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.
“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.
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.)
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.
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?
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.
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”.
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.
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.
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…
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.
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.
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
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.
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.
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
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
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.
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:
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.
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.
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 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:
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.
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.
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.
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.
….
Even a scarf caught nearly half of all the particles.
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.
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.
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?)
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.
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.
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.
….
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.
For most people Coronavirus is like the flu or even a cold, but for 20% it’s something awful. Even in younger patients — a few seemingly fit and healthy 40 and 50 year olds are gasping for air as their lungs fill with blood and fluid and it’s “like a near death drowning” or “inhaling caustic gas”. Forgive the language in the headline — those were this docs exact words. He’s working at a New Orleans hospital and his whole attitude to the virus has changed dramatically.
“It first struck me how different it was when I saw my first coronavirus patient go bad. I was like, Holy shit, this is not the flu. Watching this relatively young guy, gasping for air, pink frothy secretions coming out of his tube and out of his mouth. The ventilator should have been doing the work of breathing but he was still gasping for air, moving his mouth, moving his body, struggling. We had to restrain him. With all the coronavirus patients, we’ve had to restrain them. They really hyperventilate, really struggle to breathe. When you’re in that mindstate of struggling to breathe and delirious with fever, you don’t know when someone is trying to help you, so you’ll try to rip the breathing tube out because you feel it is choking you, but you are drowning.
If you don’t feel motivated to stay home and order online, then go read all of this story at ProPublica from end to end. Most likely, if you catch Coronavirus, this won’t happen to you. But the whole pain of quarantine might look like a small price to pay. How many people in each cohort does this dire situation occur too? Perhaps it’s only 1 in a 1000. Or perhaps it’s more. Can someone find the latest stats from Italy on how many need ICU in different cohorts. Presumably, if the mortality rate is 40% with ARDS, then this happens to 2.5 times whatever the mortality rate is.
UPDATE: In comments Lee Valentine points out the doc’s in New Orleans should not have restrained the patient. They should have been paralyzed and unconscious (as the other ICU specialist described in this video).
I was disappointed to read this report of the corona virus ARDS cases. Disappointed because the cases were mismanaged. ARDS victims should NOT be restrained, EVER. They MUST be paralyzed with drugs.
So far, I have had only one corona ARDS patient. He arrived four days ago. There are two now in my hospital. It’s a serious worry that if Los Angeles gets many more we’ll not have enough specialists who know how to manage them. If our current rate of new cases continues, we’ll have all ventilators available in use for corona ARDS in a few weeks.” — Lee Valentine
This is knocking out what should be perfectly fit, healthy people.
…then all of a sudden, they go into complete respiratory arrest, shut down and can’t breathe at all.”
“It’s called acute respiratory distress syndrome, ARDS. That means the lungs are filled with fluid. And it’s notable for the way the X-ray looks: The entire lung is basically whited out from fluid. Patients with ARDS are extremely difficult to oxygenate. It has a really high mortality rate, about 40%.
Look at State by State outcomes: visit Covid Act Now
Its an excellent display of modeled outcomes across the US*. Click on each state in the US to find out predicted death tolls and the day hospitals will be overwhelmed with too little action.
Dear readers, get out of the way of this virus. My advice is to stay home. Order online. Wear masks if you have to venture out. Keep kids home from school. Don’t visit anyone or allow visitors in to your home who have not strictly quarantined for the last two weeks. We started this last week.
h/t Bill in Oz.
Eg It’s too late now for New York State to avoid losing control of hospitals
But they could still Crush the Curve and save a lot of people, but even that action now will have far higher death tolls that it would if it had been started last week.
New York State has a population of 20 million. So the figures in the table below are directly comparable to Australian outcomes with a population of 25m (with the hope that lower population density, warmer weather, and two weeks warning could be an advantage.)
New York outcomes.
There are four levels of action modeled here (from March 19th). The final death tolls are very different.
New York outcomes.
The advantage of “Crushing the Curve” now means we can wait to find out which treatments work. It’s always possible to ease up on the level of quarantine and pick the higher death toll options, but it isn’t possible to choose the low death futures if we do too little too late. If we are headed for the Wuhan Style lockdown anyhow, sooner is better, and we can release it later when extra hospital beds or drugs or treatments are available. Figure that even if we choose “Social distancing” now, once people see the lists of obituaries and queues of coffins, and desperation in hospital wards as awful choices are made, many people will voluntarily stay housebound. The CCP was ordering workers to go back to work, but they didn’t want to.
Eg. California needs to act this week
California outcomes.
…
California outcomes.
*All models are still wrong. But discuss the assumptions, don’t shoot the messenger.
The wave coming is not just a “bit bigger” than hospitals can handle
Western Australian specialists estimate that at present rate, in 45 days Coronavirus cases will fill up their entire state hospital system. Two weeks later Covid patients will also fill all the beds in the extra two copies of their entire state hospital network that haven’t been built yet.
Hospitals will need 20 times as many ventilators as they have.
“Peak need for ventilators will be over four thousands in a system where we have less than two hundred. Again, most of those needing a ventilator will die. “
Perhaps we are overreacting?
