Stop with the fatalism: Don’t flatten it, Crush The Curve on Coronavirus

There is a third way — Why are we so fatalistic?

It’s not a choice between Let It Rip and the slow bleed of “Flatten the Curve”. It’s not a choice of health versus money. The third option no one is mentioning is to Crush The Curve: we go hard, fast, and do a major short sharp quarantine. It’s not radical, it’s just textbook epidemiology, it saves more lives and it saves the economy too.

SlowMo, Boris and Trump are still two weeks behind the virus. It’s time to get the Third Option on the table.

Flattening the Curve is a fatalistic slow bleed that must last months. It rescues us from the demolition derby that the Let It Rip disaster is cursing on Italian hospitals, but it’s deadly for the economy. All leaders who are keeping schools open while turning student dorms into triage units are locked into this limited thinking. It’s the Influenza-plan rejigged.

There is another way — (as I’ve been saying) — we stop dithering and acting two-weeks-late, and jump ahead of this inanimate code. We aim for extinction — hunt every infection down, keep most people at home, reduce the spread, then finish by following […]

Antiviral drugs – antimalarials and anti HIV may be useful

I’ve said from the start that anti-virals were always going to be more useful to us this year than vaccines, which take so long to test and be ready for use. What we really need are anti-virals which also happen to be preapproved and tested and hopefully in mass production. Chloroquine is cheap too, though I doubt Australian stocks of the drug are very high, or that our genius rulers have arranged more. This may be a godsend in Africa where chloroquine use is already high and may reduce the spread of Covid-19 somewhat.

The UK banned export of chloroquine a few weeks ago. Clearly someone there thought it might be useful.

Wang et al reported on Feb 4th that Chloroquine (anti-Malarial) and Remdesivir (anti HIV) may be useful against Coronavirus. They used lab experiments on cells in glass, which had promise. But “in vitro” doesn’t always mean “in vivo”. So I’ve been waiting for some results on people. Early reports were ambiguous. Recently this was hyped as an “Australian cure” which really just meant the start of a proper trial.

There are links to papers and discussion below but I can’t beat this great description explaining how inside the […]

Australia waited to boost mask production til now ?! — Greg Hunt and Brendan Murphy’s deadly incompetence

Australia has only one mask factory, and the Army was only sent in yesterday to start helping to ramp up production?

Six weeks after this disaster was obvious to bloggers-watching-twitter-feeds, the entirely predictable shortage of masks is only just starting to be addressed? Why weren’t they doing this a month ago?

Australian Defence Force soldiers have been deployed to help Australia’s only mask manufacturer, Med-Con, near Shepparton.

The Federal Government confirmed on Tuesday about a dozen ADF personnel would be called out under the Defence Assistance to the Civil Community rules to help Med-Con ramp up production of personal protective equipment.

Three army trucks were seen heading north on Old Dookie Rd about 7.20 am Wednesday morning.

Australians are panic buying because the sheer incompetence of our medical advice and management is obvious to everyone. It didn’t occur to me to suggest the government get local mask production running because any sensible ten year old would have seen that coming.

The Greg Hunt mantra on Jan 31: WHO declares emergency. “We are prepared.”

March 5th: Dental practices face closure because of shortage of surgical masks.

March 18th: doctors are warning a promised influx […]

Delay = death. Countries that act slowly increase the fatality rate by 10x

Dithering politicians push the fatality from 0.5% toward 5%

A gritty analysis by Tomas Pueyo shows how leaders inertia is killing people every day. Some of the victims of tomorrows Virus Get-Togethers won’t die for a few weeks, but the next batch starts tomorrow (and every day until the nation self-isolates, stops the pox-parties, the cough-shopping, and pneumonia-planes. ). And each day there are more than the day before. Sounds macabre, but at this point in an exponential epidemic, it’s just how it is. Since we didn’t stop the Airbussed virus, we’re going to have to shut everything down anyhow, the later we do it, the larger the cost, and the longer it takes. We have to get ahead of this virus.

Meanwhile in Australia, the average punter seems to realize this and the mood is hitting feverish notes with tramplings in supermarkets — The government is calling for calm, but doctors are calling for borders to close, and schools to go online, they’re standing outside schools with signs telling parents not to send their children to school. Doctors are warning that we are the next “Italy” if we don’t get our act together. But the government says it’s too […]

Doctors in West Australia call for closure of state borders

I seem to have the uncanny ability to predict what frontline experts will recommend days in advance. It’s not genius. Just medical training and that the solution to this is so Bleeding Obvious, and politicians are still 2 to 3 weeks behind an exploding epidemic of an inanimate nucleic acid code.

