Coronavirus - worldwide spread and control

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https://www.independent.co.uk/voice...s-hospital-symptoms-italy-china-a9397736.html

This doctor also speaks about what I said before, the spread of community cases, narrow testing criteria and severe cases they’ve already been seeing in hospital.

“Yet as an NHS doctor currently caring for coronavirus patients, let me tell you: you have no idea how bad it’s going to get.

Without wanting to sound alarmist, the numbers are inescapable.

One week ago, we had 40 confirmed cases in the UK. We took no specific general measures other than to contain and trace the contact patients had had with others. Yesterday, we had over ten times that number of cases, and still apart from screening intensive care patients, our testing criteria have barely changed. We still aren’t testing community cases that clinically look like coronavirus if they haven’t travelled or had contact with confirmed cases. Hospital cases are only beginning to be tested this week, and only at the discretion of clinicians.

Until now, a suspected case was not allowed to be tested unless they had an obvious link to certain countries or infected patients. I’ve seen at least three people with severe disease who weren’t allowed to be tested, and heard of dozens more. This long-overdue policy change will soon be reflected – possibly as soon as the next 24-48 hours – in a big spike in case numbers.

For an idea of how quickly case numbers can explode, look to Italy. One week after it hit 320 cases, the country reported 2,036; a week later, nearly 10,000; next week that number will likely rise to 50,000 or more. There’s nothing I have seen that tells me the exact same thing isn’t coming for us in the UK. We only have around 4,000 intensive care unit (ICU) beds in England, 80% of which are already full. If we follow the same trajectory as Italy, with 10% of coronavirus patients needing ICU treatment, we will need 200 beds next week, 1,000 the week after. That’s already the entire ICU capacity. Every two days after that, we will need twice the number of beds again.”
 
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In Germany:

As of Monday all plannable surgeries will be postponed

In order to keep the hospitals free for corona patients, the federal and state governments want to postpone all plannable surgeries, admissions and procedures. As far as medically justifiable, this is to apply from Monday for an indefinite period of time, according to a resolution passed by the federal government and the state premiers on Thursday evening.

Bavaria's Minister President Markus Söder said that they wanted to put up a "protective umbrella for hospitals". What is needed is a "strengthening of the entire hospital landscape". This, he said, must be reorganized so that sufficient intensive care beds are available.

"Under no circumstances should it lead to a situation, as in Italy and elsewhere, where hospitals have to make decisions about which patient to treat at what age," the CSU leader emphasized. He added that the federal and state governments had agreed to lay the corresponding financial foundations for this "beyond the normal billing system". Hospitals that convert must have the certainty that they will be financially compensated.

Translated with deepl (free version)
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https://www.tagesspiegel.de/wissen/...sich-in-freiwillige-quarantaene/25560996.html
 
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In Berlin:

In view of the rising number of infected persons, schools and daycare centres in Berlin will gradually be closing from next week onwards. This was announced by the governing mayor Michael Mueller (SPD) on Friday. The closure is to begin on Monday with the upper school centers.

The measures in the fight against the virus are becoming more and more stringent: the cultural administration has announced the closure of all state-owned cultural institutions, including theatres, opera and concert halls, museums and libraries. The Prussian Cultural Heritage Foundation announced the same step for its institutions, above all the Museum Island. The Berlin Football Association has suspended all amateur football matches.

Charité [Berlin's largest hospital] virologist Christian Drosten, wants to soon restrict treatments mainly to senior citizens and people with underlying diseases.

Translated with DeepL (free version)
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https://www.tagesspiegel.de/berlin/...iner-schulen-werden-geschlossen/25605226.html
 
Other countries are doing so much to try to limit this virus. Interesting how the UK has some special new information or science that the other countries and even the WHO doesn’t, and have decided by themselves to not close anything down.

Saw today the Glastonbury’s line up. Big football matches going ahead. Cheltenham still going ahead. Festivals with thousands of people happening.

As an MP said last night, I’d like to see the modelling this decision was based on.
 
Sean said:
This is getting nasty fast.

