Coronavirus - worldwide spread and control

[Snow Leopard]

It seems that in the UK every year 50.000 people die from pneumonia (5% of all cases). This makes on average 4.166 per month (but with a typical peak in late winter/ early spring, I think).

https://www.google.com/search?

It would be interesting to know the number of non-corona pneumonia cases and deaths this year.

Yes, we need to be reporting all-cause mortality figures as well.

In some countries the lockdown is likely saving lives due to lower motor vehicle collisions and less transmission of other viruses. But prolonged lockdown will cause increase in mortality due to suicide, lack of medical treatment (or medication) for other vulnerable people.

 

[Esther12]

The UK’s mitigation approach was devised by England’s chief medical officer Chris Whitty, and chief scientific adviser, Patrick Vallance. According to a person who has spoken to Whitty and Vallance, they took the view that the UK should not attempt to suppress the outbreak entirely, but rather prioritise protecting the elderly and vulnerable and ensuring the NHS did not become overwhelmed, while allowing the rest of population to build up “herd immunity”.

This strategy meant that widespread testing of every coronavirus case was not a priority for the UK, the person said, since the government’s scientists were assuming that between 60% and 80% of the population would become infected.

Accordingly, no preparations were made to increase manufacturing or imports of testing kits, nor to expand the UK’s laboratory capacity. Imports of testing kits are now extremely difficult as other nations seek more than ever to keep them for their own use.

The government has publicly insisted that herd immunity is not the UK’s policy. But the person familiar with Whitty and Vallance’s thinking said they believed it privately remains a long-term objective.

https://www.buzzfeed.com/alexwickham/uk-coronavirus-testing-explainer

 

[Snow Leopard]

Isn't the goal (and likely outcome given current infection rates) to flatten the curve until a vaccine/treatment is available? Which means heavy restrictions for a year or more.

 

[Simon M]

So far, China seems to be successful in getting people back to work and businesses running again, without a new epidemic flareup.

Here’s a piece from the reputable Science magazine (run by the journal Science).
https://www.sciencemag.org/news/2020/03/can-china-return-normalcy-while-keeping-coronavirus-check#
Although people seem to suspect that the figures are being manipulated to some extent, it also seems that things really are going pretty well. China is being very careful about how it relaxes controls. And continues to test, trace contacts of cases and quarantine.

 

[Barry]

And continues to test, trace contacts of cases and quarantine

This will be key I imagine. You cannot control something if you do not know what it is doing.

 

[Robert 1973]

From the Guardian, there are still at it:

Two behavioural scientists have written to Chris Whitty, the chief medical officer for England, to warn about the potential unintended consequences of mass public testing for coronavirus infection.

Prof Madelynne Arden at Sheffield Hallam University and Prof Christopher Armitage at the University of Manchester have told Whitty they felt compelled to share their concerns about the likely impact of mass testing on the public’s adherence to the lockdown and social distancing measures.

Reported by Ian Sample, whose name is familiar.

I wonder if the behavioural scientists have been advising Michael Gove to lie:

 

[JemPD]

One of the things that is concerning me about the non eradication policy & what seems to be going to be a continuous loosening & tightening of lockdown indefinitely... It is much worse psychologically to be messed about - now you can go out, now you cant, now you can, now you cant, now you can, now you cant. PEople will get pissed off & tell the gov to stick it... at which point I'm concerned that resentment will grow towards the vulnerable people all this inconvenience & 'hardship' is for the benefit of.

They have been so clear msg that it's for the vulnerable -over 70s & underlyings, & everyone else will be fine... that people think that's who they're doing this for.... which is fine for now, but as time goes on there will be a growing resentment towards all those (who are already considered a burden to society) who are 'making' them do it. If the message doesn't modify it will be us who get 'blamed'.

 

[BurnA]

Isn't the goal (and likely outcome given current infection rates) to flatten the curve until a vaccine/treatment is available?

I hope not.
Vaccine could be years away.
People have latched on to the idea that it could be 18 months. Well, it could be 10 years too.

 

[Hoopoe]

By the looks of it in about a week the peak should be reached. After that the number of sick people should begin to shrink.

 

[large donner]

Just watching the news about mass drive thru testing in portcabins and also walk thrus around the world.

I watched the process of collection of the swab to test and the result available in 24 hours and its seems absolutely clear that such mass production of non stop back to back tests in a small area is ripe to produce lab contamination potentially causing an uknown number of false positives.

