sood" to find popular press descriptions of the study - I failed to find the preprint of the scientific article) that gets an antibody rate of 2.8 to 5.6%. The first (Santa Clara County) study came up with 2.58 to 5.70%.

Apparently, the paper describing the methods has not yet been released (even though they thought it appropriate to release the results by press release), which is an odd decision. However, a version of the paper was somehow leaked. Notably, the Stanford and USC studies share many authors (e.g. the first author of the USC study, Dr Sood, is also an author on the Stanford study, the first author of the Stanford study is an author on the USC study, and the two studies have the same senior author), so it is possible that they would share similar methodological flaws.

Here's a popular press article dicussing the two reports along with some of the criticism: https://www.buzzfeednews.com/articl...ntibody-test-santa-clara-los-angeles-stanford

I am not necessarily saying that their estimates are wrong, just that there are some valid criticisms of the methods and analyses used by the studies, so they should be take with a grain of salt.

 

[DennisN]

BBC reports about uncertainties regarding the potential treatment drug remdesivir:

Hopes dashed as Coronavirus drug remdesivir fails first trial (BBC, 24 april 2020)

A couple of quotes:

There had been widespread hope that remdesivir could treat Covid-19.

But a Chinese trial showed that the drug had not been successful, according to draft documents accidentally published by the World Health Organization.

The drug did not improve patients' condition or reduce the pathogen's presence in the bloodstream, it said.

The US firm behind the drug, Gilead Sciences, said the document had mischaracterised the study.

[...]

Gilead has disputed the WHO post.

"We believe the post included inappropriate characterisations of the study," a spokesman for Gilead said, adding that it was terminated early due to low enrolment and was therefore not statistically meaningful.

"As such, the study results are inconclusive, though trends in the data suggest a potential benefit for remdesivir, particularly among patients treated early in disease," he said.

This does not spell the end of the road for the drug, however, and several continuing trials will soon provide a clearer picture on the drug's use.

EDIT:

And a new BBC article about the brand new vaccine trial in UK:

Coronavirus: First patients injected in UK vaccine trial (BBC, 24 april 2020)

The first human trial in Europe of a Coronavirus vaccine has begun in Oxford.
Two volunteers were injected, the first of more than 800 people recruited for the study.
Half will receive the Covid-19 vaccine, and half a control vaccine which protects against meningitis but not coronavirus.
The design of the trial means volunteers will not know which vaccine they are getting, though doctors will.
[...]

 

[Vanadium 50]

Thanks for hunting that down. I am more than a little irritated by this. I have always held that "if it isn't published (or at least available as a preprint), it doesn't exist". If the authors aren't willing for this to stand up for peer review, it shouldn't influence public policy.

However, I think BuzzFeed's criticisms are largely unfair.

#1. The scientists sought media attention before having supporting data. That's certainly a fair criticism of the scientists, but not of the science. Oh, and when you say "Notably, the Stanford and USC studies share many authors (e.g. the first author of the USC study, Dr Sood, is also an author on the Stanford county study, the first author of the Stanford study is an author on the USC study, and the two studies have the same senior author) , so it is possible that they would share similar methodological flaws.", it contradicts the BuzzFeed article you linked to, which says both teams share a member.

#2. The antibody test’s accuracy rates may be shakier than presented. Sure. But there's no evidence that this is the case or that the correction was done incorrectly. Any number in any paper can be wrong, and a good paper - which we do not have - will give enough information for people to judge for themselves. Further the criticism that no amount of testing will ever give perfect certainty is as old as statistics itself.

However, just for giggles I looked at the numbers they have provided.

They say 2 false positives in 371 tests, which they correct for.. That works out to a 95% CL that the truth is less than 6.3. That means they are 95% confident that the false positive rate is less than 1.7%. If I take the following sentence in KCET's report literally - "Preliminary results of the study found that of 863 people randomly selected for testing, 4.1% had antibodies in their system, indicating they had been infected at some point with the virus ", i.e. that the 4.1% is raw, it would be corrected down to 3.6% but at 95% CL could be as low (95% CL) as 2.4%: i.e. the true number could be as small as 2/3 of their central value.