All we can do now is try to slow the spread, so it doesn't overwhelm health systems, or take down too many of the general workforce at any moment.

:grumpy:
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Indeed. Update from Berlin:

As the spokeswoman of the senate announced, a concept is also to be developed "by which public transport can be reduced to a minimum, the focus is to be placed on rail transport". According to this, "critical infrastructures, gas, electricity and water supply" are to remain guaranteed, as well as the operation of hospitals, fire brigade and police.

(translated by deepL)
https://www.tagesspiegel.de/berlin/...hulen-und-kitas-reduziert-oepnv/25605226.html
 
Does anyone know any epidemiologists/scientists/researchers on twitter who are based in the UK or do research on the UK measures and do predictions and publish papers. I’ve seen lots of US based researchers, like the one Cheshire posted above - it’s really interesting. but a lot of what they apply it to and the context in other posts is the US or Europe situation. In the US, or Europe, schools and companies and universities seem to be closing, trying to prevent harm and doing a lot better than what’s happening in the Uk.

I would like to see some scientists and their predictions for the UK. And their recommendations etc. Does anyone have links? Thank you.
 
lunarainbows said:
As an MP said last night, I’d like to see the modelling this decision was based on.
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Yes. It's not simply about the model, but the dry run scenario being adopted.

I've been thinking about this. My following comments are based purely on the possible spread mechanisms, and ignore the humanitarian aspects (because conflating the two just confuses things), but be assured I fully appreciate the humanitarian aspects.

A thought experiment, nothing more, and not to be taken as expert opinion - far from it. Just conjecture.

Suppose an unreal situation, where the population is 100% static, and there is a small outbreak somewhere. That would spread outwards like the flame front of a fire, ripples from dropping a stone in water. The disease has a specific duration, after which those who survive it are then immune and no longer contagious. So you have this spreading ripple of contagious cases, with an ever increasing area within it that is effectively a safe area - no one nearby to catch the disease from, and no risk of the disease being transmitted by domino effect from the contagious perimeter. Now suppose (this is purely a hypothetical thought experiment remember), that some uninfected people fly from outside perimeter into the safe area. They would remain safe surely. The contagion cannot cross the safe zone.

Now back to reality, where movement obviously can lead to transmission. My above thought experiment is presumably going to be part of the modelling, just one of the many factors that will be in play. The more the epidemic spreads within the UK, the more that above mechanism would start to contribute within the model, I imagine; by the time a large number of people have been infected, the more it would potentially dominate.

For any one model, you can run many scenarios through it, and then base your actions on whatever scenario you think appropriate; for one model you can dry run many scenarios. What if the UK government have decided to take a different approach? That for the moment at least, the only way people gain any immunity is to actually catch the virus, and thereafter most are OK and contribute to any safe zones. With something like this the only decisions are hard decision, and I wonder if the UK government has decided to pursue a different disease spread scenario, given there is no vaccine in the immediate future, and there is no way of stopping it anyway. If the modelling shows that no matter what you do there is no way of avoiding some people dying, would this scenario actually be no worse than the other scenarios, other than palatability?

But it would surely mean you would have to have extremely stringent controls to prevent constantly importing the infection from outside the UK, and reseeding it.

In reality all the various factors that go into the modelling will be highly interactive, but have to be identified and addressed separately.

Like I say, the above is largely uninformed conjecture on my part. I've no medical qualifications. And I am only too well aware of the humanitarian issues.
 
Barry, I think the problem with your thought experiment which, if I understand it correctly, is to expose everyone to the infection so they all either become immune or die. The outcome from that would be the maximum possible number of deaths surely, and happening as fast as the disease can spread. Sure, after all the vulnerable individuals have died, the remaining ones are immune, but at what cost.

If that were a good strategy, by logical extension we should expose every child to smallpox, diphtheria, tetanus, ... and those who survive all those diseases would be the super healthy immune population. That's the point of vaccination - to create herd immunity without putting the population through the massive death rate in order to achieve it.

