Coronavirus - worldwide spread and control

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Wuhan Health Commission have published a Q&A on how they deal with asymptomatic cases. Of course, it’s far, far more thorough and on the opposite end of the scale to how we deal with even our symptomatic cases in the UK.



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Also very interesting:

 
Is there going to be a massive increase in the birth rate nine months after lockdown was imposed in countries around the world? Think of all that unused energy (from not working) and the boredom. I think lots more babies is inevitable.
 
Michiel Tack said:
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.
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I am not sure what it's like in other countries.
 
Sasha said:
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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It might be based on that, indeed. But I think that begs quite a lot of questions. How do you test a vaccine unless you in the middle of spreading infection - you need to vaccinate people who have a reasonable chance of getting infected in a reasonably short time. Maybe you could test the vaccine in some poor third world country where nobody is in lockdown and the epidemic is still wild - but would you then have the infrastructure to do the study?

I just don't think people are thinking through the logistics. It is a bit like suddenly planning a dinner party having forgotten that it is Sunday and the shops are shut.

It is quite likely that a vaccine will get developed within a couple of years but eighteen months is just a number plucked out of the air.
 
Jonathan Edwards said:
It is quite likely that a vaccine will get developed within a couple of years but eighteen months is just a number plucked out of the air.
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Not to disagree, but to clarify for some readers, we have vaccines now. What we do not know is safety and efficacy, hence the commencement of trials. Once a vaccine is found effective and acceptably safe, we then need to expedite approval, manufacture in quantity, then distribute to where its needed and set up vaccination programs in local areas. Its a long road, hence the delays.

It does no good to suddenly release a vaccine that does not work, or even worse, is substantially dangerous in its own right. If testing is rushed it could add to the chaos, not help it.

Responses discussing safety of vaccines moved to biology thread.
 
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We may be getting our antibody testing through a high street shop or Amazon very soon, within a few weeks or days even by the sounds of this article:

https://www.theguardian.com/world/2...home-testing-to-be-made-available-within-days

“Thousands of 15-minute home tests for coronavirus will be delivered by Amazon to people self-isolating with symptoms or will go on sale on the high street within days, according to Public Health England (PHE), in a move that could restore many people’s lives to a semblance of pre-lockdown normality.”

What does that mean? So if you test positive you go back to work? Is there complete and irrefutable evidence that if you’ve had it once, you won’t get it again.

More importantly, even if you’ve had it once, is there proof you cannot harbour it and pass it on? For example just by being out and about, you could get the virus on your hair or skin or clothes and even if it doesn’t infect you - that virus can then easily pass to others, eg those you live with, if you work in the food industry, if you touch a surface with a hand that had already touched the virus etc, which someone else touches. Has this not been taken into account? The more people out and about, the more unsafe it becomes, surely? And this is at a time when we are supposed to be in lockdown. Am I missing something because I feel quite worried / confused about this.

Edit: I can understand it can be helpful in specific cases like the NHS but what about in general?
 
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One thing maybe the behaviour nudge people have not factored in is that common sense would say that 'rule fatigue' is maybe most likely to strike if you`re told to lockdown, unlock, lockdown, unlock and so on for a couple of years. It seems a likely breeding ground for all sorts of false beliefs about it being OK to play out because after all it was OK last week.
 
lunarainbows said:
What does that mean? So if you test positive you go back to work? Is there complete and irrefutable evidence that if you’ve had it once, you won’t get it again.
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It seems that the tests measure IgM and IgG antibody responses to the virus. In general with tests like this you rely on two samples a fortnight apart to show a rise in levels to be sure they mean something. It may be that the current test is specific enough to give a firm answer on one sample but it is likely to be less than perfect.

IgM rises early in the immune response but I would have thought it might well not be above normal at the time of symptom onset. IgG certainly is unlikely to be.

Sarah Bosely has written a piece on this which, not unexpectedly, is very confusing. There is no mention of the fact that the value of this test is to show that you are likely to be immune ONCE YOUR CURRENT SYMPTOMS have subsided and you have stopped coughing out droplets everywhere. With luck the advice would be that if the test is positive you should self-isolate for seven days after symptoms have settled and after that you are likely to be immune and able to work with patients. It certainly would not mean that if positive you are ready to go out to work.

