Coronavirus - worldwide spread and control

[Leila]

The presidents of Germany's four biggest science institutions have published a joint statement based on a mathematical analysis of the current data.

According to science journalist Kai Kupferschmidt this might help to ease some of the emerging backlash our CDC is getting for its somewhat incoherent communication on COVID strategies.

From what I understand it's also a clear "no" to herd immunity.

They also emphasize though that political decisions have to take other factors into account (economy, psychological factors etc.)

translation with deepl

• Different and independent models of different groups on the spread of SARS-CoV-2 come to consistent results. Since the end of March the reproduction number R was slightly below 1.
  
  
• The clear decline in new infections N that we are currently observing is the combined effect of all the measures introduced in March and the behavioural adjustments of the population.
  
  
• The situation is not stable, even a small increase in the reproductive rate would take us back to a phase of exponential growth. Therefore, until a vaccine becomes available, the reproduction rate must be kept below 1. The new R-value close to 1 reported by the RKI on 28 April 2020 makes it clear that in this phase further consistent contact restrictions are necessary.
  
  
• The value of R in response to a modified measure can only be estimated with a delay of two to three weeks.
  
  
• According to the data available so far, achieving "herd immunity" would require a period of several years if the health care system is not to be overloaded. With such a strategy, restrictive measures would have to be maintained over the entire period.
  
  
• From the point of view of modelling, the following two-phase strategy appears to be reasonable: In the first phase, new infections are further reduced until effective contact tracing is possible. In the second phase, an adaptive strategy based on low numbers of new infections follows.
  
  Edit: @lycaena Sorry, I didn't see you've already posted this!

 

[Hoopoe]

The first case in Italy was identified on the 21st of February. Now investigators say it appears that at this point there were already 1200 cases in the Lombardy region.

There also was already some excess mortality in January.

The virus appears to have circulated in Italy for over a month without anyone noticing.

 

[mango]

The numbers I posted show that with static/flat daily infection rates, even at five times what has been reported in the last few weeks, herd immunity will never be achieved in Sweden

The narrative in Swedish media is a bit different... at least that's the impression I am getting. Although there are some articles reporting on, for example, the unknowns of antibodies, Chinese research suggesting that herd immunity might be very uncertain and far into the future, critical opinion pieces etc, at the same time there are also news articles and interviews with chief epidemiologist Anders Tegnell, maths professor Tom Britton and others claiming things like "Stockholm might achieve herd immunity in May" etc.

Examples of articles/sources: here, here, here and here (Norwegian NRK).

 

[Amw66]

The FT data on excess deaths is a few weeks old so is now out of date. The more recent data suggests Sweden is doing much worse than that unfortunately. If you scroll down to the map of z-score by country on the following webpage you’ll see what I mean:

https://www.euromomo.eu/graphs-and-maps#excess-mortality

The Euromomo website is also the source of the graph posted above by @lunarainbows showing that in the past couple of weeks the UK has zoomed ahead of Italy and Spain and now sadly has the highest rate of excess deaths in Europe.

Edit: typo

Thanks , I will bookmark that website.
Sadly relatives in Sweden think things are not so bad

 

[FMMM1]

Sadly, it looks from the new piece in the guardian on the contact App https://www.theguardian.com/politic...-plans-an-nhs-app-and-an-army-of-health-staff

that there are still no reliable plans for contact tracing. I am pretty sure that the information from the app will be unusable - a muddle of flagging all sorts of possible contacts most of which being of no relevance with the added worry of loss of confidentiality. Contact tracing requires person to person analysis of each real case by someone intelligent. I think they will need about 30,000 such people. There is no sign that this is understood by the people making decisions.

There are easily 30,000 people available e.g. central Government have basically sent everyone, who doesn't need to be in the office, home (with a computer). From among those 100K's you should be able to find 30K who aren't doing essential work. You need a nucleus of trained people i.e. to train the new folks; however, the enlarged group, of people doing contact tracing, isn't going to happen spontaneously. They've had months to get this up and running.

 

[spinoza577]

translation with deepl

• Different and independent models of different groups on the spread of SARS-CoV-2 come to consistent results. Since the end of March the reproduction number R was slightly below 1.