Western Australia is an example of what the rest of the West faces. There are 2.5m people here, but only 120 confirmed cases. In a state which took six years to build one hospital all we need to do is triple our hospital capacity in 6 weeks. Laughing…
The Doctors call for the immediate closure of borders. Which was impossible a few days ago, in a state that only has two sealed roads out, but is now happening on Tuesday “at 1:30pm”. (Presumably the new border guards have to drive out from Perth.) Amazing how fast the world changes once other leaders act.
Doctors want schools closed immediately and social distancing halved “at a minimum”. They warn “Social isolation measures are manifestly inadequate”.
“People will forgive the imposed hardships they may suffer but they will not forgive us if we, knowingly, do not act now to stop the demise of thousands of Western Australians.”
Hospital beds required, Western Australia, (Click to enlarge)
These dreadful numbers will not pan out, but only because the unfolding disaster will spark all the draconian lock-downs (shelter in place) and quarantine conditions I’ve been saying would come. People will do it voluntarily out of fear anyway once more stories start to hit the news.
We will slow this, and keep deaths far below these tallies. After which I expect the naysayers will pop up and mock the big numbers and tell us they were right all along. “It was nothing”. “See I told you it would peter out. ”
Almost 50 of WA’s top specialists have penned a chilling open letter to Premier Mark McGowan, warning of thousands of WA coronavirus deaths “without strong and decisive leadership”.
“Without strong action and decisive leadership, first tens, then hundreds and then thousands of vulnerable West Australians will die as a result of COVID-19 infection.
“Most of these deaths will be in the course of just a few weeks. There will be many who will become critically ill and die with hospital staff unable to do anything to prevent their demise.
“We will have colleagues who die.
“We will have nurses, business leaders, school teachers, mothers, fathers, and our grandparents who will die with us unable to do anything but watch it happen.
“We will run out of ventilators and those who need them will then die.
This modeling* estimates that if people cut their social contacts in half the total peak ventilators and hospital admissions will decrease by about six fold. Notice that the dates of the peaks stretch out by another three months with “social distancing”.
Table, model estimate of peak cases coronavirus, WA (Click to enlarge)
I still say Crush The Curve, the slow bleed is still awful. Declare War and get rid of this.
This would mean there would be an extra 400 Intensive Care Unit ventilators required a day to meet the demand. But if every West Australian reduced their normal social contact by half, infections would peak in mid-to-late August and only 52 new ICU ventilators a day would be needed. If tough measures are not put in place, the doctors estimate the number of hospital beds required would be three times those currently available.
The list of surgeons and specialists includes many respiratory experts, but what would they know?
Prepared as well as anywhere in the world (which means “hopeless”)
The state has almost run out of testing kits. Like the US and Italy, community transmission will be expertly identified right after people turn up needing intensive care for pneumonia.
A “grand round” meeting of doctors at Fiona Stanley Hospital on Wednesday heard questions about whether transmission was already happening given the strict testing criteria.
A shortage of reagents needed for testing means only people with a fever or respiratory illness and have either returned from overseas or had close contact with a known case are eligible. Health or aged workers are also tested.
In the United States and northern Italy, the first indicator of widespread transmission was when patients started to arrive at hospital that required intensive care. That has yet to happen in WA hospitals, but if it does, by that point the disease is “out of the bag”, the FSH meeting heard.
Not so. At that point, the disease will have been “out of the bag” for one or two weeks already.
Dumb bit of code is still weeks ahead of bureaucrats. If we don’t have community spread in WA, and we did lock down, we would get rid of it. Now is exactly the time to close everything.
Whereever you live, if they are not quarantining everything, write to your politicians and media.
The first epicentre in Italy was Vò, a little town of 3,000. It was shut down, fully tested and twice and nine days apart. By testing, isolating, and tracking, they reduced the spread to almost nothing, and this is despite the extraordinary discovery that when the first death happened, already 3% of the town had the disease.
At that point surely the Italian government should have immediately closed everything?
Mr Zaia, Veneto’s governor, said the trial was “criticised by most sides” but that isolating numbers of undetected positive cases has resulted in Vo Euganeo being today “the safest place in Italy”.
Andrea Crisanti and Antonio Cassone, The Guardian, March 20.
Our experiment came to be by chance. The Italian authorities had a strong emotional reaction to news of the country’s first death – which was in Vò. The whole town was put into quarantine and every inhabitant was tested.
In the first round of testing, 89 people tested positive. In the second round, the number had dropped to six, who remained in isolation. In this way, we managed to eradicate coronavirus from Vò, achieving a 100% recovery rate for those previously infected while recording no further cases of transmission.
The headline is a bit silly — mass testing doesn’t eradicate anything, but it does make strict isolation and containment easier to achieve. Now we probably need mass blind shutdowns to achieve the same effect when earlier action and mass testing then could have crushed the curve with much less effort.
