Coronavirus - worldwide spread and control

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strategist said:
Avoid hospitals if you can. And healthcare workers need good personal protection and disinfection routines.
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I just saw this short interview on Dutch tv (see Twitter source below) where a hospital manager said that the Italian healthcare system is quite different. He said that in the Netherlands people go to their GP if they are ill while in Italy the hospital has a more important role - in the Italian system you often go directly to the hospital even for relatively minor symptoms or health problems.

Do you know if this is true? It could be one of the many hypotheses why Italy has been so badly afflicted, namely that concentration in the hospitals helped to further spread the epidemic, as the letter of doctors from Bergamo suggested.

 
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I think this Ferguson chap at Imperial is still in cloud cuckoo land. He has just said:

Ferguson says that, under the policies that were in force earlier, the NHS would still have been overwhelmed - even with the extra critical beds available.

Now, in the light of the new measures, he says he thinks in some areas intensive care units will get very close to capacity.

But over, across the nation as a whole, he says he is reasonably confident that the NHS will have the resources to cope.

Clark says people will find that “tremendously reassuring”


Does Ferguson not realise that it is already not coping and the number of cases needing ITU is likely to treble even if the incidence rate plateaus now. More likely it will increase five fold. He seems to have no understanding of practical health care.
 
C4
NHS: Dozen trusts fear intensive care units could be full by next week
79,679 views
•24 Mar 2020


It comes as a survey of Hospital Trusts reveals that 13 Trusts say they will run out of intensive care capacity next week. At the same time, a new tracker app has been launched today which analyses covid-19 symptoms submitted by users, to map how fast the virus is spreading and in which areas of the country.
 
Another modelling paper that looks interesting which addresses issues around symptoms within different age groups and how this may affect tramsission

Age-dependent effects in the transmission and control of COVID-19 epidemics
https://cmmid.github.io/topics/covid19/current-patterns-transmission/age_hypotheses.html
The COVID-19 pandemic has shown a markedly low proportion of cases among children. Age disparities in observed cases could be explained by assortative mixing patterns and reactive school closures which decrease mixing between children, or by children exhibiting lower susceptibility to infection, or by children having a lower propensity to show clinical symptoms. We formally test these hypotheses by fitting an age-structured mathematical model to epidemic data from six countries, finding strong age dependence in the probability of developing clinical symptoms, rising from around 20% in under 10s to over 70% in older adults. We find that interventions aimed at halting transmission in children may have minimal effects on preventing cases depending on the relative transmissibility of subclinical infections. Our estimated age-specific clinical fraction has implications for the expected global burden of clinical cases because of demographic differences across settings. In younger populations, the expected clinical attack rate would be lower, although it is likely that comorbidities in low-income countries will affect disease severity. Without effective control measures, regions with older populations may see disproportionally more clinical cases, particularly in the later stages of the pandemic.

The role of age in transmission is critical to designing interventions aiming to decrease transmission in the population as a whole, and to projecting the expected global burden. Early evidence, including presented here, suggests that there is age dependence in the risk of clinical symptoms following infection. Understanding if and by how much subclinical infections contribute to transmission has implications for predicted global burden and the impact of control interventions. This question must be resolved to effectively forecast and control COVID-19 epidemics.
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Jeremy Hunt - a very good speech about all the strategies the govt stopped doing: rigorously testing every case, contact tracing of every case and then isolation of infected contacts.

Despite promising to increase testing, tests per day are still at or less than 5,000-8,000 in the UK, which is more or less actually what they were a week ago. He points out experience of South Korea and China, and breaking the chain of transmission. Just as important if not more important than social distancing.

“By the end of next week we would have 1 million cases in this country. Unless we radically change direction, we won’t know where those million cases are”

 
While I agree testing would be useful I do not see anything wrong with people being told to self isolate if they have symptoms even if it has not been confirmed that they have the virus. The test takes 24 - 48 hours to give a result so you have to be quarantined for that amount of time anyway. That is usual for viruses and doctors consider a patient positive for any virus because they can't wait until the test comes back before they treat.

