Coronavirus - worldwide spread and control

[Marco]

I'm sure this has been mentioned before but if anyone want to contribute to better understanding this pandemic you can sign up to this symptom tracker app at King's College London :

New symptom tracking app aims to slow spread of coronavirus

https://www.kcl.ac.uk/news/new-symptom-tracking-app-aims-to-slow-spread-of-coronavirus

App here :

https://covid.joinzoe.com/

Apparently there are plans to roll this out in the USA also.

 

[wigglethemouse]

Stealing a second article directly:
Early epidemiological assessment of the transmission potential and virulence of corona disease in Wuhan City, China, Jan-Feb 2020
Mizomoto et al

from the abstract


Full article available.

This is showing that R0 was modellied to be as high as 5.2 before isolation/separation takes place! That explains the rapid increases we see on the charts, and ties in Ian Lipkins suggestion in the recent podcast that R0 was likely much higher than being reported.

I thought this was very interesting. Hospitals are breeding ground for a higher CFR. This correlates what has been reported in Italy. From PDF page 14.

These findings indicate that the death risk in Wuhan is estimated to be much higher than those in other areas, which is likely explained by hospital-based transmission [32]. Indeed, past nosocomial outbreaks have been reported to elevate the CFR associated with MERS and SARS outbreaks, where inpatients affected by underlying disease or seniors infected in the hospital setting have raised the CFR to values as high as 20% for a MERS outbreak.

Unfortunately I don't understand how they estimated an inferred fatality rate of 0.12%. They mention surveillance studies but I didn't follow the links, which led to an assumption of 20% infection rate in Wuhan.

 

[BurnA]

It seems UK health secretary Matt Hancock prioritised testing for patients over healthcare workers, saying it could be the difference between treatment to save a patient or not.

I was under the impression testing is more for public benefit than anything else.
If a patient is sick and suspect Covid-19, they need to isolate or get to a hospital, I didn't think a test would change that. Will a test change the prognosis.

What's the consensus on who should be prioritised for testing?

 

[Jonathan Edwards]

I agree that what Hancock said seemed odd. I am unclear who gets tested. If you just having some symptoms it seems you do not qualify. If you pitch up at hospital clearly ill then maybe you do, but then if you are that ill then you need specialised care anyway and from what the Chinese say a scan, which you would need anyway, is likely to be diagnostic.

But surely the point is that there ought to be enough resources to test both? It looks very much as if we are getting in to the Italian situation of hospital-based transmission (nosocomial). A friend of mine needing major surgery urgently went in for pre-op assessment and ended up Covid positive and with no surgery. An infectious disease specialist in East England pointed out to a lan colleague of mine that a good part of the problem is the closure of hospital pathology labs and outsourcing. Hospital infectious disease specialists cannot do anything because they don't have the lab facilities any more.

 

[FMMM1]

I agree that what Hancock said seemed odd. I am unclear who gets tested. If you just having some symptoms it seems you do not qualify. If you pitch up at hospital clearly ill then maybe you do, but then if you are that ill then you need specialised care anyway and from what the Chinese say a scan, which you would need anyway, is likely to be diagnostic.

But surely the point is that there ought to be enough resources to test both? It looks very much as if we are getting in to the Italian situation of hospital-based transmission (nosocomial). A friend of mine needing major surgery urgently went in for pre-op assessment and ended up Covid positive and with no surgery. An infectious disease specialist in East England pointed out to a lan colleague of mine that a good part of the problem is the closure of hospital pathology labs and outsourcing. Hospital infectious disease specialists cannot do anything because they don't have the lab facilities any more.

What I'm not sure about is how many are antigen tests i.e. to determine who has the virus/are infectious?

From a population perspective, what is the point in testing for antibodies i.e. determining whether a person has been exposed/has recovered? The herd immunity thing will only be significant in reducing transmission when possibly 30% of the population have had the virus/are immune. So your looking at a year of pointless immunity testing.

OK the purpose is that the number sounds impressive and similar to e.g. Germany (500,000 per week); however, the German testing is antigen testing and allows measures to reduce transmission.

Pretty neat politically, even if it is based on the ignorance of the general population.

There was a comedy called Hancock's Half Hour --- sure someone's come up with that before.

 

[Amw66]

https://www.theguardian.com/world/2020/mar/13/herd-immunity-will-the-uks-coronavirus-strategy-work

Dr David Halpern, a psychologist ...

Just some thoughts reading all this. Firstly, here in Scotland health care workers are being tested. Before all this started, coronavirus was tested as part of a general screening that included flu and other respiratory viruses. If the test was positive and it was clinically necessary the sample was sent to one of 2 centres who tested for the actual coronavirus it was. (The same thing is done for enteroviral species) Once the pandemic started our local lab began doing the specific Covid19 PCR.

Now they are trying out cartridges which will be used at point of care and look for IgM which will show a current infection and IgG which will show a past infection (broadly speaking) The value of that test is that it gives a result much, much faster than PCR.