70% asymptomatic or mild — good but ominous data
Italy’s death rate of known cases is shockingly high (which is why I gave up calculating it weeks ago). These numbers are similarish to the Chinese rates where roughly 80% were described as asymptomatic or mild. It probably just depends on the definition of “mild”:
… asymptomatic or quasi-symptomatic subjects represent a good 70% of all virus-infected people and, still worse, an unknown, yet impossible to ignore portion of them can transmit the virus to others…
It shows it’s possible to Crush the Curve and get rid of this virus, but it takes mass testing which we now can’t do because we didn’t act soon enough. But we may be able to do if we ramp up production of tests kits like our lives (and our economy) depended upon it.
On the plus side, this reduces the mortality rate but even so, if we lose control of hospitals we know 3 to 5 times as many people will die if we can’t offer everyone who needs it an ICU unit.
If the fact that only those presenting with the virus were being tested was accounted for, the mortality percentage would fall to more “normal” levels. This is shown by the mortality in the Veneto region, which is steadily around 2.5-3%, still high but threefold less than the ones in Lombardy and Emilia-Romagna.
In Veneto about 8% of the total population was tested. So we still don’t know what the death rate really is.
From the beginning I’ve said that hidden asymptomatic cases will reduce the fatality rate. We aren’t going to get good numbers on that til we do mass blood testing looking for antibodies that show people have fought off an infection. These have to be done before antibody titres fall (and we don’t know how fast that happens, and whether people carry some protection for a long period or not. SARS responses appear to stay for longer, but the common cold Coronavirus infections last in the order of one year.
Estimating mortality rates is still a guessing game
The best estimates we have are from The Diamond Princess where everyone was tested and South Korea which has done more testing per capita than anywhere. Respectively, the mortality rates were 1% and 0.9%. Given that the Diamond Princess passengers were older the mortality rate in a normal demographic group might be as low as 0.5%.
On the Diamond Princess half the people who tested positive were asymptomatic (49%). But the idea that 80% of the ship didn’t catch the virus is nothing to cheer about. On board the Diamond Princess one infection became 712 in just four weeks –– two of which were supposedly under quarantine conditions.
The cruise ship Diamond Princess set off from Yokohama on January 20, with about 3,700 passengers and crew. On Jan 23 a man got sick and left the boat in Hong Kong on Jan 25th. It took four weeks to infect 20% of the ship and half that time was spent under quarantine conditions. Of the infected, fully 178 people have still not recovered and 14 remain classed as “severe/critical”. This is a bugger of a virus.
Stay out of the way of this virus, stay home if you can, get your kids out of school. Just stop mixing for the next few weeks and see what unfolds.
Some in the Republican Party knew what was coming. At least four Senators in the US are being accused of insider trading, selling stocks before the crash, but not warning the public or making sure the US was prepared. Senator Richard Burr sold something like a million dollars in their own stocks on Feb 13th. At private briefings his message was that this virus was aggressive, more like the Spanish Flu, “the military might be mobilized”. Burr was probably more aware than most because he “helped to write the Pandemic and All-Hazards Preparedness Act (PAHPA).”
On the other hand Senator Loeffer says she was not involved in choosing the stocks that were sold on her portfolio. But others say some of these blind trusts sold shares the same day the Senators were briefed in some cases as early as Jan 24th. The Senators claim they were only acting on public news services. Possibly, even if they knew, they may have been bound by some Party ruling not to contradict the President.
Think about it: Trump certainly knew how bad it was going to get, but kept on downplaying it, at a time when being straightforward would have given people time and impetus to prepare. Trump’s most loyal backers then were calling it a hoax, and dunking on people like me for hyping panic, and so forth. This top Senate Republican (and no doubt other Senate Republicans) knew that the president was misleading the public, and said nothing. If he felt comfortable telling wealthy donors about this, why didn’t he tell the general public? Because it would contradict the president’s messaging? Why?
Having senior Republican lawmakers contradicting the president at that relatively early stage, based on information they knew, would have been in the country’s best interest. Sen. Burr told rich, well-connected supporters what was coming, but not the people who elected him. He owes them an explanation. And I would like to know why the Senate Republicans, all of whom surely had the same information, did not challenge the president, and warn the public while we still had time.
…To be honest, it’s not [Burr’s] stock-selling that bothers me — it’s that he had reason to believe the coronavirus crisis was going to be a lot worse than he was letting on in public. He ought to have been warning us all.
Has Trump thrown away the 2020 election?
Which day did he realize the trainwreck was coming?
The chairman of the Senate Intelligence Committee warned a small group of well-connected constituents three weeks ago to prepare for dire economic and societal effects of the coronavirus, according to a secret recording obtained by NPR.
The remarks from U.S. Sen. Richard Burr were more stark than any he had delivered in more public forums.
On Feb. 27, when the United States had 15 confirmed cases of COVID-19, President Trump was tamping down fears and suggesting that the virus could be seasonal.
“It’s going to disappear. One day, it’s like a miracle. It will disappear,” the president said then, before adding, “it could get worse before it gets better. It could maybe go away. We’ll see what happens.”
On that same day, Burr attended a luncheon held at a social club called the Capitol Hill Club. And he delivered a much more alarming message.
Burr sold personal stocks worth between $628,000 and $1.72 million in 33 separate transactions on a single day, February 13th, according to public disclosures.
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