WA hospitals call for state border closures to deal with coronavirus fears (COVID-19)

Top doctors across WA’s biggest hospitals are sensationally calling for the state to effectively close its borders to protect West Australians from the coronavirus pandemic.

In a remarkable letter obtained by The West Live to be discussed exclusively on this morning’s show, it can be revealed the Combined Medical Leads Advisory Group has raised concerns about the “extremely limited” availability of testing infrastructure and supplies in WA.

The group, which includes senior medicos from FSH, RPH and SCGH, also warns there is “limited evidence of effective anti-viral treatment”, “no effective vaccine” and that rationing is already in place at hospitals.

It recommends that to “flatten the curve” that attention should be paid to “extending isolation restrictions to all personal interstate travel”.

Just to spell this out, all states […]

More proof that viruses don’t have wings — UPDATE: SlowMo moves!

BREAKING NEWS: Since writing this Scott Morrison has finally moved to quarantine all arrivals including planes and ships. He’s still two weeks behind the virus, and playing catch up with Jacinda Ardern, the real leader. But finally the bleeding obvious has dawned.

He won’t close schools, and perhaps, suddenly that will now be a viable option, though Sydney still needs short sharp major action to save lives. Could they bear doing no sport or social events for two weeks?

The big risk to most states are now flights from Sydney. Will NSW aim for the “slow bleed” eking out infections over months, hoping none accidentally go wild, or will it aim to wipe this out in three weeks so life gets back to normal, and Australia can play sport again against New Zealand, asap?

With this news, just in the nick of time, the future is now looking better. My prediction: Watch as leaders all round the world pick this up. This is a good boost for nation states and sovereign borders. All eyes are on the EU now where the open border policy has been disastrous — Spain (6,300), Germany (4500) […]

Strap Yourself in: just three weeks from 3 patients to a hospital system on brink of collapse. 12% need intensive care.

Get out of the way of this virus.

Could Italy be suffering from a different and nastier strain?

Figures from South Korea and the Diamond Princess may not be a good guide to what’s happening in Italy and Iran. There something seriously different going on there. Death rates are much higher than expected. Three weeks ago, Italy officially had three cases, now a thousand people are dead and 12,000 have the virus. The hospital system is already at the point of being overwhelmed. Reports say that even stroke patients are now missing out on help, the ICU wards are overflowing, and the staff are prioritizing younger people because they have a better chance of survival.

Perhaps Italians hug more and spread more, perhaps it’s worse because they have an older demographic. But perhaps this is a deadlier strain than the one Japan, Hong Kong, Taiwan, Singapore and South Korea appear to be containing. The Italian strain, whatever it is, is from the Iranian strain. Every country that has imported infected passengers from Iran will likely also have the Iranian strain.

Do we really want to follow Iran and Italy?

It’s not impossible — Just stop feeding the virus fresh bodies […]

Did I say disruption was coming?

And so it begins.

Suddenly there are no more weddings for a quarter of all of Italy. No more movies, pubs, dance halls or trains to some parts of the country either. Italy is about to overtake South Korea for the number two spot on the list no country wants to lead, unless Iran beats Italy to it (which it almost certainly has already). Today 16 million Italians are not free to go about their business, or go to school.

On Feb 21st, Italy had three cases, now 366 people are dead, and 7353 are infected (at least). How life has changed in two weeks and three days. Suddenly France and Germany are about to reach the 1,000 mark. This is what exponential curves feel like.

“We are facing an emergency, a national emergency,” Prime Minister Giuseppe Conte said in announcing the government decree in a news conference after 2 a.m. — NY Times

The Frankfurt and London exchanges dropped by 8 percent in early Monday trading, while in Paris stocks were trading 4 percent lower. An index of Europe’s 50 biggest companies was down nearly 6 percent.

Oil prices lost nearly a quarter […]

Good sign: South Korea may be getting control of Coronavirus — is this the middle scenario future?

Watching South Korea — it appears to have stopped the exponential spread of Coronavirus

Heartening. At its peaks last Saturday and Tuesday, South Korea acquired 800 new infections per day. Since then, whatever it is doing, South Korea has managed to keep the new daily cases between 300-800. That may not sound like much, but in exponential terms it could have been a lot worse. Is this the future for us in the West? Perhaps with aggressive action, and local or statewide lockdowns, wealthy western nations may get outbreaks under control. Will we spend the next year with periodic major lockdowns as outbreaks occur, but manage to keep the virus from en masse spread without hospitals being overwhelmed? But can poor countries achieve this? If not, we will have to close flights to stop repeated debilitating and deadly outbreaks, while doing our best to help them. The world will become divided into nations which have this controlled, and those who don’t. This is still the pandemonium I’ve been talking about for six weeks; we could have avoided it, but it’s better than other scenarios. It’s a middle-run scenario.

