Coronavirus - worldwide spread and control

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Marco said:
I can only go by the shortages of reagents, swabs etc being widely reported in many countries although it does appear, in a UK context at least, that small labs were ready and willing to pitch in except PHE bureaucracy prevented them from doing so.

At least we're agreed that now is not the time for rolling out indiscriminate testing - but this is still what the media keep pushing as if numbers are all that matter.

As for what should have been done - this is debatable - but I'm more concerned about what needs to be done in the coming few weeks.

While decorating yesterday (I stocked up on materials before the lockdown) I was shocked listening on the radio to the Northern Ireland health minister who sounded close to tears. They expect numbers to peak in the next two weeks with approx 500 hospital admissions per week. NI currently has 150 ventilators and the minister was 'praying to god' they could ramp up provision in time.
Party
His response to questions regarding other 'controversial' aspects of the government response was that he 'was too busy trying to save lives to play politics'.

I'd rather government's were allowed to
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Jonathan Edwards said:
Do we know this? It is not what my laboratory colleagues (such as my nephew Al who goes on TV to talk about these things) have been telling me. They have been wanting to help for weeks but government has shown little interest. Even I have been asked to help to get round bureaucratic blockages but I was not qualified to do so.


I think now is not the best time to try to roll out indiscriminate testing because hopefully we are the peak of infection rates. The testing should never have been curtailed earlier on. It will be badly needed once the peak has turned. But even so we need far more targeted testing right now - of health and care home workers.

If 90% of tests are coming back negative then the test is not being overused. Tests of this sort should be picking up percentages of that sort if they are going to tease out the real cases in the way needed.

I am sorry to disagree but people have very definitely been sitting on their arses for two months now.
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Basically the Northern Ireland Health Minister followed the UK Westminster Government approach --- were going to get it anyway, best to get it out of the way --- not damage the economy.

In the Republic of Ireland the (stand in) prime minister (Leo Varadkar) is a former doctor whose family members and partner are doctors in Ireland/UK. The Republic of Ireland basically followed WHO guidance i.e. test (health care staff & members of the public as resources permit), trace contacts, quarantine (they have Covid-19 hotels!) --- reduce transmission. As @Trish has indicated above this may in part be due to the knowledge --- of the decision makers in Government --- Leo Varadkar was a Doctor and he has family who are front line Doctors.

So basically the question in Northern Ireland is do you follow the UK or Republic of Ireland.

As @Jonathan Edwards has said "people have very definitely been sitting on their arses for two months now"; Doctors etc. knew that there were insufficient ventilators to meet the demands months ago. The difficulty for the Northern Ireland Health Minister is that he now has to explain the policy of sitting on their arses--. I'm not much taken with calling on the people to stand outside and clap our amazing health care workers or "praying for more ventilators" --- I grudgingly admire the PR though.
 
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I wouldn't have expected temperature to make any difference, the environment in the viruses hosts is broadly constant and independent of external climate. The amount of sunshine (UV) might have made a difference in ease of transmission, but temperature, in the ranges people are comfortable living in, not very likely IMO (as someone who knows nuffin')
 
Wonko said:
I wouldn't have expected temperature to make any difference, the environment in the viruses hosts is broadly constant and independent of external climate. The amount of sunshine (UV) might have made a difference in ease of transmission, but temperature, in the ranges people are comfortable living in, not very likely IMO (as someone who knows nuffin')
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Some people thought that temperature could have an influence like it has on the flu. ANd that it would fade away with the summer coming.
 
Marco said:
For what it's worth I was listening to local radio yesterday (BBC Radio Ulster Nolan show) and with regards to testing it was anecdote,anecdote, anecdote followed by a complete rebuttal from the chief medic.



Unfortunately testing in ROI appears to have been quite chaotic even if well intentioned :



https://sluggerotoole.com/2020/03/3...northern-ireland-need-more-searching-inquiry/



Agreed.



I have. I just don't think there's enough information there on which to base any judgement.
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Regarding: "I have. I just don't think there's enough information there on which to base any judgement."
There are 5 million people in Veneto and 10 million people in Lombardy -- what do you mean there [not] "enough information there on which to base any judgement."? The death toll was 500/million in Lombardy and EDIT 57/million in Veneto.

From Harvard Business Review:
"The most notable example is the contrast between the approaches taken by Lombardy and Veneto, two neighboring regions with similar socioeconomic profiles.