The problem arises when an unusually virulent new disease arises for which there is no herd immunity and no vaccine. You have the choice then of trying to prevent as many people as possible from getting the disease for the year or two it takes to develop a vaccine with pretty drastic control measures, as done with ebola, for example, or to try to do the vaccine's job for it by getting herd immunity the painful way by killing off all the vulnerable individuals.

Personally, with a death rate somewhere between 1% and 4% as seems to be the case here, I'd go for using pretty drastic control measures to prevent as many infections as possible for the year or two while work continues on developing a vaccine.
 
Trish said:
Barry, I think the problem with your thought experiment which, if I understand it correctly, is to expose everyone to the infection so they all either become immune or die. The outcome from that would be the maximum possible number of deaths surely, and happening as fast as the disease can spread. Sure, after all the vulnerable individuals have died, the remaining ones are immune, but at what cost.

If that were a good strategy, by logical extension we should expose every child to smallpox, diphtheria, tetanus, ... and those who survive all those diseases would be the super healthy immune population. That's the point of vaccination - to create herd immunity without putting the population through the massive death rate in order to achieve it.

The problem arises when an unusually virulent new disease arises for which there is no herd immunity and no vaccine. You have the choice then of trying to prevent as many people as possible from getting the disease for the year or two it takes to develop a vaccine with pretty drastic control measures, as done with ebola, for example, or to try to do the vaccine's job for it by getting herd immunity the painful way by killing off all the vulnerable individuals.

Personally, with a death rate somewhere between 1% and 4% as seems to be the case here, I'd go for using pretty drastic control measures to prevent as many infections as possible for the year or two while work continues on developing a vaccine.
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I hope you appreciate I was not advocating it but playing devil's advocate. And that in reality the thought experiment bit of it would never happen on its own in reality anyway - the bit where no one moves etc.

I was wondering if the scenario being adopted was to lean slightly more towards running a natural immunity scenario through the model, and whether that would influence timings of when you do things. Such things are so complex that the results can sometimes be counter intuitive, and I was just wondering if such a scenario, with delayed strict controls, might play in the model differently to what might seem obvious. Obviously if everything was just left to its own accord then it would go amok. But I'm assuming a key metric is to limit the peak number of hospitalised cases at any one time, and that that will be a key parameter into the model - scenarios that minimise this would presumably be top of the list. If there were a scenario where natural immunity barriers played some part (maybe just a small part), then would that be factored in.

I am in no way advocating anything, because I am far too under-qualified to do that. But wondering if you run all the possible scenarios through the model, the most obvious scenario may not the only one that keeps the peak down, albeit inevitably spreads it further over time.

And I agree that minimising deaths in the time before a vaccine is available should be the top priority. And I also agree that extremely stringent controls would seem the way to go. But I was just highlighting another potential factor in case that also plays a part, even though unintuitive. But I suspect you are right on balance, and indeed the country that has a culture enabling the most draconian control strategies, China, looks to be proving the validity of that.
 
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With this being a new virus everyone is likely to get it sooner or later. Many of the precautions being put in place are to prevent everyone getting it at once. If there are 400 ventilators in a region they can treat 400 patients but if 1200 come at once they can't cope.

If drastic precautions are taken, no one will get ill, but how long can it be kept up for? After 1, 2, 3 months people will go outside again, then bang, everyone gets ill at once. Some diseases will go away if no one gets it, but we are past that stage with this.

So large outdoor gatherings now, where a few people get infected, but enough for the health system to cope with are OK.

It is too late to prevent the virus coming here. All the measures are to keep the number of people ill at any one time manageable.
 
ladycatlover said:
What I don't understand is why they aren't testing people with the symptoms - they will never have accurate numbers if they don't do that.
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Because they cannot. The tests are in short supply except in countries that began manufacturing them very early, such as probably South Korea. In other words they cannot do it because globally our governments and health authorities stuffed up. Pharma is severely limited here, though no doubt working on vaccines and hoping to be first to get one to market, possibly without adequate testing. Alternative testing is limited, unreliable, or very expensive.

PS to be clear, this required all new tests be developed, made and distributed. Its not like we know what to do with a brand new viral strain.
 
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