JoNova

A science presenter, writer, speaker & former TV host; author of The Skeptic's Handbook (over 200,000 copies distributed & available in 15 languages).


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How about 27 feet of social distancing

How big should that gap be?

The WHO recommends “3 feet”, the CDC recommends 6 feet, but new research shows they got the model wrong and we might need to be 30 feet apart. Not to mention that the cloud of aerosols can wander suspended for hours. So we may need to be 30 feet and three hours apart.

No wonder churches and places where people sing are such high risk events, and why an astonishing 12,000 health workers are infected  with coronavirus in Spain.

They aren’t sure if their new findings  have clinical implications, which says a lot about how much we don’t know. The 27 ft distance applies to sneezes, so if the other party isn’t sneezing you might not have to be so far. Lucky sneezing isn’t that common, though the dry cough is. Personal trainers at 27 feet is going to be tricky.

Coronavirus could travel 27 feet

NY Post

MIT associate professor Lydia Bourouiba, who has researched the dynamics of coughs and sneezes for years, warns in newly published research that the current guidelines are based on outdated models from the 1930s.

Rather than the assumed safety of 6 foot, Bourouiba warns that “pathogen-bearing droplets of all sizes can travel 23 to 27 feet.”

Her research, published in the Journal of the American Medical Association, also warns that “droplets that settle along the trajectory can contaminate surfaces” — and “residues or droplet nuclei” may “stay suspended in the air for hours.”

Sneezing

Keep reading  →

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Australia’s very low death rate is due to younger patients, plenty of tests

Right now Australia has one of the lowest death rates from coronavirus in the world. With 4,561 cases but only 19 deaths, the clumsy Case Fatality Rate is only 0.4%  –  lower even than Germany. While some commentators think that’s a reason to ease up it may be partly due to temporary good geographical luck. Plus winter is coming…

1. Australians with Coronavirus are younger (for the moment).

Most infections in Australia came from overseas travel — something the 20 to 70 year olds do a lot of, but apparently the 80+ age group aren’t flying on 20 hour long haul trips across the Pacific. (Last week the most common source of Australia’s cases was the USA, especially Aspen). This week the main source is Europe, and the nation called “cruise ships”.  If and when the virus starts to spread among the older cohorts the death rates will rise. (Unless we figure out that treatment first).

 

Compare the ages groups of patients in Korea and Italy. Fully 40% of Italian (known) cases are 70+.

Statista — demographics of Italian and South Korean cases

 

Demographics Italy, Korea

Italy and South Korean demographics

Fortune

As of March 14, South Korea reported that nearly 30% of its confirmed coronavirus cases were in patients ages 20 to 29. In Italy, by comparison, 3.7% of coronavirus patients fell into that age range, according to a report from Andreas Backhaus, a research fellow at the Centre for European Policy Studies.

 

2.  Australia has done a lot of testing –

Australia has tested 230,000 people or about 1% of the population, and since most of those tests were aimed at travellers they have found the infected younger cohort, unlike countries with less testing. Australia has done slightly more tests per capita than South Korea (which has done about 400,000 tests on a population of 52m).

Germany also also has low rates — largely due to lots of testing and a younger group of patients

Keep reading  →

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Coronavirus: Signs of peaks in the West

Good. Real signs of the flattening of new daily cases of Coronavirus or #CCPVirus in Italy, and possibly in Spain. Instead, ponder that if Italy didn’t slow the spread the 6,500 new cases on March 21 could have become 17,000 new cases every day by now.

Italy appears to have peaked — starting on March 21st — but may need to stop keeping sick people at home

On March 9th when Italy had about 9,000 cases in total, and 500 deaths, the government declared a quarantine across the whole nation. By March 11 everything that could be shut down, was. These changes appear, finally, to have stopped the exponential growth in new cases about 10 days later. But even after three weeks of lockdown there are still 5000 new people getting infected every day. One professor, Andrew Chrisanti, thinks it is because they are telling infected people to stay home instead of isolating them from their families. Presumably if Italians live in larger extended families, they must get the infected out of homes.

“In our opinion, the infections are happening at home.” Crisanti helped coordinate the coronavirus response in Italy’s affluent northeastern region of Veneto, where blanket testing was introduced at the start of Italy’s outbreak in the second half of February. That helped identify cases and limit contagion much more successfully than in the neighboring Lombardy region where only people with severe symptoms are tested, and only in hospitals.

Lombardy has since been hit with 6,360 registered coronavirus deaths, far more than any other Italian region, whereas Veneto has recorded just 392 fatalities. However, the Lombardy outbreak was much bigger from the outset. – Stefano Bernabi, Reuters

In the three weeks since the nationwide quarantine was called, the total cases expanded from 9,000 to 100,000, and deaths increased from 500 to 10,000.

Numbers and graphs from Worldmeter

Spain — may be peaking now.

Too early to tell.