In TV the mathematician Meyer-Herrmann (?) said R0 is based on official numbers of positive cases, in each model. But these are not representative, and therefore only one instrument to get some truth.

No surprise that no consent is seen across experts and the world. It would be better to admit that we don´t know already. (rather the only possibility)

• The clear decline in new infections N that we are currently observing is the combined effect of all the measures introduced in March and the behavioural adjustments of the population.

The behaviroul adaptions then are considered to account also for the surprising decline of R0 right after the lockdown has been implemented. It´s easy saying, forgetting about the possibility that it might have declined for other reasons. I guess they wouldn´t have said explictly "behavioural adaptions" and "measures" if not for this reason. Their interpretation might be right though, but the discussion is turning to be skewed.


What I replied here may be the answere to this question:

I still don't understand why you are asking this question. No one is disputing that exponential spread until "herd immunity" is achieved is the simplistic case that doesn't account for complex human behaviour, as humans will change their behaviour to avoid getting sick and dying.

It doesn´t account for many unknowns. I guess it is not known why common colds do not infect the whole population. It comes and goes, changes and reappears. (For R0 in common colds: wiki/Basic_reproduction_number, 2-3)

But for the wide ranged impacts of measures it would be important to know how the virus behaves. Maybe we fight against windmills. Turning the attention from R0 to fatality rate: A German newspaper titled a quote from a doctor: We rescue people who are about to die anyway in the next half year. For comparison: The 2009 recession caused in the US 250.000 excess cancer cases in the future, and this obviously not in parts of the population where dying is normal.

It would be much more better to openly say that we don´t already have a picture, and based on guesses to indeed to go for this or that strategy (saying what the downsides may be), instead to allow an underlying panic (as it looks to me). There is no way not to become guilty in either way (which is not new, btw).

And numbers must be presented in a manner that make clear which possibilities are right now known, instead of suggesting any definitve knowledge. If you already need to seek for important numbers, and painting your own graphs something is not ok.

 

[BurnA]

The virus appears to have circulated in Italy for over a month without anyone noticing.

I find that hard to believe.
(that no-one noticed)
I would have thought people working in the ski resorts might have had an unusually high incidence. For a while nearly all the new cases around Europe were due to returning skiers.

 

[Esther12]

The Guardian has an article on the UK's response: https://www.theguardian.com/world/2...nside-story-of-uk-covid-19-coronavirus-crisis

This section on the claims about 'Behavioural Fatigue' could be of interest to people here:

The delay to introducing stricter measures, until the lockdown was finally ordered on 23 March, appears to have been at least partly based on a flawed misreading of the government’s own scientific advice. In early March, Whitty mentioned the idea that the government should wait to impose restrictions because people might tire of them, later saying this was based on both “common sense” and “behavioural science”. “What we are moving now to is a phase when we will be having to ask members of the general public to do different things than they would normally do,” he said. “There is a risk if we go too early people will understandably get fatigued and it will be difficult to sustain this over time.”

Hancock supported that, suggesting it was the result of official advice. “The evidence of past epidemics and past crises of this nature shows that people do tire of these sorts of social distancing measures, so if we start them too early, they lose their effect and actually it is worse,” he said. “The social science and the behavioural science are a very important part of the scientific advice that we rely on.”

Yet this concept of “fatigue” was rejected by the behavioural scientists appointed by the government itself to Sage’s subcommittee, SPI–B. “The word was never used in any of our committee reports,” said Susan Michie, a SPI-B member. “It is just not a concept that exists in behavioural science, and it was unhelpful for it to be used.” Four other members of SPI-B also told the Guardian that the committee never advised that people would tire of restrictive measures.

The publicly available summaries of their conclusions show the group advised that people should be given clear explanations and reasons for social distancing measures, and warn that those measures would affect people unequally, but nowhere do they suggest that people will become “fatigued”. Three behavioural scientists on SPI-B, Stephen Reicher, John Drury and Clifford Stott, even wrote an article for the Psychologist journal, rejecting the notion of “fatigue” and suggesting that delaying stricter social distancing measures on that premise was taking a risk with lives. “Psychological considerations were put at odds with what medical science demanded,” they wrote.