Lombardy, one Europe’s wealthiest and most productive areas, has been disproportionately hit by Covid-19. As of March 26, it held the grim record of nearly 35,000 novel coronavirus cases and 5,000 deaths in a population of 10 million. Veneto, by contrast, fared significantly better, with 7,000 cases and 287 deaths in a population of 5 million, despite experiencing sustained community spread early on."
[https://hbr.org/2020/03/lessons-from-italys-response-to-coronavirus]
 
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spinoza577 said:
Because there is a close relationship between the north of Italy and Wuhan (making fashion and clothes) the scenario of how the virus developed might be a bit more complicate.

Maybe the virus comes from China (and its bats), but maybe the virus found in the north of Italy the best environment to prosper (air pollution, an aged population) and to possibly further mutate. And this might have been taken place already in November of last year or even before (and now materializes in a visible manner).

I don´t know how likely this or any related scenario is. In the comments of the youtube video with the inventer of this hypothesis Prof Giuseppe Remuzzi are some more speculations. Hope its no fake.



A Chinese newspaper on this issue:
https://www.scmp.com/news/china/soc...ange-pneumonia-seen-lombardy-november-leading
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Thanks, I found this very interesting, and looking at comments on the video, where people are thinking they or their family members may have had the virus towards the end of last year.

Early January my husband and I, and a lot of people locally, had what seemed at the time and unusual virus, which started with a dry cough for a few days before developing into a more recognizable viral infection when it then affected more our voices and into our chests, though not really, really deep down and feeling virally aches etc but for us no temperature and debilitating energywise. I was having to get up 2-3 times a night to cough up muck and clear my chest. It was all very exhausting. I have very rarely in my life had chest infections so it was unusual and others commented it was an unusual virus. I'd say it's only in the last 3 weeks or so that we've felt back to "normal" after it. OK I quite appreciate it may have been another virus completely, but from hearing this about it possibly being out there earlier I do wonder.

I spoke to a doctor whose son in law works in international trade, including with China, and he had told him there had been delays/problems with getting deliveries from China October/November time because of some virus going around affecting workers in ports. Again it may have been some other virus, who knows, but interesting.
 
FMMM1 said:

Lombardy, one Europe’s wealthiest and most productive areas, has been disproportionately hit by Covid-19. As of March 26, it held the grim record of nearly 35,000 novel coronavirus cases and 5,000 deaths in a population of 10 million. Veneto, by contrast, fared significantly better, with 7,000 cases and 287 deaths in a population of 5 million, despite experiencing sustained community spread early on."
[https://hbr.org/2020/03/lessons-from-italys-response-to-coronavirus]
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Thanks - I read it. Lots of maybe's.
 
This is a long article, and mostly focused on USA issues (from NPR, National Public Radio), but I found it interesting. Explains some of the testing failures in the USA.

Fighting COVID-19 Is Like 'Whack-A-Mole,' Says Writer Who Warned Of A Pandemic

https://www.npr.org/sections/health...ack-a-mole-says-writer-who-warned-of-pandemic

The story has an audio link (42 minutes, I didn't listen) and a written version (summary with interview highlights).

Here's a quote from a section labeled, "On how American hubris and exceptionalism have contributed to the slow response"

There is a thing called the Global Health Security Index, which ranks different countries according to their levels of preparedness for pandemics, according to 140 different criteria, based on regulations from the World Health Organization. And out of all the countries that were assessed, the United States has the highest score — 83.5, a solid B. But if you look at how the country has actually reacted to the pandemic, I think we probably get something like an F. This nation that was meant to be the most prepared of all has really flubbed its response, and I think, to a degree, that has shocked even the most alarmed or pessimistic people who I'd spoken to before, in my earlier reporting.
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Chracteristics of Covid-19 patients dying in Italy. Report based on available data on March 20th 2020.

1. Sample [table shows that in Lombardy 68% positive tested died, in Emilia-Romagna 16,4%, otherwise much less].

2. Demographics

3. Pre-existing conditions

Diseases [first number being N second number being %]
schemic heart disease - 145 - 30.1
Atrial Fibrillation - 106 - 22.0
Stroke - 54 - 11.2
Hypertension - 355 - 73.8
Diabetes - 163 - 33.9
Dementia - 57 - 11.9
COPD - 66 - 13.7
Active cancer in the past 5 years - 94 - 19.5
Chronic liver disease - 18 - 3.7
Chronic renal failure - 97 - 20.2

Number of comorbidities
0 comorbidities - 6 - 1.2
1 comorbidity - 113 - 23.5
2 comorbidities - 128 - 26.6
3 comorbidities and over - 234 - 4

4. Symptoms

5. Acute conditions

Acute Respiratory Distress syndrome was observed in the majority of patients (96.5% of cases), followed by acute renal failure (29.2%). Acute cardiac injury was observed in 10.4% of cases and superinfection in 8.5%.