Peaking, Daily New Cases, Coronavirus, graphs, Germany.

….

 

France is still rising

Peaking, Daily New Cases, Coronavirus, graphs, USA, UK, Australia.

….

 

The UK is expecting numbers to rise rapidly in the next two weeks

“It was announced today one in four NHS doctors are off work sick or in isolation. Professor Andrew Goddard, president of the Royal College of Physicians, said about 25 per cent of the doctor workforce is off, either with coronavirus or because a family member or housemate is ill.”

Peaking, Daily New Cases, Coronavirus, graphs, UK.

….

 

USA — 20,000 new infections a day — growing 16% a day

Australia

This is likely a real plateau, but due to slowing down international arrivals — it may be temporary. Community spread could still take off in the next few weeks. Since we aren’t testing “out there” we don’t know. And with 900 House Parties in Brisbane on the weekend (that we know of) the virus might be quietly partying too.

Thanks to some luck, Australia has closed borders, mandatory quarantine, mostly closed schools, and a lot of people are staying home, so perhaps the toll won’t rise further. Watch this space. In this case luck means –  we’re lucky it’s not winter. We’re lucky those infected are in younger age groups so the death rate is lower. Mostly we’re lucky we could learn some harsh lessons from Italy, Spain and the rest of the world first, and still get away with being unprepared and incompetent.

Now is not the time to lift the restrictions. But here’s hoping we don’t need them for too many weeks.

Peaking, Daily New Cases, Coronavirus, graphs, Spain.

….

Keep reading  →

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Korean professor surprised Western people don’t wear masks which are “very effective”

Professor Kim Woo-Ju, Professor Infectious Diseases, Korea, says that masks are “definitely effective”. “I find it quite odd” that the west people don’t wear masks.” “People wearing a mask have a significantly lower chance of getting infected than those who don’t.” WHO says not to wear masks, he says “I disagree.”

Around the middle of the interview he says that one of the reasons Korea has  low rate of infection is because they wear masks — as good as N95 (P2) — this is the same type as what the doctors wear.

He says Korea, and all the South East Asian countries are also experienced because they went through the SARS and MERS outbreaks. They knew what to do, they knew they needed tests fast.

He speaks well. h/t MichaelSmithNews. (via Annie ) and Chiefio somewhere (via Bill in Oz)

“In 30 years of pandemics, Ebola, MERS, Swine Flu … the Covid-19 epidemic is the most challenging”.

  • In the 80+ age group the death rate is 11%
  • With the largest number of tests anywhere, they find 20% have no symptoms. But it is still not random testing. And the number may be different in other countries due to genes, climate (which affects vitamin D levels) or diet.
  • About 30% of cases the patients cannot smell or taste. That can last 5 – 10 days. (It’s good to know their senses come back).
  • They are seeing reactivation of cases released from hospital — people who tested negative and have been released. This is occurring a week or later and is very unusual. (5 – 6 minutes)
  • At 5 – 10 degrees and 30% humidity the virus can survive a long time at least 5 – 7 days on a table.
  • 20% of their new cases in Korea are from flights.
  • Anti-virals are the most promising form of treatment, including the anti-HIV and Chloroquine related ones. He didn’t rave about them, but said they are somewhat useful.

Airborne transmission can happen in churches or where people are singing and shouting loudly. The airborne droplets can stay elevated longer, can dry out, and that means people will be infected much further away. This explains why churches or mosques can be the largest sources of infection. Presumably rock concerts would be too.

They use phones to track people in self quarantine and expect them to enter their symptoms daily. (!)

Schools have been delayed, but many young people are still studying at academies at night time and people are still going to night clubs, but 10% of their cases are in their 20-something group.

As I said last week some people are making their own masks

Does anyone here want to make masks and sell them to readers? I’m happy to connect up supply and demand if you know someone with a sewing machine. There must be a way to solve this. If we got people wearing masks and it reduced spread by 50% that means we all get out of this faster…. (and in that last post there was a study of Australian parents looking after kids with influenza and if they wore masks they prevented 3 out of 4 infections in parents.) 

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We Can Hammer Coronavirus in weeks instead we Rush to War Unarmoured

If you only read one serious page about how to deal with this crisis read Coronavirus: The Hammer and the Dance. The countries that “get this” approach will be the first to recover.

It’s all the things I’ve been suggesting but done on big scale with an expert team.

What I call the Slow Bleed is officially known as Mitigation. It’s the 6 month Flu strategy that kills people and the economy.

When I said Crush the Curve, they call it The Hammer, the hardest form of suppression. The Dance is the delicate recovery process until we get a vaccine, a treatment or a nicer mutant version of the virus.

Hammer and Dance with coronavirus

1. Hammer and Dance — there is a better plan   (click to enlarge)

 

Eventually we’ll all get to the Hammer Crush approach because the alternative is so horrible.