 

[FMMM1]

I would view the system dynamics a bit differently. I agree a heavy hammer. I also agree that you can then consider easing certain restrictions. However, the Catch22 of the time frame here means that the aim of easing restrictions is specifically to find restrictions that turn out to make no difference at all to spread. As an example it might be that allowing people to buy plants from garden centres might turn out to be no problem. With luck certain extra aspects of normal life could return.

But this is not a case of lifting controls that are actually doing a useful job. The exponential and poorly understood dynamics of the infection mean that ANY loss of control will return us to the same disaster we have now. Lots of systems have a safe zone - like microphones operating below the level of positive feedback howl. Viruses do not have a safe zone. Or at least if you want to keep in a safe zone the epidemic will smoulder for years.

I suspect what we need to do is identify new restrictions - very likely wearing masks would be one - that are actually much less of a problem than banning all travel to non-essential work and once we have accrued the benefit of those to start easing off on things not with the idea of letting the virus get going a bit but with the idea of continuing the process of eradication. Once we have eradication we are in the clear. Without it we are forced to turn the mike down so low for the entire concert that nobody will hear us sing. You don't protect the economy by putting on inaudible concerts.

The strategy you are proposing @Jonathan Edwards aligns with Anthony Costello's suggestion i.e. you can introduce measures to ease restrictions


In fact it also allows your economy to recover, so those focused on the economy should be able to support the strategy. The South Korean strategy seems to have allowed their communities to return to something relatively normal --- low number of cases (and thereby lower risk to the vulnerable), people returning to work --- OK you wear a mask but at this stage this looks like heading in the right direction

 

[Snow Leopard]

One of the things that is concerning me about the non eradication policy & what seems to be going to be a continuous loosening & tightening of lockdown indefinitely... It is much worse psychologically to be messed about - now you can go out, now you cant, now you can, now you cant, now you can, now you cant. PEople will get pissed off & tell the gov to stick it... at which point I'm concerned that resentment will grow towards the vulnerable people all this inconvenience & 'hardship' is for the benefit of.

I agree that such a policy is going to cause major social problems, but what is the alternative?

Total lockdown of the whole world for months (which won't happen), or years of the virus simmering around the world with partial restrictions.

So far, China seems to be successful in getting people back to work and businesses running again, without a new epidemic flareup.

This is China we're talking about, there is no freedom of the press and the Chinese people are experts in skirting directives from the government when out of view. The virus is not gone.

 

[lunarainbows]

One of the things that is concerning me about the non eradication policy & what seems to be going to be a continuous loosening & tightening of lockdown indefinitely... It is much worse psychologically to be messed about - now you can go out, now you cant, now you can, now you cant, now you can, now you cant. PEople will get pissed off & tell the gov to stick it... at which point I'm concerned that resentment will grow towards the vulnerable people all this inconvenience & 'hardship' is for the benefit of.

They have been so clear msg that it's for the vulnerable -over 70s & underlyings, & everyone else will be fine... that people think that's who they're doing this for.... which is fine for now, but as time goes on there will be a growing resentment towards all those (who are already considered a burden to society) who are 'making' them do it. If the message doesn't modify it will be us who get 'blamed'.

Yes, this. Also the fact that we just won’t feel safe, and won’t actually be safe, out and about, but also in places like hospitals. How will they be able to ever make hospitals safe enough for people to have surgeries, resume cancer and autoimmune treatment, resume scans and screening and blood tests and appointments and so on.. when the virus is continually lurking, continually flares up, and cross infects inside the hospitals and causes surges again.. potentially causing everything to be closed down once again, like we are seeing now. People could go into hospital with something else and come out with coronavirus or die from it. Doctors will get infected.

I don’t know why this sort of thing doesn’t seem to have been taken into account in the strategy of mitigation / only suppressing to a certain level. It’s not just about reducing ICU demand, there’s all these “side effects” that come with it; if they’re not going to be focused on actually eliminating the virus.

 

[Art Vandelay]

From what I see coming out of Oz, testing is seriously lagging. This is likely a reflection of a choice to... ride the wave, I guess. Lots of comments and reports I see indicate they are trying the herd immunity/modest proposal and basically abandoned rigorous testing as part of the solution.

I hope this is just from limited information and skimming, not quite reading in detail, but everything I see coming out from down under supports that. Not good.

Not true. Australia has tested nearly 1% of the population (slightly more per capita than South Korea)

Mr Hunt said more than 230,000 tests had been done in Australia, which had produced accurate data of the virus's spread.

 

[Woolie]

Related to this:


He writes:

Great find, Michiel.