Their central value is 331,000 and their quoted lower limit is 221.000. Their quoted lower bound (which is presumably a 68% number) is 221,000. So I don't see evidence of a problem, although one could always come up later.

#3: The Santa Clara County study picked and sorted participants in questionable ways.

If true, that wouldn't say anything about the Los Angeles study.

BuzzFeed's fourth, unnumbered, objection is that this would be viewed positively by the political right. I would respond to that by saying we should know the truth, no matter who benefits and who does not.

 

[Astronuc]

The Houston Livestock Show and Rodeo is the city’s largest event, attracting 2.5 million people and generating nearly $400 million. But officials pushed forward with the 20-day event until there was a positive COVID-19 case from community spread.
https://www.propublica.org/article/...ton-rodeo-and-proceeded-with-the-event-anyway

“It is my belief that you should use your authority to basically shut down the Houston Rodeo or at least those components of it that will take place in a closed arena,” attorney Seth Chandler, the former director of the University of Houston’s Health Law & Policy Institute, wrote to Dr. David Persse, the head of the city’s Health Department, before opening day.

Ultimately, on March 11, after eight days, the rodeo shut down. A police officer from a neighboring county who attended a pre-rodeo barbecue tested positive for COVID-19 — evidence that it was now spreading in the community. The health department is now confident the officer caught the virus at the rodeo.

So far, at least 18 people who attended the rodeo and live in four counties surrounding Houston have tested positive for the coronavirus, though it is unclear if they all contracted it at the event.

While testing remains problematic across the United States, Texas ranks among the worst in the country.

Back in January and February:

Rodeo organizers and city Health Department officials had tracked the spread of the Coronavirus since January and more closely as opening day approached, knowing it would impact the efforts of 35,000 volunteers, 135 full-time staff and the millions of dollars in educational grants and scholarships given to participants.

In his weekly update to the mayor on Feb. 27, Persse wrote about community spread in California and Washington State. “As predicted, the U.S. strategy of ‘containment’ appears to begin to fail. We should expect to have community spread in Texas shortly.”

The show went on, and some attendees became ill.

 

[russ_watters]

In iOS you can disable it. One of the reasons I use iOS.

While I'd agree this is likely true for those with the most modern devices that are fully connected, I don't believe enough people (of all ages) in the country have smartphones that are current enough to be effective at managing this...

1) I operate my phone with GPS/wifi/bluetooth disabled.

Google tells me that cell phone market penetration in the US among adults as of 2019 was 96%, with 99% from ages 18-49, gradually decreasing to 91% from 65+. Presumably it drops little for teenagers and then gradually decreases to zero among younger kids. All cell phones, whether smartphones or not, have location tracking and for almost all by GPS.
https://www.pewresearch.org/internet/fact-sheet/mobile/

And of course, that's just cell phones. It doesn't include tablets, laptops, smart watches/fitness bands, baby LoJacks, cars, game systems, cameras, ets.

Google also tells me about 90% of people keep location services on on their smartphones. It's probably higher on non-smartphones, and higher still on those other devices, especially those in which people never thought to check if they had a GPS or where location tracking is the primary function.
https://geomarketing.com/overwhelming-number-of-smartphone-users-keep-location-services-open

For the least likely people to have location trackers on them almost all the time - kids and the elderly - they are likely to be either mostly immobile already (the elderly) or paired-up with someone who has a location tracker (kids).

So I think it is safe to say that all but a small single-digit percentage of Americans and other westerners are being tracked. You guys are outliers.

I would hope - expect, even - that Google and Apple are already using that data to predict who has COVID-19 (and has been with the flu, for a decade). It should be relatively easy given how predictable people have become due to mandatory isolation.

Here's the true story of my mandatory isolation, and what I expect Google knows about it, or easily could if they chose to:

Mandatory isolation started for me 5 weeks ago tomorrow. On that Friday, 3/20 I briefly went to work to gather needed materials for isolation, hit-up a grocery store on my way home, and then started my isolation. Since then, I've visited four places outside my home (besides the mailbox), three of them more than once.