Even Imperial College concludes that slow “Mitigation” is just not viable: in the UK the demand for ICU beds would exceed capacity 8-fold, and there would be something like a quarter of a million UK deaths, and over a million in the US. They conclude that epidemic suppression is the only strategy, yet their predictions on that are dire. Their March 16 report has a chilling dystopian graph that hammers the infection then bounces up and down through cycles of suppression and release. But it ignores the key advantages of buying us time. We are not doomed to repeat each infection cycle. Right now we are unprepared, unarmoured, but some are headed into battle already — there aren’t enough beds, ventilators, specialists, drugs, masks, results, trials, or anything but guesses and hints. A two month pause would help so much more. Even a two week pause would.

Stanford Engineer Tomas Pueyo and a “group of normal citizens” which includes epidemiologists and experts have spelled it out in detail. It’s already been translated into 30 languages, and almost 35,000 people have signed their Petition to the Whitehouse.

At the moment Spain, Italy are facing the fight of their lives, but some of the rest of the West are almost giving up without a fight.

The red line in the graph below is not an error

The red line marks the size of the ICU capacity. This is the size of the challenge we face and it’s why there is no other realistic choice. Would we like to have a hospital system, or would we rather stone age luck?

ICE Beds, capacity, Coronavirus

2. Hospitals will be overwhelmed  (click to enlarge)

Their summary:

When you’re done reading the article, this is what you’ll take away:

  • Our healthcare system is already collapsing.
  • Countries have two options: either they fight it hard now, or they will suffer a massive epidemic.
  • If they choose the epidemic, hundreds of thousands will die. In some countries, millions.
  • And that might not even eliminate further waves of infections.
  • If we fight hard now, we will curb the deaths.
  • We will relieve our healthcare system.
  • We will prepare better.
  • We will learn.
  • The world has never learned as fast about anything, ever.
  • And we need it, because we know so little about this virus.
  • All of this will achieve something critical: Buy Us Time.
  • If we choose to fight hard, the fight will be sudden, then gradual.
  • We will be locked in for weeks, not months.
  • Then, we will get more and more freedoms back.
  • It might not be back to normal immediately.
  • But it will be close, and eventually back to normal.
  • And we can do all that while considering the rest of the economy too.

Ok, let’s do this.

Spain, Germany, France and the US all have more cases than Italy when it ordered the lockdown.

Collateral damage could mean 1.5m more deaths in the US

There are 4 million admissions to the ICU in the US every year, and 500k (~13%) of them die. Without ICU beds, that share would likely go much closer to 80%. Even if only 50% died, in a year-long epidemic you go from 500k deaths a year to 2M, so you’re adding 1.5M deaths, just with collateral damage.

The case for South Korea

Because it was started so fast, the hard part was done in three weeks, and it wasn’t as hard as it will be in slower countries.

South Korea, infection control, Coronavirus, daily new cases, graph.

3. South Korea, case-load managed and is now doing the dance to keep it under control.   (click to enlarge)

Feeding this virus comes with a risk

The more mutations there are the more versions of this virus we get:

Not only that, but the best way for this virus to mutate is to have millions of opportunities to do so, which is exactly what a mitigation strategy would provide: hundreds of millions of people infected.

Under a suppression strategy, after the first wave is done, the death toll is in the thousands, and not in the millions.

It’s a no brainer, but

Suppression would get us:

  • Fewer total cases of Coronavirus
  • Immediate relief for the healthcare system and the humans who run it
  • Reduction in fatality rate
  • Reduction in collateral damage
  • Ability for infected, isolated and quarantined healthcare workers to get better and back to work. In Italy, healthcare workers represent 8% of all contagions.
The Imperial College graph from mid March shows just how far beyond our hospital capacity we are even with quite serious measures to slow the spread.
Imprisoning the over 70s and closing schools still won’t save us from the Hospital Bed Bomb. That’s why we need to do more, go hard, go fast and wage War from our strongest advantage point — time. Without fresh bodies the virus doesn’t survive longer than a couple of weeks at room temperature. And the hotter it is, the shorter the viral “lifespan”.
ICE Beds, capacity, Coronavirus

4. Imperial College estimates of the effect of various forms of mitigation.  (click to enlarge)

My favourite quote:

What if it turned out that in two months we discovered a treatment for the coronavirus? How stupid would we look if we already had millions of deaths following a mitigation strategy?

The speed of medical research is unprecedented. Labs all over the world are onto this, and because of the huge cost — there is a huge incentive to solve this. Note that the most promising avenues are in mass testing approaches and anti-virals or anti-inflammatory lines.  Vaccine research can not be sped up to the same extent.  There are inevitable bottlenecks in testing and waiting for humans to react and in being sure that all risks are being checked. Testing of other approaches is much faster.

We have The Code. We understand the biological alphabet. We will find a way to treat or neutralize this virus. It’s just a question of when.

South Korea, infection control, Coronavirus, daily new cases, graph.