I think the problem with a lot of the psychology on human judgement and decision-making is that Psychology loves a story. There's good ink in telling a story about how humans fail at assessing risk ("We're not as good as we think we are!"). There's not much ink in telling a story about how we actually make fairly reasonable judgements in a lot of situations. Ironically Gigerenzer was one of the guys who was trying to get the boring story told a bit more, but he seems to have got caught up in the irrationality stuff lately.

This bit really good:

We can even play the psychologists at their own game: there are also biases in the opposite direction to those discussed above. For instance, “exponential growth bias” might mean that our standard ways of reasoning break down in a situation where a threat accelerates like this virus. As observed in an insightful article on Italy’s ongoing horrific experience, there’s also “confirmation bias”, where we seek out evidence that confirms our previous beliefs or desires.

In this case, many were understandably desperate to believe that the virus wouldn’t be too much of a problem, and it seems to have led them to underreact very badly indeed. None of the psychological writers above seemed to consider these opposing biases — and ironically, it might have been because they were biased against thinking about them.

For example, the team’s head, David Halpern, was interviewed as a “government coronavirus science advisor” about broad policies of “cocooning” older people. He was also quoted in support of the idea — which might yet seem grievously misguided in hindsight — that social-distancing measures should only be brought in gradually, to avoid people becoming fatigued. After he was reportedly “bollocked” by No.10 a fortnight ago for introducing the unfortunate phrase “herd immunity” into the national conversation, Halpern hasn’t (to my knowledge) been heard from again in public.

OMG I just realised I knew this guy Dave Halpern - he was a student in our department when I was doing my PhD. Smart guy, he was, intense. At the time, he was doing a study of how the architecture of prisons could influence the wellbeing of prisoners. I saw him a few months after that, and he said his results had been disappointing and that he was starting to despair about whether architecture could really improve prisoner wellbeing (I kid you not!).

 

[Woolie]

So, I don't think the line on the chart tells us a lot about the real number of cases in New Zealand or about the impact of the 5 days of lockdown.

You misunderstand - my purpose was not to map the "true cases" of COVID in NZ (of course these aren't the total "true cases" in NZ). The set of reported cases is a highly selected sample, but changes in the rates of detection of those cases are information if the detection practices are reasonably well known.

 

[Hutan]

You misunderstand - my purpose was not to map the "true cases" of COVID in NZ

Never thought that you were aiming to do that. Just making the point that the sample reflected in that chart didn't have much to do with the 5 or 6 days of lock down for the general public.

The set of reported cases is a highly selected sample, but changes in the rates of detection of those cases are information if the detection practices are reasonably well known.

The detection practices are changing over time, so there are difficulties comparing reported rates over time, even within a single country.

It's sounding a bit hopeful in NZ though now, isn't it. Seems that the government is talking about doing random testing to try to get a better understanding of whether there are cases outside the known clusters.

 

[Jonathan Edwards]

I am pretty sure that the reality will be that Western countries will rapidly come to realise that it is simply not possible to run a hospital based health service for all the other conditions people suffer from unless the infection rate with Covid19 is way down below the 1 in 10,000 level. More than that and you have cross contamination in hospitals because they are busy complicated physical places.

If you can get levels down below 1 in 10,000 then there is no reason not to eradicate - it is the same process taken to conclusion. If we are waiting for a vaccine there will be plenty of time to eradicate. What on earth is the point of not doing so?

I think health care workers are very likely to take industrial action if they are forced to work under the current conditions again under a deliberate policy of letting the virus spread a bit more. Maybe not in the UK but very likely in Italy or Spain who will face the situation first.

 

[Jonathan Edwards]

The detection practices are changing over time, so there are difficulties comparing reported rates over time, even within a single country.

I guess that the detection policy may be the same and well known but I would not be surprised if the proportion of infected people who make themselves known for testing changed dramatically. I think at the beginning people assumed that getting diagnosis was a good idea. I suspect a lot of people now may be frightened to go anywhere near a hospital and not ask for testing unless they are really sick.

 

[alex3619]

I suspect a lot of people now may be frightened to go anywhere near a hospital and not ask for testing unless they are really sick.

This can be more prudence than fear. Hospital waiting areas are likely to be high risk in a pandemic. You want to be really sure you need help before turning up. In fact I keep seeing doctors suggesting that, suggesting instead that patients contact their regular doctor and discuss options, one of which is they might be told to go into hospital for testing ... or avoid it. A doctor can at least make an educated guess for options once they have the specifics of an individual case.