Before I had even settled-in to my pattern, by Sunday Google already knew I was sick. I told it so by repeatedly Googling "coronavirus symptoms", "coronavirus vs sinus infection symptoms chart" and other such terms. And by trying, unsuccessfully, to buy an oral thermometer online and at a pharmacy I went to that I rarely visit. Starting in the afternoon, I noticed a just barely perceptable scratchy throat, that gradually got worse. I was worried because I had just visited my parents for brunch (my normal Sunday routine) and to scold my mother that, no, she couldn't play bridge next week and to give my parents some alcohol wipes and hand sanitizer.

By Tuesday, I was moderately sick. Google knew this because I was still spending 9 hours a day using my work laptop in my office (via cell phone GPS and the laptop's Chrome browser) instead of lying in bed or on my couch all day. But I wasn't exercising anymore and was walking slower (according to the phone's accelerometers). And because I called my doctor's office after using Google Maps to find the phone number, even though it is probably stored in my contacts.

I didn't return to the pharmacy, so Google knew the doctor diagnosed the throat-sinus infection as viral and didn't prescribe antibiotics. It knew I didn't drive to a testing site, so the doctor did not suspect COVID-19. It knew from GPS and the phone's accelerometers tracking my movement in my house (or lack thereof) that the infection peaked on Friday, and then rapidly improved on Saturday. By middle of the next week I was exercising again, and settled down into my routine, which I've followed almost exactly for the next 4 weeks.

The key limitation in their capabilities isn't the tracking coverage. It's not even the accuracy. It's the latency. The detection only works once a person is sick enough change their behavior or flag themselves (as I did). I suspect I got my throat-sinus infection at the grocery store two days before symptoms started, but I also suspect Google knows it nearly for certain, because they'd been tracking that very infection's spread. A heads-up would have been nice...

 

[Tendex]

Of course China could have done it, but why protect others from them?

This question, in case it is not just rhetorical/cynical, could lead to a number of intriguing or even frightening answers that I won't pursue here as they would go off-topic and would probably break forum rules .
But since this thread is about containment efforts I think it is relevant to ponder about why China established the largest and strictest lockdown in history according to the WHO and IA, to avoid spreading the epidemics inside China but it didn't include the logical measure of avoiding the virus spreading worlwide by closing all international departures of people from China to other countries. I mean talk about the most effective and efficient containment effort to avoid a pandemia at their disposal and just "forgetting" it, as one can read in the Wuhan lockdown timeline WP article: "23 January, transport in Wuhan, Huanggang and Ezhou severely restricted, including closure of public transit, trains, airports, and major highways. Wuhan airport was not closed for departures completely; flights still left to many destinations."
I haven't seen many people commenting on this. I think that, should a new virus outbreak arise, this should be a must from the first moment, basically because once the virus is globalized, the containment effort is orders of magnitude less effective whatever the measures a country takes, and orders of magnitude more costly.

In the US we instituted a travel ban from China on February 2, which I think was reasonably early, but Europe didn't (not sure when they did their own) and we didn't implement one from Europe until March 14, which was way too late since as you said, the virus was already widespread in several countries such as Italy. A significant fraction of the East Coast outbreak has origins from Europe.

Exactly, this is why I said that either all countries agreed from the start to ban travel from China, which is very difficult or the measure was doomed to be ineffective.

 

[kadiot]

According to latest study, COVID 19 virus died fast under direct sunlight.

 

[wukunlin]

But since this thread is about containment efforts I think it is relevant to ponder about why China established the largest and strictest lockdown in history according to the WHO and IA, to avoid spreading the epidemics inside China but it didn't include the logical measure of avoiding the virus spreading worlwide by closing all international departures of people from China to other countries. I mean talk about the most effective and efficient containment effort to avoid a pandemia at their disposal and just "forgetting" it, as one can read in the Wuhan lockdown timeline WP article: "23 January, transport in Wuhan, Huanggang and Ezhou severely restricted, including closure of public transit, trains, airports, and major highways. Wuhan airport was not closed for departures completely; flights still left to many destinations."
I haven't seen many people commenting on this. I think that, should a new virus outbreak arise, this should be a must from the first moment, basically because once the virus is globalized, the containment effort is orders of magnitude less effective whatever the measures a country takes, and orders of magnitude more costly.