5. The escalation of medical knowledge    (click to enlarge)

This is no time to just give up

On one side, countries can go the mitigation route: create a massive epidemic, overwhelm the healthcare system, drive the death of millions of people, and release new mutations of this virus in the wild.

On the other, countries can fight. They can lock down for a few weeks to buy us time, create an educated action plan, and control this virus until we have a vaccine.

If you agree with this article and want the US Government to take action, please sign the White House petition to implement a Hammer-and-Dance Suppression strategy.

Here’s the latest mutation map. Many of these changes are just “decoration” — they don’t necessarily change the virus in a meaningful way, but they do mark the “heritage” of each subgroup of viruses.

Evolution is at work in the virus world. We know the virus will mutate to become more infectious, but we don’t know whether it will be more or less deadly.

ICE Beds, capacity, Coronavirus

6. The branching chains of Coronavirus around the world.  (click to enlarge)

Buy Us Time to Fight the Coronavirus and Save Millions of Lives with a Hammer-and-Dance Suppression…

Our healthcare system is collapsing. It will only get worse. Mitigation-”flattening the curve”-isn’t enough. We must…

 Compare these two scenarios

ICE Beds, capacity, Coronavirus

7. Mitigation — The Slow Bleed   (click to enlarge)

Don’t miss that the whole scale changes here

This is not just a bit better, it’s an order of magnitude (or three) better.

Every day we delay starting the hammer means more total deaths and many more days on the other side before the hammer ends and the dance begins. Exponential curves are so unforgiving when they are rising, but they can collapse just as fast on the downside. The further we drag the Ro (rate of infection) down, the faster we bring new cases down.

The payoffs from making Ro close to zero are astronomical at this point. We ought be prepared to throw everything at hammering this flat.

ICE Beds, capacity, Coronavirus

8. The Hammer and Dance (click to enlarge)

This is the group to follow, to share, to discuss:

This article has been the result of a herculean effort by a group of normal citizens working around the clock to find all the relevant research available to structure it into one piece, in case it can help others process all the information that is out there about the coronavirus.

See all the endorsements from Professors, experts and commentators, if you are interested in that sort of thing. Doesn’t show they are right, just that they are not crazy.

On Modelling: It’s still wrong. These are estimated projections, based on assumptions and incomplete information. But data from nations all over the world already shows the trends and patterns are correct. The nations that got on top of things fast are already doing the dance — like  South Korea and Taiwan. The nations that tried the slow bleed reactive approach have had catastrophic outcomes (if not in actual total death –  its been measured in disruption and pain, and we have not even tried to count the collateral losses).

And all the nations that tried mitigating get overwhelmed and end up doing the hammer anyway. It’s inevitable so do it now. It’ll never be faster or more effective than starting today.

There’s a lot more detail at the original — read it all there. Hammer and the Dance

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Weekend Unthreaded

Anyone know where Pat is? We miss him, hope he is OK.

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Bill Gates pandemic warning in 2015

Apparently no one listened to him.

The thing we were always afraid of was a virus that people could shed even if they felt well enough to get on a plane…

He’s right about “the blood of survivors” –  blood contains antibodies to the virus after they recover. So plasma from survivors might help current victims. And that trial will happen in New York.

But we don’t need a “global heath system”. We have that already and it’s worse than useless. Back in January the WHO was telling everyone not to stop flights from China. Absurd WHO declarations became the convenient excuse for weak Chief Medical Officers to recommend exactly the wrong thing. WHO advice worked out well for China, but is currently killing citizens everywhere else.

How cheap and easy closing those borders looks now eh?

China bought the WHO a long time ago. WHO chief, Tedros Adhanom, was recently the Foreign Minister for Ethiopia, which is now securely Debt Trapped on China’s Belt and Road. Even as the CCP suppressed doctors, hid the true statistics, and welded their own citizens in their apartments, Tedros fawned over President Xi.

The petition calling to sack the WHO Chief now has 637,000 signatures.

Call for the resignation of Tedros Adhanom Ghebreyesus, WHO Director General

We don’t want a global health system. We just need sovereign borders.

h/t Steve H, Albert.

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Dire report turned into fake news that death projections have been “downgraded”

Be wary of reports that the new Imperial College modeling on Coronavirus has downgraded the threat.  With headlines like these (below), you could be forgiven for thinking Coronavirus posed less of a problem.  The updated model talked of UK deaths being “only” 20,000, not 500,000, but because they were modeling two totally different scenarios. The update assumed that drastic action had started.

The headlines could have said “Draconian Shutdown could save 480,000 lives”.

If Ferguson has any confidence now that the virus will peak a lot sooner — in mid-April — and the UK will not crash their hospital ICU bed supply, it’s only because the country is finally taking serious action and because  “the UK should have the testing capacity “within a few weeks” to copy what South Korea has done and aggressively test and trace the general population.