The Guardian understands that Halpern’s Behavioural Insights Team, or “nudge unit”, was also opposed to this view that people would tire of restrictive measures. One senior Whitehall source said Whitty himself was the main advocate of the “fatigue” notion, based partly on his own experience of patients in medical practice who do not see drug prescriptions through to their completion.

A Downing Street spokesperson, responding on behalf of Whitty, emphasised that he was indeed concerned about timing interventions, and their impact on people’s wellbeing if introduced too early, and that Sage had agreed a balance needed to be struck between the impact of measures, and the time the public could feasibly sustain them.

I'm somewhat suspicious of some of the framing there, but it's interesting to see who is trying to present what story.

 

[lunarainbows]

I remember this professors name coming up earlier but don’t think this has been posted yet, a new interview by Cathy Newman Channel 4 News, with Prof John Edmunds (Prof of epidemiology) from SAGE:



If you start watching at around 10mins, when asked about mitigation and suppression, he says “I don’t know the difference between that”. Cathy Newman then says well there’s a difference and explains it to him - mitigating it is just containing it while suppression is squashing it completely. He says “that’s just semantics, isn’t it?”

What? He’s on SAGE and giving advice to the Govt. he thinks squashing it completely and just containing it via mitigation, is the same? Isn’t this what he studies, the control of diseases, as an epidemiologist?

The rest of the interview is also illuminating.

Edit: At one point when asked why they didn’t model lockdown until the end of March, he says “I don’t think anybody looked at it”...”in some sense was difficult to imagine just how easy the lockdown was” ....

edit 2: having watched the interview, I get the impression he is trying to justify govt policy.

 

[BurnA]

The Guardian has an article on the UK's response: https://www.theguardian.com/world/2...nside-story-of-uk-covid-19-coronavirus-crisis

This section on the claims about 'Behavioural Fatigue' could be of interest to people here:



I'm somewhat suspicious of some of the framing there, but it's interesting to see who is trying to present what story.

Leaving aside who said what for a moment, the idea makes no sense at all.

By leaving it till later, the lockdown would (I assume) generally need to be longer anyway, thus completing negating the concept of trying to avoid 'lockdown fatigue'.

 

[Jonathan Edwards]

Yet this concept of “fatigue” was rejected by the behavioural scientists appointed by the government itself to Sage’s subcommittee, SPI–B. “The word was never used in any of our committee reports,” said Susan Michie,
...
The Guardian understands that Halpern’s Behavioural Insights Team, or “nudge unit”, was also opposed to this view that people would tire of restrictive measures. One senior Whitehall source said Whitty himself was the main advocate of the “fatigue” notion,

I can believe this. If the physicians were dumb enough not to see what made sense they were dumb enough to bring in pseudo behavioural science that even the behavioural scientists did not believe in.

But maybe two caveats.

I seem to remember there were some citations, including Wessely, that were given as background to the decision making at some point. Where did they come from?

The other thing of course is that in addition to people sitting on a committee there are those people who rather than sit on the committee recommend that those people do sit on the committee. There is another layer of people hovering in the background. After all, someone has to recommend the committee members.. That seemed very much to apply to NICE. It applies to the MRC.

I think it highly likely that Chris Whitty is in regular conversation with this other layer of people. Maybe that is where he got the idea from?

 

[Esther12]

New piece on Cumming's involvement in SAGE, which makes it sound like he interfered inappropriately in a way that was useful for prompting a more rapid implementation of social distancing policies. The UK's 'top experts' are so politically malleable that it lessened the harm caused by their incompetence (this time).

https://www.bloomberg.com/news/arti...-s-johnson-pushed-scientists-to-back-lockdown

I fear that none of the needed lessons will be learnt from this.

Leaving aside who said what for a moment, the idea makes no sense at all.

By leaving it till later, the lockdown would (I assume) generally need to be longer anyway, thus completing negating the concept of trying to avoid 'lockdown fatigue'.