There is also a shortage of testing kits and a shortage of lab systems set up to do the test. This is all being sorted now but was not the case last week.

The other problem is that a negative test doesn't mean much unless it is repeated. You can be asymptomatic today and test negative but infective tomorrow. Only a positive test says anything.

In individual circumstances testing can be useful, but the simple advice to stay isolated if you have symptoms is the important part.

As people with ME we know all the problems of having doctors relying on tests to decide there is nothing wrong with us instead of using common sense and the evidence of their eyes.

Antibody testing should be available soon which gives a fast result and is more accurate than PCR and that will change things for the better.
 
The UK's coronavirus policy may sound scientific. It isn't

“The modellers use hypotheses/assumptions, which they then feed into models, and use to draw conclusions and make policy recommendations. Critically, they do not produce an error rate. What if these assumptions are wrong? Have they been tested? The answer is often no. For academic papers, this is fine. Flawed theories can provoke discussion. Risk management – like wisdom – requires robustness in models. But if we base our pandemic response plans on flawed academic models, people die. And they will.

....Second, but more grave, is the policymaking. No 10 appears to be enamoured with “scientism” – things that have the cosmetic attributes of science but without its rigour. This manifests itself in the nudge group that engages in experimenting with UK citizens or applying methods from behavioural economics that fail to work outside the university...”

https://www.theguardian.com/comment...oronavirus-policy-scientific-dominic-cummings
 
I have seen from a number of sources that the rtPCR test is only 70% accurate, with a high false negative. This suggests that if you have symptoms, and test negative, you should still self quarantine. This may be why some patients test positive, then negative, then positive again. It might not be reinfection, it might be test failure. A 30% failure rate would be a problem.

Does anyone have information on scientific confirmation of this level of failure for COVID-19? I am seeing it from doctors on social media, not from scientific testing sources.

Antibody testing is due soon, with multiple tests awaiting approval, but this is only useful with recovering and recovered patients.
 
Mithriel said:
While I agree testing would be useful I do not see anything wrong with people being told to self isolate if they have symptoms even if it has not been confirmed that they have the virus. The test takes 24 - 48 hours to give a result so you have to be quarantined for that amount of time anyway. That is usual for viruses and doctors consider a patient positive for any virus because they can't wait until the test comes back before they treat.

There is also a shortage of testing kits and a shortage of lab systems set up to do the test. This is all being sorted now but was not the case last week.

The other problem is that a negative test doesn't mean much unless it is repeated. You can be asymptomatic today and test negative but infective tomorrow. Only a positive test says anything.

In individual circumstances testing can be useful, but the simple advice to stay isolated if you have symptoms is the important part.

As people with ME we know all the problems of having doctors relying on tests to decide there is nothing wrong with us instead of using common sense and the evidence of their eyes.

Antibody testing should be available soon which gives a fast result and is more accurate than PCR and that will change things for the better.
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Its not testing by itself that seems to be important but the test and tracking so that if someone has a positive test you can look at who they have come into contact with and isolate them as well. I guess if we don't have any form of social distancing then the numbers isolated due to a single test could be massive. But since contacts are limited then this seems to work - or that is what they were doing in China when they got things under control.

I was wondering if it is worth testing people with symptoms and whether a better use of tests would be for those who have a high number of contacts who could be spreading the virus.
 
Sly Saint said:
I wish they would make it clear to people that even if they 'feel fine' that they might still be infected and subsequently passing the virus onto other people by not taking the appropriate measures.

When I think of the AIDS tv public health announcements back in the 80's that scared the hell out of everyone...........this on tv last night from the CMO just didn't do it

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I totally agree. A combination of that style plus the bleach type product ones that showed how contagion spreads invisibly using paint etc.
 