The full Imperial College report by Neil Ferguson’s team doesn’t suggest anything like these headlines imply. Ferguson himself has responded on twitter that the transmission of the virus is slightly faster than they thought, but the lethality is the same.

He now thinks the Ro (rate of infection) is over 3, up from 2.5.

UK has enough intensive care units for coronavirus, expert predicts

David Adam, New Scientist

and like this:

Epidemiologist Behind Highly-Cited Coronavirus Model Drastically Downgrades Projection

By Amanda Prestgiacomo, Daily Wire

Ferguson’s model projected 2.2 million dead people in the United States and 500,000 in the U.K. from COVID-19 if no action were taken to slow the virus and blunt its curve.

However, after just one day of ordered lockdowns in the U.K., Ferguson is presenting drastically downgraded estimates, revealing that far more people likely have the virus than his team figured.

Now, the epidemiologist predicts, hospitals will be just fine taking on COVID-19 patients and estimates 20,000 or far fewer people will die from the virus itself or from its agitation of other ailments, as reported by New Scientist Wednesday.

Given these results, the only approaches that can avert health system failure in the coming months are likely to be the intensive social distancing measures currently being implemented in many of the most affected countries, preferably combined with high levels of testing. These approaches are likely to have the largest impact when implemented early

@neil_ferguson

Let me be clear. This virus has a lethality substantially in excess of “seasonal” flu. Yes, up to half of those infected might not show symptoms. But that is accounted for in our estimates and always was. There is no credible data supporting the idea that 90% are asymptomatic.

There are people who really struggle with making decisions based on incomplete evidence.

Horowitz: Man who spooked the world with coronavirus model walks back his prediction

 · March 26, 2020

Before we cause irreparable harm to our lives, liberty, and economy, shouldn’t we first study the nature of the virus, how many people really have it, when it started, and what really works in containing it?

Before we allow the exponential curve to overrun our hospitals, kill patients, doctors and nurses, shouldn’t we make a decision while we still can? If it turns out that our hospitals are protected for some reason from the fate in Italy, Iran and Spain, we can always restart the whole economy after our unplanned three week holiday (h/t TdeF for that analogy).

These are the questions some of us have already been asking, but our voices were silenced because of the Imperial College of London’s study that said this would kill 2.2 million people in the U.S. and 500,000 in the U.K. Now, the author of that study himself has essentially recanted his projection, whether he admits it or not.

Yada, yada, claims of silencing is only corroborating evidence if there is actual data that the virus is not much of a threat. I’ve seen many claims of vast asymptomatic spread but no data to support that. Testing on the Diamond Princess, in Vo, and South Korea still suggest mortality rates of 0.5 – 1% are likely in situations where we don’t run out of Hospitals. Asymptomatic incidence was 50% on the Diamond Princess and most people were tested — though until we get antibody tests en masse we won’t really know who got a short asymptomatic case that resolved even before it could be tested. We would love to have that data, but we have to decide without it.

REFERENCES

Walker et al (March 26, 2020) The Global Impact of COVID-19 and Strategies for Mitigation and Suppression,

WHO Collaborating Centre for Infectious Disease Modelling, MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London (2020) doi:

March 16th, 2020, Earlier Imperial College Report

______________________________________________

Coronavirus Background: ☀ The Demographics  ☀ The Ro is 2 – 3 and exponential curves are steep. How Coronavirus kills: why the number of ICU units matters so much. ☀ Illness progression  ☀Singapore: calculations of how fast the ICU beds may run out. ☀ We should have stopped all flights so much earlier. ☀ American Samoa avoided Flu Deaths with quarantine in 1918. ☀  Vo, the Italian town that stopped the virus. ☀ Delay = Death, statistics show mortality rates rise tenfold if hospitals are overwhelmed. ☀

Economics: ☀ The huge impact on the Chinese economy, the awful case of Iran.☀

Beware UN advice:Ethiopian WHO chief was part of China’s debt trap diplomacy ☀

Stats and Data: John Hopkins Live Map Worldometer Coronavirus data in Australia

 

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Fun moments for home isolation

Looking for something to do for 14 days?

A light moment thanks to Willie and whoever the extraordinary Joseph is.

 

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Chinese company flew 80 tons of medical masks, suits, to China in Feb

Asleep at the wheel.

The Lucky Country wakes up to the cost of globalization. There are only 3,000 Covid cases here, we have barely begun, yet we’re already running out of protective gear. The lives of our doctors and nurses are at risk because bureaucrats were too slow to see the obvious, blindly unaware of foreign allegiances, and they kept using the old Influenza plan when this wasn’t influenza.

The media, led by the bloated ABC, reinforced all the incompetence, more worried that we might made bad jokes about shaking hands in hospital.

Meanwhile, below, China now has excess masks which it is donating to Belt and Road Slaves in Europe and to nations where it wants access to 5G network deals. Our masks, used as levers for China to gain power.