They were assuming that the virus would spread to 60%+ of the population whatever they did, so all they could achieve with the appx three weeks of lockdown available to them was try to lessen the spread during the largest peak. There needs to be much more investigation into where this idea that 'behavioural fatigue' meant only a brief lock down was possible came from, and what evidence was presented to support it. As you say, it does now seem to have led us into a position where we need a longer and more extensive outcome than would otherwise have been the case.

 

[Esther12]

Edit: At one point when asked why they didn’t model lockdown until the end of March, he says “I don’t think anybody looked at it”...”in some sense was difficult to imagine just how easy the lockdown was” ....

edit 2: having watched the interview, I get the impression he is trying to justify govt policy.

I think I share your impression. You'd also drawn attention to Edmunds saying some similar things earlier: https://www.s4me.info/threads/coronavirus-worldwide-spread-and-control.13287/page-113#post-251601

 

[Jonathan Edwards]

I find that hard to believe.
(that no-one noticed)
I would have thought people working in the ski resorts might have had an unusually high incidence. For a while nearly all the new cases around Europe were due to returning skiers.

It is perhaps surprising but it is worth considering what it takes to recognise a new illness.

The suggestion is that there were 1200 Lombardy cases at the point the penny dropped. Of those maybe 200 might have presented to hospital. With a certain amount of movement let us guess that most cases went to four hospitals. Very likely they would have a rota with a physician doing one day on duty each week. That means that by this time the average emergency physician might have seen 7 cases. The majority of these would have looked like bad cases of respiratory viral infection. Maybe three or four might look obviously different.

An isolated case of something unfamiliar does not necessarily give rise to the thought of an epidemic. All sorts of rare non-infective causes of respiratory distress occur occasionally. Two might raise a suspicion. Three should do.

So although on a rough calculation it looks as if at least some physicians ought to have been thinking they might have cases of what was going on in China I don't think it is too hard to believe that it took until it did to twig.

Maybe most of the early cases were in youngish adults and did fine so physicians took it no further. Maybe it was only when cross-infection of vulnerable older people occurred that there was an explosion of severe cases.

 

[Adrian]

The other thing of course is that in addition to people sitting on a committee there are those people who rather than sit on the committee recommend that those people do sit on the committee. There is another layer of people hovering in the background. After all, someone has to recommend the committee members.. That seemed very much to apply to NICE. It applies to the MRC.

I think it highly likely that Chris Whitty is in regular conversation with this other layer of people. Maybe that is where he got the idea from?

There is now a story in the guardian suggesting that given the names have leaked there is a rush to find additional experts to plug the gaps.
https://www.theguardian.com/science...es-out-request-for-experts-bolster-sage-panel

The current group seems very influenza focused. But also doesn't include public health experts

So they are looking for

One advert calls for researchers to assist the international group of Sage’s Covid-19 response team. The advert casts a wide net, seeking experts in global public health, health systems, epidemiology, infectious diseases, emerging diseases, and social or behavioural sciences.

and yet more behavioural scientists

The second advert calls for experts to support the scientific pandemic influenza group on behaviours, or SPI-B, a subgroup of the Sage Covid-19 response team. The specialisms being sought are behavioural psychology, health psychology, behaviour change and behavioural economic.

In an earlier article Costello had said:

The group includes no molecular virologists who could explain detailed pathogenic differences between Covid-19 and influenza, not one intensive care expert or nursing leader, and no immunologist to examine whether this virus produces lasting and protective immunity. There are no social scientists who could work on community engagement, nor a logistician, who would have expertise in planning for the delivery of supplies and resources during a pandemic.

Yet I wonder if they still aren't filling the gaps of the lack of expertise of molecular virologists (and knowledge of Corona viruses) and no immunologists who I assume would be needed to advise on vaccines and protective immunity.

It does all suggest that the committee selection process wasn't good.

 

[Adrian]

The suggestion is that there were 1200 Lombardy cases at the point the penny dropped. Of those maybe 200 might have presented to hospital. With a certain amount of movement let us guess that most cases went to four hospitals. Very likely they would have a rota with a physician doing one day on duty each week. That means that by this time the average emergency physician might have seen 7 cases. The majority of these would have looked like bad cases of respiratory viral infection. Maybe three or four might look obviously different.