Mithriel said:
While I agree testing would be useful I do not see anything wrong with people being told to self isolate if they have symptoms even if it has not been confirmed that they have the virus. The test takes 24 - 48 hours to give a result so you have to be quarantined for that amount of time anyway. That is usual for viruses and doctors consider a patient positive for any virus because they can't wait until the test comes back before they treat.

There is also a shortage of testing kits and a shortage of lab systems set up to do the test. This is all being sorted now but was not the case last week.

The other problem is that a negative test doesn't mean much unless it is repeated. You can be asymptomatic today and test negative but infective tomorrow. Only a positive test says anything.

In individual circumstances testing can be useful, but the simple advice to stay isolated if you have symptoms is the important part.

As people with ME we know all the problems of having doctors relying on tests to decide there is nothing wrong with us instead of using common sense and the evidence of their eyes.

Antibody testing should be available soon which gives a fast result and is more accurate than PCR and that will change things for the better.
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Agree people should be isolating and social distancing etc. But also I think it’s simply not good enough, the situation we find ourselves in. It is not just lack of testing but more importantly we need positive tests to do the contact tracing. That is what breaks chains of transmission. In Jeremy Hunt’s talk - he specifically mentions how and why breaking the chain of transmission is so important, as well as how it could be done.

It is possible. We do have the manpower. Scientists and those working in labs have tweeted / written into newspapers before, saying we already do have the manpower and capacity to be able to do those tests too - if only tests were being bought. Companies in the UK are producing tests by the tens of thousands and shipping them to Europe, while they haven’t even been approached by the NHS.

We are in a situation now where doctors and nurses do not know if they are infected. Because they don’t know if they’ve been in contact with anyone who is infected - as those patients themselves haven’t been tested. Being sent home with symptoms without being tested. anyone who has been in contact with them over the past 14 days doesn’t know - so they carry on as normal, again without being tested, and then if they fall ill, they aren’t tested. No one is traced, no one knows. This scenario plays out again and again over orders of magnitude. Yes people do need to isolate and we need lockdown too, but after a while, and even in the future, that’s only part of it.

As Tedros said, Test test test (And that doesn’t mean only antibody tests as the govt is pretending it does), trace and isolate to break chains of transmission.

Edit: I don’t think antibody tests will be helpful beyond finding out what proportion of the pop has had it. It will be small, I presume. So for everyone else, they still will need PCR when they get symptoms.
 
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Jonathan Edwards said:
This is very interesting. Staff in China dealing with COVID didn’t want psychological intervention, they asked for more rest without interruption and enough protective supplies.

Well, who could have predicted that! Amazing!
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In my limited experience of psychiatry and therapy, practicality and usefulness in real life of the type that real people want was either completely missing or was never high on the agenda. I remember once I was referred to get CBT in the IAPT system. At the time I was unemployed, broke, sick and depressed. The solutions I was offered by the therapist to fix my problems were a) go to the theatre (and bear in mind I'm really quite severely deaf, so I wouldn't have been able to hear any dialogue on stage, even if I could have afforded the tickets), and b) employ a cleaner (who I wouldn't have been able to pay).
 
ahimsa said:
I thought this article had already been posted but a forum search did not find it so I'm posting it now.

Here's an article from Dr. Atul Gawande:

Keeping the Coronavirus from Infecting Health-Care Workers:
What Singapore’s and Hong Kong’s success is teaching us about the pandemic

https://www.newyorker.com/news/news-desk/keeping-the-coronavirus-from-infecting-health-care-workers
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Western governments would do well to take note of this and stop messing about with modelling.
 
Jonathan Edwards said:
Except that that should be at least 4 years not 18 months. With the uncertain behaviour of the virus and periods of cool off it might be more like 10-20 years. It just isn't an option.
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Sorry if I've asked this before (rubbish memory) but isn't the 18 months idea based on the estimated time to a vaccine, and isn't that a reasonable position? I think that was also the strategy recommended in the 'hammer and dance' article.
 
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