Hmmmmm, very odd indeed. They only disallowed people with fever to board airplanes. There were people who took antipyretics to bypass that though...
Just guessing and throwing out some ideas here. There could be problems with closing down an international airport. Foreigners in Hubei would not be allowed to return to their home countries, doing that can lead to a huge diplomatic mess. If foreigners were allowed to leave (possibly defeating the purpose of the containment already), how about their Chinese spouses?
Did we have enough information to know that this virus was going to cause such a mess? I'd imagine disallowing foreigners from leaving as a precautionary measure can step on a lot of feet.

 

[atyy]

I mean talk about the most effective and efficient containment effort to avoid a pandemia at their disposal and just "forgetting" it, as one can read in the Wuhan lockdown timeline WP article: "23 January, transport in Wuhan, Huanggang and Ezhou severely restricted, including closure of public transit, trains, airports, and major highways. Wuhan airport was not closed for departures completely; flights still left to many destinations."

Is this true? Foreigners generally could not leave Wuhan unless their governments made special arrangements to evacuate them. Most governments quarantined the evacuees.
https://www.airport-technology.com/news/covid-19-wuhan-airport-opens/
https://edition.cnn.com/2020/02/05/us/coronavirus-wuhan-last-chartered-flights/index.html
https://www.scientificamerican.com/article/u-s-to-quarantine-195-americans-evacuated-from-wuhan/
https://www.nippon.com/en/news/yjj2...ation-flight-returns-to-japan-from-wuhan.html
https://www.theguardian.com/world/2...et-to-leave-quarantine-after-testing-negative
https://www.theguardian.com/world/2...ted-from-wuhan-regret-coming-home-coronavirus

 

[Ygggdrasil]

Oh, and when you say "Notably, the Stanford and USC studies share many authors (e.g. the first author of the USC study, Dr Sood, is also an author on the Stanford county study, the first author of the Stanford study is an author on the USC study, and the two studies have the same senior author) , so it is possible that they would share similar methodological flaws.", it contradicts the BuzzFeed article you linked to, which says both teams share a member.

Here is the author list from the Stanford study and the author list from an unofficial, leaked version of the USC study (available here)

Here's a good article from STAT news on some of the seroprevalence studies coming out that discusses some limitations: https://www.statnews.com/2020/04/24...to-be-released-heres-how-to-kick-their-tires/

Some are reporting much higher prevalence rates found in the two CA studies, e.g. 21% in New York City and 14% in New York State though we might expect these regions to have a higher prevalence because there were many more deaths there. The piece cites a study in Geneva numbers that gives a prevalence (5.5%) in the same ballpark as the CA studies. Given the lack of testing in the US and what we know about asymptomatic cases, it certainly is believable that confirmed cases could be an order of magnitude lower than actual infections. However, knowing the exact magnitude of this gap is important for determining policy, and the article does note uncertainty to these studies (I think this is the main criticism from statisticians of the CA studies, that the calculations were not properly accounting for uncertainties from the false positive and false negative rates), for example, writing:

The release from the state doesn’t disclose the sensitivity of the test used, but it does note the specificity is between 93% and 100%, a “huge range,” Ashish Jha, head of Harvard’s Global Health Institute, noted on Twitter. If the test performed at the low end of that range, New York’s infection rate would be closer to 7% — half the figure Cuomo announced — and nearly one out of every two positives would have been a false positive, Jha said.

The false positives are a major concern when using the test to tell individuals whether they are immune or not, but these should be able to be corrected for in population studies as long as the samples are actually representative or useful, which seems to be true for some studies (e.g. the New York study that sampled people at grocery stores) but may not be true for others (e.g. Stanford recruiting people from Facebook).

Again, no single study will be perfect or definitive. I've been studying biology long enough to learn not stake anything on just a single study. If more studies come out corroborating the estimates of these initial studies, we can begin to feel more solid about the results and use these to guide policy going forward.

 

[atyy]

And sometimes the false positivity rate of an antibody test that was working well can change. In Singapore, we had Dengue and COVID-19 going around at the same time. An expert was interviewed on the radio, and she was asked how likely it was to get both diseases at the same time, and she said that both are rare, so it'd be unlikely. Amazingly, a few days later, it was reported that someone did have both diseases. It was said the person was first diagnosed to have Dengue, then later diagnosed for COVID. It was also announced that the Dengue diagnosis was not incorrect, and the person in fact had both diseases.