50 shades of incompetance

Chinese-backed company’s mission to send Australian medical supplies to China, by Kate McClymont.

According to a company newsletter, the Greenland Group sourced 3 million protective masks, 700,000 hazmat suits and 500,000 pairs of protective gloves from “Australia, Canada, Turkey and other countries.”

This is the free market at work — to some extent, those supplies were more needed in Wuhan in January than in Sydney, but it left us wide open. If journalists had asked better questions of our politicians, we might end up with better politicians:

The Greenland group, which is majority owned by the Shanghai government, has sold more than a billion dollars worth of residential apartments in Sydney and Melbourne since its arrival in 2013.

A whistleblower from the company has told the Herald it was a worldwide Greenland effort — and the Sydney office was no different, sourcing bulk supplies of surgical masks, thermometers, antibacterial wipes, hand sanitisers, gloves and Panadol for shipping.

“Basically all employees, the majority of whom are Chinese, were asked to source whatever medical supplies they could,” one company insider told the Herald.

A second Chinese property company based in Sydney flew more than 80 tonnes of medical supplies to Wuhan in late February.

Kate McClymont, The Sydney Morning Herald

A second Chinese property company based in Sydney flew more than 80 tonnes of medical supplies on a corporate jet to Wuhan in late February, at the time coronavirus was devastating the regional city.

“The chartered plane with 90 tons (82 tonnes) of medical supplies, including 100,000 most needed protective coveralls and 900,000 pairs of medical gloves, has successfully departed from Sydney and arrived in Wuhan on 24 Feb,” Risland Australia posted on its LinkedIn page.

Australia is already running out of masks:

As the surge of coronavirus infections increases, healthcare workers are becoming desperate. “The shortage of personal protective equipment in NSW hospitals is scandalous,” one healthcare worker told the Herald. “Doctors and nurses on the front line feel inadequately protected, exposed and vulnerable.”

In one major Sydney hospital “junior doctors are being told there are only 30 N95 masks available for all operating theatres”. The healthcare worker said this was forcing people to source masks from the “black market,” the quality of which is dubious.

Greenland Group sourced 3 million protective masks, 700,000 hazmat suits and 500,000 pairs of protective gloves from several countries including Australia.

Only two months too late:

The Minister for Home Affairs Peter Dutton is working on a plan to crack down on hoarders who are profiteering out of COVID-19 as well as giving authorities more powers to be able to seize items at the border including medical supplies.

After covering up the severity of coronavirus and ruthlessly buying our personal protection equipment, China is now using that equipment to further its own power and wealth. Some of those purchases were not because Chinese docs needed the gear, but because China knew we would:

How China is Exploiting the Coronavirus to Weaken Democracies, by Peter Rough.

Beijing has reinforced this propaganda campaign by sending medical supplies to Europe. It is hard to believe that a country that interns more than 1 million of its own citizens is capable of altruism. Indeed, every Chinese action betrays a Machiavellian motivation behind a humanitarian guise.

Take, for example, the decision by Chinese telecommunications giant Huawei to donate 800,000 masks to the Netherlands. Why would the conglomerate, known for its closeness to the Chinese government, display such benevolence toward a country which, at the time, had hardly any coronavirus cases? Surely it could not be because the Netherlands’ auction of fifth-generation (5G) mobile licenses is slated for June, and because the Dutch still have to decide whether to exclude Huawei from its 5G networks over espionage concerns.

Or consider Italy, where China has sent doctors and donated ventilators that have been in short supply. Does China’s newfound interest in Italy’s well-being stem from genuine concern, or from that of Rome’s status as one of Europe’s biggest supporters of the Belt and Road Initiative?

Hands up who thinks China has our best interests at heart.

Save our doctors and nurses, sell the ABC and use the money to buy masks and gloves.

h/t Dave B, Peter C, Bill in Oz!

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Friday Open Thread

Where did Thursday go?

 

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Masks do help, even (maybe) stopping 75% of influenza, and you can make them

In the West the public have been discouraged from wearing face masks, and told they aren’t much help. This is mostly because they are “much help” and the front line docs and nurses really need them but no one in charge ordered enough in advance, and none of them had the honesty to say so. The daft push-me-pull-you messaging of how the useless masks are needed on the front line will go down as a case study in how not to communicate (or build trust). The truth is we do want people to wear masks in the street, because it almost certainly does slow transmission. (These Lancet authors think so too).

In high density East Asian nations, face masks are common. (And viral growth curves are generally slower, though for lots of reasons.)  Possibly after Coronavirus has gone, masks in winter might be more common here too.

Things can change fast:

Kamil Chudačík, twitter:

In Czech Republic we went from: “Look at the idiot wearing a mask!” to “Look at the idiot not wearing a mask!” in 2 days. I can say the czechs are very conservative in terms of changes so I’m surprised by this behavior.