There was this article about a month ago about an abnormal number of pnemonia cases in Lombardy in late 2019 and an investigation as to whether it could have been a Covid-19 outbreak. But I've seen no more since,
https://www.reuters.com/article/us-...arlier-emergence-of-coronavirus-idUSKBN21D2IG

 

[Adrian]

New piece on Cumming's involvement in SAGE, which makes it sound like he interfered inappropriately in a way that was useful for prompting a more rapid implementation of social distancing policies. The UK's 'top experts' are so politically malleable that it lessened the harm caused by their incompetence (this time).

From what we have seen with ME the scientists that get into positions of power are not always (often not) competent and don't challenge the prevailing view. I wonder if this will be an emerging issue as people examine what happened. I read an article about when a the currency collapsed (I think under Major) recently and one of the points it made was that the treasury was full of the wrong people and after that happened economists got taken more seriously and promoted. I wonder if we will see an effect where they look at those who scientists who seem to be in power and that there skill is not in science but in getting on and sitting on committees. Until a crisis happens no one notices.

 

[Adrian]

I'm somewhat suspicious of some of the framing there, but it's interesting to see who is trying to present what story.

Could be the nudge unit nudging responsibility away from themselves.

 

[Hoopoe]

A “strange pneumonia” was circulating in northern Italy as long ago as November, weeks before doctors were made aware of the novel coronavirus outbreak in China, one of the European country’s leading medical experts said this week. “They [general practitioners] remember having seen very strange pneumonia, very severe, particularly in old people in December and even November,” Giuseppe Remuzzi, the director of the Mario Negri Institute for Pharmacological Research in Milan, said in an interview with the National Public Radio of the United States.

https://www.scmp.com/news/china/soc...ange-pneumonia-seen-lombardy-november-leading

Remuzzi said he had learned about the cases from a few general practitioners and he has not yet been able to verify the information.

But he said there are some other suspicious cases he “knows for sure”, including two pneumonia cases in Scanzorosciate in northern Italy in December, where the patients developed high fever, a cough and had difficulty in breathing.

He said there had also been 10 patients who developed bilateral interstitial pneumonia in two other nearby towns, Fara Gera D’Adda and Crema, who had similar symptoms.

Remuzzi said local doctors considered these cases to be “unusual” but ruled out the possibility of seasonal influenza, as all these patients had been vaccinated.

“The reason we don’t know if it was Covid-19 is because at that time this could not be tested; the patients didn’t have X-rays,” he told CGTN.

They recovered within 15 days, with some receiving two or three courses of antibiotics.

Remuzzi added there had also been a patient diagnosed with bilateral interstitial pneumonia in Alzano Lombardo Hospial in Lombardy around the time

https://www.scmp.com/news/china/sci...r-repeats-warning-coronavirus-may-have-spread

 

[lunarainbows]

The narrative in Swedish media is a bit different... at least that's the impression I am getting. Although there are some articles reporting on, for example, the unknowns of antibodies, Chinese research suggesting that herd immunity might be very uncertain and far into the future, critical opinion pieces etc, at the same time there are also news articles and interviews with chief epidemiologist Anders Tegnell, maths professor Tom Britton and others claiming things like "Stockholm might achieve herd immunity in May" etc.

Examples of articles/sources: here, here, here and here (Norwegian NRK).

I find it hard to understand why there’s such a difference between the U.K. and Sweden in this respect. Both countries initially decided on herd immunity but in the U.K. they had to backtrack, (that is, they are no longer explicitly going for herd immunity the way Sweden is, and picked a suppression strategy instead), due to the outcry from scientists, journalists, newspaper articles eg by Anthony Costello, their own scientists figuring out it wasn’t (both politically and scientifically and in terms of overwhelming the NHS) feasible.

But why did Sweden not go the same way? I don’t understand how and why they’re still on herd immunity. Is it because they didn’t have the same number of cases that the U.K. did? But now it’s clear that many more people are dying there than in other neighbouring countries, and that elderly (ie the vulnerable they’re saying they’re protecting) are dying too. (I translated and read the last article you provided - the other ones were videos I think so I couldn’t watch/understand).