The Dengue diagnosis was based on an antibody test, which had been working well for years. But this turned out to be wrong in the presence of COVID-19, which gave false positives on the Dengue antibody test. So the initial Dengue diagnosis was wrong, and the person had COVID-19 without Dengue. But this took quite a bit of figuring out.

Covert COVID-19 and false-positive dengue serology in Singapore
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30158-4/fulltext

 

[Tendex]

Is this true? Foreigners generally could not leave Wuhan unless their governments made special arrangements to evacuate them. Most governments quarantined the evacuees.

Certainly from the 23rd of January flights from Wuhan were restricted but it is difficult to know how strictly, and what exceptions were made besides the evacuation cases you mention just going by the Wikipedia quote. The regular flights to Europe I mentioned in my first post likely stopped the 22nd so most of the international spread from Wuhan directly to other countries was until then rather than during the rest of January and February, but I do know that regular flights from other areas of China where the virus might have already spread before the lockdown were still flying to most countries in Europe after the 23rd of January.

 

[DennisN]

A new WHO initiative:

World leaders launch plan to speed COVID-19 drugs, vaccine; U.S. stays away (Reuters, April 24, 2020)

GENEVA/ZURICH (Reuters) - World leaders pledged on Friday to accelerate work on tests, drugs and vaccines against COVID-19 and to share them around the globe, but the United States did not take part in the launch of the World Health Organization (WHO) initiative.

French President Emmanuel Macron, German Chancellor Angela Merkel and South African President Cyril Ramaphosa were among those who joined a video conference to launch what the WHO billed as a “landmark collaboration” to fight the pandemic.

The aim is to speed development of safe and effective drugs, tests and vaccines to prevent, diagnose and treat COVID-19, the lung disease caused be the novel Coronavirus - and ensure equal access to treatments for rich and poor.

[...]

Leaders from Asia, the Middle East and the Americas also joined the videoconference, but several big countries did not participate, including China, India and Russia.

[...]

Macron urged all G7 and G20 countries to get behind the initiative, adding: “And I hope we’ll manage to reconcile around this joint initiative both China and the U.S., because this is about saying ‘the fight against COVID-19 is a common human good and there should be no division in order to win this battle’.”

Merkel said: “This concerns a global public good, to produce this vaccine and to distribute it in all parts of the world.”

Ramaphosa, chairman of the African Union, warned that the continent - with its generally poor standards of healthcare - was “extremely vulnerable to the ravages of this virus and is in need of support”.

 

[bhobba]

I have been doing a lot of posts in our local paper (digital version). Many are correctly pointing out the death rate is likely now about .1% and on that basis say the lockdown needs to be lifted. I point out that is true, and is similar to the flu death rate. It's not the death rate that is the worry - its we as yet have no vaccine and its R0 is 2.3 (maybe as high as 3) compared to the Flu's 1.3 - it really does explode if we do not try to lower that R0. A vaccine will of course do that, and if it's like the Flu vaccine, which is not 100% effective, still lowers the death rate of those that are unlucky to get it. Meanwhile we need to lower the R0 by other means such as even more testing (Australia pretty much leads the world in that - and is going to increase it even further - our current R0 is about .5 - it will die out) and simple measures like hand washing, basic social distancing etc. If it gets out of control potentially 24,000 Australians will die. Sure I think our level 3 lockdown can be significantly reduced, but we still must keep testing and tracing, plus the other sensible measures until we get the vaccine. Others however want it totally lifted which IMHO is 'madness'. Oh and they are going bonkers about the tracing app the government wants people to use due to privacy. I just don't get it - they already use Google maps etc.

Thanks
Bill

 

[bhobba]

I just read Trump's latest about not participating in the WHO world vaccine initiative:
https://thehill.com/changing-americ...18-world-leaders-kick-off-initiative-to-fight

Good thing we have Bill Gates:
https://www.businessinsider.com.au/...ifferent-vaccines-to-fight-coronavirus-2020-4

The WHO may have issues - but they still have a vital role.