The DIY mask industry

Medical staff need face masks because they do filter out small enough particles. They reduce the rate of infection. There are scores of papers. And if no medical masks are available, then even home made ones are better than nothing. Right now, teams of home sewers are getting organized, making as many masks as possible. Patterns are being shared online, and since medical masks are running out, some hospitals are even keen to get the home made sort.

In Czechia, a Facebook group called “Czechia Sews Masks” has 33 000 members.

The most useful mask is the one you wear

Another line we are told is that only the N95 (or P2) masks are good enough, but just about any old mask helps.

We’re told plain old surgical masks are just to “stop patients getting doctor germs”. But even these are surprisingly effective compared to the higher quality masks. In 2009 during the swine flu researchers asked parents looking after sick kids at home to take part in a study. The 286 parents were randomly assigned to wear one or none of these masks, mostly they ran out of enthusiasm, with only 25% managing to comply with wearing the mask for five days in a row.  But of those who did wear either type of mask, the rate of getting the flu was about 25% compared to parents who didn’t wear a mask. And surprisingly the N95 mask wasn’t statistically different from the surgical mask, even though the N95 is thicker, and considered to be much better. Of course, it could be that the sort of diligent parents who kept the mask on also had more self-control and were better hand-washers too. But in hospitals where staff do wear masks,  larger studies with 2,000 healthcare workers showed similar results (suggesting that surgical masks were just as good as the N95 masks.) Though in many other studies the N95 masks were more effective. Perhaps it depends on how well they fit. Perhaps most of the benefit is in stopping people touching their face and biting their nails?

 SmartAir Filters has a a really impressive easy-to-read description of different masks, studies, and all kinds of tests — including particle size, and comparison tests of different materials – like tea towels and pillow cases.

Coronaviruses are only 60 – 140 nm in size, insanely small, but masks are still able to filter them out. Though obviously the fit matters and air will easily leak around a poorly fitted mask. But SmartAir also use a fancy “fit-test” machine which can compare the air inside and outside the mask, and that’s while someone was wearing it. It’s a good analysis.

Do-it-yourself mask materials:

Tea-towels were surprisingly good. Double layering them made them theoretically just as good as a surgical mask (apparently). The researchers felt that they were not so easy to breathe through so, so they recommend t-shirt and pillowcase material instead. While they aren’t as effective at filtering, they are more comfortable and more likely to be worn.

Masks, materials, effectiveness.

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Even a scarf caught nearly half of all the particles.

Taiwan is making 10 million masks per day.

 Masks are reusable (with care!)  Smartair recommend hanging the mask in the sun for a few hours. So drying it out and leaving it for three days. But do be careful taking the mask off. There are bound to be youtubes to watch on how to do that correctly to minimize the risk of contamination. I”ve heard that is the most risky time.

 

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Rating: 9.8/10 (53 votes cast)

This is going to be shorter and faster than people think

Option three gathers wings

Finally the world is tossing out the pointless old Influenza Pandemic plan that called for six months of slow bleeding. Leaders are waking up to the high speed, hard and fast option. Tonight 20% of the worlds’ population are crushing that curve with a full lockdown because it’s the only option. 1.3 billion people in India are now in a three week home quarantine, joining France, Italy, China, Poland, Spain, Belgium, the United Kingdom, New York, California, South Africa, Colombia, Bolivia, Jordan and Tunisia and New Zealand. Sadly half a million people (at least) have caught Covid-19 and there will be another few doublings before the new lockdowns even start to show on the graphs.

Maybe stop feeding it fresh meat?

The Lucky Country Downunder, meanwhile, is copying the Italian-plan-that-failed with a bunch of wishy arbitrary rules that change by the day and are not remotely enough. We know the infection is spreading, but we’re still able to share our germs in Centerlink queues, at Kmart and while getting a haircut. We can’t have 6 people at a wedding, but we can have 600 at a school. Borders are closed but people are still going through them for essential jobs, and “every job is essential” says Scott Morrison.

Obviously after more people die, we’ll do the hard sharp lockdown too. I predict exponential numbers will rise exponentially in Australia, and the PM and Brendan-two-weeks-too-late-Murphy will say “it looks worrying but this is what we expected.” Then they’ll make some excuse for how people are not social distancing enough on their way to work and school and back and how, now, “medically” the time is right for a lockdown.

Simpletons will wonder why, if they knew numbers would rise, they didn’t do it earlier.

But even smart people won’t be able to answer that.

The worst of this will hopefully be over in four to six weeks. Not six months. The sooner we start the better. It’s not the end of the world to mind the kids at home (parents do it every school holidays).

The difference between Covid-19 and Influenza is that this disease is so awful we can afford (we have to afford) to eradicate it — or at the very least — deal with it, find a treatment, a cure, a vaccine. Everyone thinks we can’t possibly stop Influenza, but the truth is, if it hurt this much, we could. We’d find a way. We don’t because the price is just too high.