As it stands, PCR takes 24 48 hours to give a result. You can't wait that long before you start treating a patient so they must all be considered positive. That is why self isolating as if you were positive has to be started before PCR results. When there is a shortage of kits, self isolating without being tested makes sense. The exception is key workers and that is why Scotland is testing them.

I am too cognitively challenged to consider what the government did or should be doing, but the reasons for testing are mixed and articles and statements seem to be getting them all mixed up (it may be me trying to understand)

There is patient care first and foremost.
Care for medical personnel and other key workers.
Testing and isolating contacts. Very important at the start of an outbreak and now, people will really believe in the disease if they have a positive test.
Then there is epidemiology to give us the data to understand the virus and how it spreads. This data should inform policy and will be vital for the future.

One of the articles said that the problem with logarithmic emergencies was that the time to act was at the very beginning but then people assume it was never much a crisis at all. If you avert a disaster no one thinks there would have been one.

That happened with the millennium bug where planes didn't fall out of the sky and civilization collapse, well things stopped working, because of the amount of time, effort and money that went into fixing it.

Then there was the swine flu epidemic where people decided it was a plot to sell tamiflu and trick people into getting vaccinated.

The one thing we can be certain of for the future is that there are going to be years of recriminations no matter which government and what they decided to do.

Academic / commercial testing launched

 

[Jonathan Edwards]

It looks as if the antibody tests so far are too unreliable to be much use. I thought it was a bit much to expect a reliable IgM test early on. Antibody tests will be useful for individuals who did not get the antigen test while they were ill and want to return to a more normal existence. If I had positive antibody test I could go around being useful rather than hiding away.

There is going to be a huge problem, though, as pointed out in the Guardian, when antibody positivity is taken as a passport to normal life. All sorts of shenanigans will supervene.

 

[FMMM1]

When I read the first stories and papers coming out of China a month or so ago, I seem to remember them saying ventilators were not that effective as the virus had caused changes in the lungs so oxygen couldn't be absorbed well. What made the difference was ECMO.

Source : https://www.ucsfhealth.org/treatments/extracorporeal-membrane-oxygenation

Since the virus has exploded in Europe and the US I have not heard anything about ECMO and I have no idea why that is??????????????? Anyone know?

The figures I saw quoted today in the US was that 80% of COVID-19 patients on ventilators die. I don't know if that is true or not, but if it is, shouldn't we also be using ECMO?

I Googled "ECMO versus ventilator" and the first hit suggests you may be right i.e. better outcomes [https://www.medicalnewstoday.com/articles/164041#1]. I assume there's a reason for using ventilators while accepting that ECMO would be better (cost/availability/level of specialist care required --)

 

[Hoopoe]

There is going to be a huge problem, though, as pointed out in the Guardian, when antibody positivity is taken as a passport to normal life. All sorts of shenanigans will supervene.

Oh no. I was hoping that this would enable society to continue to function somewhat while the virus isn't fully controlled yet.

I didn't read the Guardian article but I heard Germany is planning to give coronavirus certificates for those with antibodies.

 

[lunarainbows]

I also heard about ECMO - from what I remember, China ordered thousands of them to be made from Germany, to help with the outbreak. It also looks like (from a quick google search) the WHO has recommended them to be used also in some cases of coronavirus - perhaps severe cases. However here in the UK we have very few of these machines - around 15 I think for the whole country - and as far as I know, no extra ones have been ordered. I don’t know why.

 

[Leila]

Oh no. I was hoping that this would enable society to continue to function somewhat while the virus isn't fully controlled yet.

I didn't read the Guardian article but I heard Germany is planning to give coronavirus certificates for those with antibodies.

If these certificates grant the right to e.g. work, move freely in public spaces, maybe cross borders, it could be an incentive or even a necessity for people to deliberatly get infected.

 

[lunarainbows]

On the ECMO topic, someone has tried to start a UK petition here:

Urgently puchase more ECMO machines to treat critical coronavirus patients
The UK only has 15 beds available for adult extracorporeal membrane oxygenation (ECMO) treatment at five centres across England. How can the government not be actively buying addition more ECMO machines? China purchased thousands! Italy is buying more. Mortality rate can be improved with ECMO.

https://petition.parliament.uk/petitions/301533

The petition was rejected for the reason that its not something the government or parliament are “responsible for”.

 

[lunarainbows]

I think this is the antibody article Jonathan Edwards is referring to:

https://www.theguardian.com/politic...end-covid-19-lockdown-with-immunity-passports

No 10 seeks to end coronavirus lockdown with ' immunity passports'
Fresh criticism over testing plan as Matt Hancock says early antibody results ‘poor’

 

[FMMM1]

On the ECMO topic, someone has tried to start a UK petition here:

Urgently puchase more ECMO machines to treat critical coronavirus patients
The UK only has 15 beds available for adult extracorporeal membrane oxygenation (ECMO) treatment at five centres across England. How can the government not be actively buying addition more ECMO machines? China purchased thousands! Italy is buying more. Mortality rate can be improved with ECMO.

https://petition.parliament.uk/petitions/301533

The petition was rejected for the reason that its not something the government or parliament are “responsible for”.

Unbelievable i.e. providing equipment to save lives in an epidemic is not something the government or parliament are “responsible for”.