Thanks
Bill

 

[DennisN]

A quite long article on BBC today about Sweden's strategy:

Coronavirus: Has Sweden got its science right? (BBC, 25 april 2020)

It includes differing opinions and also touches on quite many things that I have previously posted about in this thread. To me it seems one of the main reasons for the strategy has been to enable a long period of social distancing:

In addition, the Swedish Public Health Agency pushed the idea early on that a large proportion of cases were likely to be mild.

But it denied its strategy was based on the overall goal of herd immunity.

A core aim was to introduce less stringent social distancing measures that could be maintained over a long period time. Schools for under-16s have remained open to enable parents to keep working in key areas.

(my bolding)

Sweden, with a population of 10 million, remains amongst the top 20 in the world when it comes to the total number of cases, even though it mostly only tests those with severe symptoms. More widespread checks on key workers are now being introduced.

It has higher death rates in relation to its population size than anywhere else in Scandinavia.

Unlike in some countries, Sweden's statistics do include elderly care home residents, who account for around 50% of all deaths. Dr Tegnell admits that is a major concern.

I just quoted two parts of the article regarding the reasons for the strategy and the difficulty in comparing countries directly due to various differences in counting cases and deaths. Please read the entire article for more details.

As I've said before, I think time will tell, and be the ultimate judge how well this has worked out. It seems the government and the health agency in Sweden have currently got strong approval and strong support from the public.

Personally I expect there will be very tough political consequences for the government in the future if it turns out that our strategy and result was considerably worse than the other scandinavian countries.

EDIT 1:

Another new article by The Guardian on the topic, and about different lockdown exit plans in Europe:
Sweden queries basis of lockdowns as Germany keeps its guard up (The Guardian, 24 april 2020)

EDIT 2:

A new article by The Guardian about the comparison of death rates in Europe:
Is comparing Covid-19 death rates across Europe helpful? (The Guardian, 24 april 2020)

Belgium appears hardest hit on paper, but not all countries count non-hospital fatalities

[...]

The comparison game has been especially marked in Belgium, which on paper has the unhappy title of highest number of Covid-19 deaths per capita in Europe. Belgium – population 11.5 million – has counted at least 6,675 deaths since the start of the outbreak, more than Germany, which is nearly eight times more populous.

But such comparisons can be misleading. Unlike the UK, Italy or Spain, Belgium counts all Coronavirus deaths outside hospitals in its daily statistics: deaths in care homes account for 53% of the total. Belgium’s official toll also includes people suspected of having died of coronavirus, without a confirmed diagnosis. Nearly all deaths in care homes (94%) are suspected Covid-19 cases, rather than confirmed – an approach that has led some to complain Belgium is overestimating the number of fatalities.

[...]

Variations in counting of Covid-19 deaths, different testing strategies and lockdown policies make international comparisons a minefield. “A comparison between [EU] member states is difficult and should be done with extreme caution,” said a spokesperson at the European Centre for Disease Prevention and Control, the EU agency to tackle infectious diseases.

The agency is urging governments to count everyone who dies of coronavirus, irrespective of whether they die in hospital, a care home or private residence, as well as recording deaths where Covid-19 was “the main or contributing cause”.

EDIT 3:

Sweden to shut bars and restaurants that ignore Coronavirus restrictions (Reuters, 24 april 2020)

STOCKHOLM (Reuters) - Sweden warned on Friday it would shut restaurants and bars in the capital that did not comply with guidelines aimed at preventing the spread of the novel coronavirus, amid signs Stockholm residents were beginning to ignore the rules.

[...]

“As the sun begins to shine, we are beginning to see some worrying reports of open-air restaurants full of customers, of places packed with people, and we have to take this seriously,” Damberg told a news conference.

“I don’t want to see any full open-air restaurants in Stockholm or anywhere else. Otherwise, businesses will be closed.”

He said this would apply to bars and restaurant around the country, not just Stockholm.

[...]

 

[DennisN]

Worrying news reports about Brazil :

• Brazilian city health systems on verge of collapse (The Guardian live update, 25 april 2020)
• Brazil threatens to become COVID-19 hotspot with health system on verge of collapse (ABC News, 25 april 2020)

Cases of the new Coronavirus are overwhelming hospitals, morgues and cemeteries across Brazil as Latin Americas largest nation veers closer to becoming one of the world’s pandemic hot spots.
[...]