The other thing would be that if you test negative that may mean that the symptoms you have on the day of the test are unlikely to be due to Corona. That does not in any way mean that you are not infected with corona (which might start giving symptoms in a couple of days and be infectious tomorrow).
 
Shutting down the economy for years would have such a high cost that to avoid that they'd do almost anything. eg: a truly massive expansion in testing, so everyone could be tested regularly - something like that would presumably allow for an effective policy of containment.
 
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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They clearly can't be in their right minds, and must therefore be desperately in need of psychological interventions. No doubt some folk we know could write a paper on it.
 
Esther12 said:
Shutting down the economy for years would have such a high cost that to avoid that they'd do almost anything. eg: a truly massive expansion in testing, so everyone could be tested regularly - something like that would presumably allow for an effective policy of containment.
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And eradication. If you can reduce the number of cases from 1000 a day to 10 then you can reduce it to zero. It doesn't get harder the fewer the cases. It gets much easier.
 
The NHS should be able to cope with the coronavirus outbreak now the country is in lockdown, according to infectious diseases expert Prof Neil Ferguson.

Keeping people inside and increasing NHS staff and beds would prevent intensive care units (ICUs) from being overwhelmed nationally, he said.

There could still be some difficulties at a local level, he told MPs.

But there was now a "reasonable degree of certainty" the government measures would put the epidemic into decline.
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https://www.bbc.co.uk/news/health-52035615
 
Jonathan Edwards said:
It seems that the tests measure IgM and IgG antibody responses to the virus. In general with tests like this you rely on two samples a fortnight apart to show a rise in levels to be sure they mean something. It may be that the current test is specific enough to give a firm answer on one sample but it is likely to be less than perfect.

IgM rises early in the immune response but I would have thought it might well not be above normal at the time of symptom onset. IgG certainly is unlikely to be.

Sarah Bosely has written a piece on this which, not unexpectedly, is very confusing. There is no mention of the fact that the value of this test is to show that you are likely to be immune ONCE YOUR CURRENT SYMPTOMS have subsided and you have stopped coughing out droplets everywhere. With luck the advice would be that if the test is positive you should self-isolate for seven days after symptoms have settled and after that you are likely to be immune and able to work with patients. It certainly would not mean that if positive you are ready to go out to work.

The other thing would be that if you test negative that may mean that the symptoms you have on the day of the test are unlikely to be due to Corona. That does not in any way mean that you are not infected with corona (which might start giving symptoms in a couple of days and be infectious tomorrow).
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Thanks @Jonathan Edwards.

What about my second point? Leaving aside NHS staff, who are essential staff. But non-essential, and I mean really non-essential (not what the govt thinks is essential or non-essential!), staff. Many people would get an antibody test and if positive, be told to return to work. But then because there’s more people out and about, even if they can’t spread the virus by being infected, they can still spread the virus by unknowingly picking it up on their hands clothes etc, and bringing it back into their towns/communities and houses, and spread it to those who are not immune. Which is why surely it’s important to have lockdown for all. It doesn’t look like the govt have thought about this?
 
New data on containment strategies from China

"The effect of human mobility and control measures on the COVID-19 epidemic in China"

"Containment of respiratory infections is particularly difficult if they are characterized by relatively mild symptoms or transmission before the onset of disease (23, 24).

Intensive control measures, including travel restrictions, have been implemented to limit the spread of COVID-19 in China. Here, we show that travel restrictions are particularly useful in the early stage of an outbreak when it is confined to a certain area that acts as a major source.

However, travel restrictions may be less effective once the outbreak is more widespread. The combination of interventions implemented in China were clearly successful in mitigating spread and reducing local transmission of COVID-19, although in this work it was not possible to definitively determine the impact of each intervention.

Much further work is required to determine how to balance optimally the expected positive effect on public health with the negative impact on freedom of movement, the economy, and society at large."
 
lunarainbows said:
they can still spread the virus by unknowingly picking it up on their hands clothes etc, and bringing it back into their towns/communities and houses, and spread it to those who are not immune.
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I actually think the risk associated with this is very small. In theory it could occur but the alternative is likely to be someone else doing that activity who is actually excreting virus and not knowing it.
 
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