@Jonathan Edwards the Government seems to be keen to stay out of the operation side i.e. health care delivery.

Still I don't see why the Government cannot lead on acquiring essential equipment; it's just waved a big lump of debt for health trusts --- so why not spend that money on purchasing essential equipment?

 

[large donner]

There is going to be a huge problem, though, as pointed out in the Guardian, when antibody positivity is taken as a passport to normal life. All sorts of shenanigans will supervene.

All Shenanigans are go.... past tense, perhaps 36 years old!

Yet the future will be new in this brave world.

 

[Amw66]

 

[lunarainbows]

Reading about the antibody testing in the Guardian article, and the fact the govt may be relying on these as the way out of lockdown..

“However, some critics fear that this could lead to resentment in the population who have not had the virus, and that people might even deliberately try to get infected in order to obtain an immunity certificate.

However, in the wider population, fraud could be an issue, which could rule out home-based testing, and there were concerns about unintended consequences. “People going out to deliberately get infected so they could get back to work is a concern and I don’t know how you’d avoid that,” he said. “Those are big issues.””

I can definitely see this happening. If you don’t have the virus you’re stuck inside without proper access to the outside world, and if you’ve had it, you’re “free” again? I can see people taking risks to try to catch it, thinking it’ll be “mild” for them - and likely passing it onto others too, in the process - and since there’s no way to determine whether they will die or be affected badly, case numbers can go up, problems in hospitals.. oh gosh I can see some big problems with this.

 

[wigglethemouse]

The petition was rejected for the reason that its not something the government or parliament are “responsible for”.

Here is the rejection

Why was this petition rejected?
It’s about something that the UK Government or Parliament is not responsible for.

Treatments are a clinical decision for the NHS, not the UK Government or Parliament.

We only reject petitions that don’t meet the petition standards.

They weren't making a treatment decision, they were asked to support purchasing. Awful.

 

[Esther12]

An article on a pre-print that I've not read, but have seen discussed around that place. It looked at the different economic outcomes of different cities responses to the 1918 flu.

But the economic outcomes of the 1918 flu were very different in different cities, depending on their response to the pandemic. The study, which analyzed 43 cities, found that the areas that moved more aggressively to limit activities and physical interactions among the public had more economic growth following the 1918 pandemic.

https://amp.wbur.org/bostonomix/202...nomic-impact-covid-19-coronavirus-spanish-flu

 

[zzz]

With all the data about the spread of COVID-19 coming out daily, it's often hard to see what's going on and what the underlying trends are. I have found the video How To Tell If We're Beating COVID-19 to be extremely helpful in displaying these trends in a way that is easy to see and understand:

​

Once you have viewed the video, you can go to the Covid Trends Web site, which will draw a new chart in real time, just as in the video. Data is completely up to date as of the end of the previous day. For example, here is the completed chart as of the end of April 1st:

[If the image is less than full sized, you can click on it to make it bigger.]

Note that in the time since the video was created, the US has pulled out well ahead of all other countries. The slope of the US curve has been declining just a little bit recently, but the curve is still pretty close to straight exponential growth. There are no traces in the US curve of the changes in slope that show up in the curves of Italy and Spain, for example, which does not bode well for the near future of COVID-19 in the US.

As you can see, on the right you can select as many or as few countries as you want to be shown on the graph. The end of a country's curve is always associated with a red dot, with the country's name nearby.

When you have more than a few countries, such as in the chart above, the plain display may make it difficult to see the full curve for any given country. Fortunately, if you hover your mouse over any part of the curve for a particular country, the country's full curve is highlighted in red, and a popup appears with the name of the country, the date over which the mouse is positioned, the total number of confirmed cases, and the total number of weekly cases. For example, in the above chart, it is a bit difficult to see how the UK is doing. By highlighting part of the UK's curve, the progress is much more obvious:

Note that the "Customize" section in the upper right can also be very useful. For example, instead of "Confirmed Cases", you can display "Reported Deaths":

Again, the US and UK have some of the straightest lines on the graph, which means that exponential growth is continuing here. Reported deaths tends to be a more reliable statistic than confirmed cases, mainly because deaths tend to be reported on or very near the day they occur, while cases of COVID-19 are typically reported a couple of weeks after infection, or not at all in asymptomatic cases. Furthermore, even symptomatic cases of COVID-19 are often not reported if the symptoms are mild.

Also, the "World" selection can be customized to one of a few countries that are subdivided into states or provinces. For example, here is the US chart of confirmed cases divided by state:

Note the New York is the one state that is starting to noticeably bend its curve. All the other states are pretty much straight lines, which means that exponential growth is continuing in the rest of the country. As with the country display, you can add or subtract states on the right as you wish; the results are shown immediately.

You can also do any of these plots using a linear scale instead of the default logarithmic scale. Here is the original country chart using a linear scale:

As you can see, the linear scale can often make the differences between countries or their subdivisions even more obvious. In this case, the difference between the US and the rest of the world shows up quite dramatically. And interestingly, due to the way the axes are defined, even though they are linear, exponential growth still shows up as a straight line.