[...]
Medical officials in Rio de Janeiro and at least four other major cities have warned that their hospital systems are on the verge of collapse, or already too overwhelmed to take any more patients.
[...]

 

[mfb]

The claim that Belgium overestimates its deaths is very questionable, given that their excess deaths are twice the COVID-19 deaths. What is the cause of death of all these other people? Here is the article again.
I can't tell how reliable the baseline curves are (here is a comment by V50), but the increase is clearly much larger than the official COVID-19 deaths.

I just read Trump's latest about not participating in the WHO world vaccine initiative:
https://thehill.com/changing-americ...18-world-leaders-kick-off-initiative-to-fight

Meanwhile he was suggesting bleach injections...

After the Wuhan lockdown started many countries were interested in flying their people out. What options did China have? Say no, keeping foreigners in the country against their will? As far as I understand these people were quarantined on arrival. But it was too late already.

 

[Vanadium 50]

I have been doing a lot of posts in our local paper

Perhaps you could use that position to initiate a discussion on goals. Is the goal

1. To flatten the curve?
2. To extinguish the disease in humanity now?
3. To save every life, no matter the cost?

I don't think the goals have been articulated clearly. As late as yesterday, I was seeing PSA's saying that the goal was flattening, but as Russ keeps reminding me, that's all changed and the goal is actually extinction.

It seems to be that the cost a society is willing to pay depends on the goals' benefits and probability of success, so a discussion of that would be beneficial in a democratic society.

 

[bhobba]

I don't think the goals have been articulated clearly.

That one is being discussed endlessly. Let's just say it's far from clear what the goal is, except Australia is in a good position to decide it's next step. Our lockdown must be relaxed slowly and carefully, that's all that nearly everyone (not all though) agrees on. I am a believer in the tracing app the government wants to deploy, but there is fierce debate about it.

Thanks
Bill

 

[bhobba]

Meanwhile he was suggesting bleach injections...

I gave up trying to figure him out long ago. So has a very seasoned and successful ex politician here in Australia, called Graham Richardson. He just notes, somehow, and even he does not know how, it seems to work for him. He confounds even the experts.

Thanks
Bill

 

[mfb]

Perhaps you could use that position to initiate a discussion on goals. Is the goal

1. To flatten the curve?
2. To extinguish the disease in humanity now?
3. To save every life, no matter the cost?

A couple of island countries are on a good way to local extinction, I expect them to aim at that if they don't depend too much on tourism.
Australia is down to 10-20 new cases per day after 6700 total cases.
New Zealand is down to 5 new cases per day after 1500 total cases.
Iceland found zero new cases on Thursday and a single new case on Friday (1800 total cases). Overall they tested 13% of their population now.
Malta is down to 1-2 new cases per day (450 total cases).
Not a country, but Hawaii's new cases are very low as well (600 total cases). They might depend too much on tourism to keep that up, however.

Keeping the case count low is an option you didn't list.

Interesting things found on the way: Puerto Rico reduced its total number of cases (double counting error).

 

[StevieTNZ]

New Zealand is down to 5 new cases per day after 1500 total cases.

Today it is reported we have nine new cases, although that is pretty good.

 

[mfb]

I took the average over the last days. The exact range doesn't matter: 39 cases in 7 days, 30 cases in 6 days, 25 in 5 days, 22 cases in 4 days are all consistent with "5 per day". In two weeks this might be 0-1 cases per day if the trend continues, and maybe 0 per day in three weeks? Iceland could reach that point in 1-2 weeks already.

 

[StevieTNZ]

In two weeks this might be 0-1 cases per day if the trend continues, and maybe 0 per day in three weeks?

I hope so! I'm sick of this lockdown.

 

[bhobba]

Today it is reported we have nine new cases, although that is pretty good.

It does vary in both Aus and NZ - the main thing is to keep R0 less than 1. I think NZ is like Aus at about .5 - at that level it will go away - eventually. It is now being considered lifting travel restrictions between Australia and NZ and sporting competitions returning eg cricket. But that's a bit down the track.

Queensland is now lifting restrictions, but I will do a separate post about that.

Thanks
Bill