8. Death under the age of 50 years

To date (March the 20th), 36 of 3200 (1.1%) COVID-19 positive patients under the age of 50 have died. In particular, 9 of these were younger than 40 years, 8 men and 1 woman (age range between 31 and 39 years). For 2 patients under the age of 40 years, no clinical information is available; the remaining 7 had serious pre-existing pathologies (cardiovascular, renal, psychiatric pathologies, diabetes, obesity).
 
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A thought that struck me today is that the move from contact tracing and testing to 'mitigation', with a bit of herd immunity thrown in, without trying to keep up with contacts by testing may have a slightly different origin.

There seems no doubt that there was heated disagreement early on amongst UK advisors about how much to restrict activities like flights and football games and whether or not to 'let the epidemic warm up a bit' before locking down. Political pressures to protect business economics no doubt played a part - ironically since the result seems to have been the worst possible one for business. But health administrators prepared to be swayed one way or another may have been swayed by a different consideration.

It may have been realised, but perhaps deliberately never voiced at meetings, that the phase 1 part of the strategy of test and trace was going to collapse long before it had a chance of achieving anything simply because infrastructure had been eroded in 'reforms' in 2003 and reviews since 2010. Those responsible may have been faced with the prospect that if they pushed for testing and tracing, within a week it would be clear that there were no resources to do that. Closing down testing would have avoided a serious embarrassment. That embarrassment has come home to roost but since decisions seem to have been made by people with no practical understanding of clinical infectious disease medicine perhaps they thought it worth crossing their fingers and going for phase 2.
 
@Jonathan Edwards that’s interesting what you say. But I wonder if we really don’t have resources to do the testing and tracing? Jeremy Hunt said in a video which I posted a while ago, in parliament, that he thinks we would have had capacity to do it - if for example all the civil servants, people working in offices doing other jobs that were non-essential etc, could turn their attention to tracing, we do have a lot of manpower and capability to do it.

And I’ve seen people come on the TV from various labs, universities etc saying they also think they have the capability to do tests, to test everyone needed. I’m not sure about making tests, but even then, labs have been saying they have reagents I think? So to me it seemed a lack of will and not wanting to put the amount of time and money and resources needed into making it work.
 
lunarainbows said:
So to me it seemed a lack of will and not wanting to put the huge amount of time and money needed into making it work.
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I think it may be mindset as much as anything. For the last 20 years Uk health service administrators have only really had one job - that is to find ways to avoid doing things. They become highly skilled at finding reasons not to do things. That is why I resigned at 60. I was not allowed to provide a safe and effective service. People who have risen up the ranks because of being skilled in doing nothing are not the sort of people who can suddenly get things moving. The chemicals and tubes are there. What I suspect was not there was the administrative infrastructure to set up a big testing program.
 
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
Our posterior estimates of basic reproduction number (R) in Wuhan City, China in 2019-2020 reached values as high as 5.20 (95%CrI: 5.04-5.47)

and the enhanced public health intervention after January 23rd in 2020 was associated with a declined R at 0.58 (95%CrI: 0.51-0.64),

with the total number of infections (i.e. cumulative infections) estimated at 1905526 (95%CrI: 1350283-2655936) in Wuhan City, raising the proportion of infected individuals to 19.1% (95%CrI: 13.5-26.6%).

We also found that most recent crude infection fatality ratio (IFR) and time-delay adjusted IFR is estimated to be 0.04% (95% CrI: 0.03-0.06%) and 0.12% (95%CrI: 0.08-0.17%), which is several orders of magnitude smaller than the crude CFR estimated at 4.19%
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Full article available.
 
spinoza577 said:
sars-cov-2-viral-load-and-the-severity-of-covid-19
Oxford COVID-19 Evidence Service Team, Centre for Evidence Based Medicine, march 26th.
not peer-reviewed




They look also at SARS-co-1 and Influenza. Influenza:


Healthcare Workers
A detailed list of available information follows.
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Just now at 13 hours EST I heard on CBC Radio that in the Province of Ontario 1 in 10 people affected with Covid work in health care; no further breakdown was offered.
 
lunarainbows said:
Dawn Butler MP.

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This fits in with the report I mentioned yesterday, where the Italian doctor (who has recently published in the New England Journal of Medicine) stated that it is imperative to keep more Covid patients at home, to provide mobile units, and to place the severe Covid patients in a separate hospital or institution dedicated to them.
 
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