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Rating: 8.4/10 (77 votes cast)

Trump might yet pull off a gamechanger thanks to chloroquine

A High Stakes Game

If the trials of the anti-malarial chloroquine (or variants) work, Trump will get away with all the understatements he said in February.

On twitter the combination of Hydroxychloroquine and azithromycin are known as #TrumpPills. The trials started Tuesday. We don’t know the results but doctors are buying up pharmacy stocks across the US — presumably to protect themselves (hopefully).

As the death tolls mounts, the Democrats are surely planning to put all the Trump quotes like “it’s going to disappear. One day, it’s like a miracle” on high rotation leading up to the election. But if the trials of anti-viral agents bring good news, he can reframe the past as if he was betting on that in February. (Perhaps he was?)

Though not many people spend two trillion dollars on a problem that’s disappearing.

Combo of existing drugs shows promise against COVID-19

Most patients treated with hydroxychloroquine alone cleared the virus in three to six days, compared to an average of 20 in China — …

The authors advise: “Use this treatment cocktail early, and don’t wait until a patient is on a ventilator in the intensive-care unit.” They also note that in some places hydroxychloroquine is being used as a prophylactic treatment for health workers in high exposure situations.

Key takeaway: “Our experience suggests that hydroxychloroquine, with or without a Z-Pak, should be a first-line treatment. Unfortunately, there is already a shortage of hydroxychloroquine.

Just as we think we’ve got used to the rate-of-change of the rate-of-change, things might change the other way.

Bloomberg reports that a new study shows Chloroquine Is No Better Than Regular Coronavirus Care. But under the headline they reveal that that new study wasn’t statistically significant, involved only 30 people, and that regular Chinese care includes other anti-virals like lopinavir and ritonavir. In other words, it was not much of a trial.

The whole world will be watching these results. Spare a thought for Indonesia which has ordered 3 million chloroquine tablets in a population of 260 million people and where people are falling in the streets today.

But if it’s not Chloroquine, there are plenty of other possibles: like blood plasma from survivors.

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Rating: 9.6/10 (37 votes cast)

Young and fit brought down, means hard sharp quarantine coming everywhere

 Message to the young and immortal

A fully fit 28 year old who ran marathons tells what it was like for him to get Coronavirus. He ended up spending 13 days in ICU. His ongoing liver problems and weakness will take a month or two to get better.

His message to young people out at parties or on the beach: ” You might survive, but the old person that didn’t get that ventilator might not…”

But the spread of stories like this rule out some future paths.

Forget all the pussy-foot weak quarantines

This shows that the “Let it RIP” approach and the “Herd Immunity” approach were never even worth discussing. The community would not tolerate the risk or inhumanity of either. But this also shows that the Slow Bleed approach of weak Social Distancing for six months will be dumped like a hot rock asap (it’ll be rebadged and quietly wrapped in stronger stuff). As Italy found (and now Spain) weak quarantine doesn’t work very well. Only serious quarantine can solve this.

Speaking of solving this: Good to hear that cases are possibly slowing in Italy. Looks promising. What did Italy do 12 days ago — On March 12th, as the death toll hit 827, and infections topped 12,000, they locked down all shops bar the essential ones. They clamped down on public gatherings. Non-essential travel was stopped. Sadly in the last twelve days the totals have climbed to 64,000 Italians infected, and 6,000 dead and more presumably will die, though it already appears to be leveling (could be an illusion). How many lives would have been saved if Italy had acted a day sooner? (Or a week?). Some countries have the gift of time to act faster.

Italy cases start to level off. Graph. Coronavirus

Have new daily cases in Italy finally peaked?   Source: Worldometer, Italy

As stories like these spread (below of the 28 year old) a quite reasonable fear will grow and people will choose to quarantine, indeed some will refuse to go to work. There is no way the economy can keep running along with business as usual while the threat of this ticks in the background. This is not something we can live with for six months — the fear will take over a healthy economy and make it unhealthy without any government intervention anyway. The only option is some variation of short sharp and hard quarantine, or crushing the curve as I’ve been saying.  It’s where we are all headed.

If we do the quarantine properly the infection will peak and fall much sooner. If we get enough testing kits, we can pursue this virus and search and destroy every last copy.  Then as I said — we reopen the clean zones one by one, keep borders and barriers tight and gradually reduce the infected zone. As each clean zone reopens (sooner than people think) small parts of the economy will spring back to life.

 

 


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Right now, the path out of this is clear:

1. Start “stay at home” quarantine asap. Close schools (apart from essential services families).Lock all borders. The more the better. Even regions.

2. Order mass supplies of Chloroquine (or all other potentially useful anti-virals.)

3. Build factories to make test kits and ventilators en masse.

4. Use the test kits to identify who has immunity and who does and doesn’t need protective gear or isolation.

5. After two weeks of quarantine we can identify regions with no  infections. Build from there.

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Rating: 9.1/10 (58 votes cast)