We are fortunate that this is not as airborne and infectious as […]

The story of the 25 year old British man who had Coronavirus last November in Wuhan

Sobering

This 25 year old British man caught the virus in Wuhan on November 25. He must have been one of the earliest cases, and it was only recognised belatedly that he had Coronavirus. Twice, he thought he was well, only to relapse. But he does recover. I suspect this is the rarer “severe” type case in an otherwise healthy young man. Theoretically 80% of people get the easier five day version and recover. Notably, for him it’s 24 days before he feels well properly. Can this disease affect pets, which is very ususual? If so, can it affect other mammals, like livestock?

What it’s REALLY like to catch coronavirus: First British victim, 25, describes how ‘worst disease he ever had’ left him sweating, shivering, and struggling to breathe as his eyes burned and bones ached

Day 5: I’m over my cold. It really wasn’t anything.

Day 7: I spoke too soon. I feel dreadful. This is no longer just a cold. I ache all over, my head is thumping, my eyes are burning, my throat is constricted. The cold has travelled down to my chest and I have a hacking cough.

[…]

Even China stops flights with Coronavirus, but the West flys in deadly virus at 1000km/hr

The irony: while Australia blocks fruit flies, China blocks deadly viruses

How long before China bans flights from the US, UK and Australia? Count the days…

Coronavirus: China orders travellers quarantined amid outbreak

[BBC] Travellers from countries with severe coronavirus outbreaks who arrive in some parts of China will have to undergo a 14-day quarantine, state media say.

Travellers from the virus hotspots of South Korea, Japan, Iran and Italy arriving in the capital will have to be isolated, a Beijing official has said.

Shanghai and Guangdong announced similar restrictions earlier.

Authorities are worried the virus might be imported back into the country.

Although most virus deaths have been in China, Monday saw nine times more new infections outside China than in.

Shanghai said it would require new arrivals from countries with “relatively serious virus conditions” to be isolated, without naming the countries.

Chinese official statistics suggest they are getting the outbreak under control, which is hard to believe, but they are acting like they do. If most of their population is still at risk of further outbreaks, then they would care about risky incoming flights.

Meanwhile our […]

Australia joins 96 countries in banning flights from South Korea

Leading the pack, at about number 92, Australia bans flights from South Korea

South Korea added to Australia’s coronavirus travel ban list, restrictions for travellers from Italy

[ABC News] The Federal Government has expanded its coronavirus travel ban to include South Korea, and added additional precautions for travellers from Italy, amid fears about the spread of the disease.

The revised bans will be in place until Saturday, March 14 but the Government will review the situation within a week to determine if the travel restrictions need to be extended further.

Since the government was at least one week too late with the Iranian block, how will the medical experts stay ahead of the curve on other countries with no testing? Eg Indonesia? Or in this case, Europe and Dubai?

First case of Coronavirus in Western Australia that was brought in accidentally:

The woman in her 30s from Perth’s southern suburbs returned a positive result after holidaying in Iceland and the UK, and returning to WA via Dubai on Monday.

It’s still a soft loopholey quarantine:

9.5 out of 10 based on 51 ratings […]

Coronavirus War Room Time — Mortality rate 1-3%. Hello?

In a word: bum.

WHO announced their estimates of 3.4% global mortality today. All the caveats apply — it includes rubbery-figures-from-China and comes from the Useless UN and a group headed by a star apologist-for-Xi. But here’s the thing, look at the numbers outside China (see the big table below), and its a similar ballpark. Sorry to rant on about this virus.

The World Health Organization had said last week that the mortality rate of COVID-19 can differ, ranging from 0.7% to up to 4%, depending on the quality of the health-care system where it’s treated.

Don’t look now: Big Numbers Coming. Assuming 60% of people catch it before some treatment appears, a death rate of 0.7% – 4% means bad news for some furry number from 100,000 to 600,000 Australians. Double that for the UK. And 1.4m – 8m in the United States. There is a wide range of mortality rates, which may reflect that there are two kinds of mortality rates here — one where people get great ICU care, and one where hospitals are overrun and they don’t. We’ll probably pin that to the low end if we keep cases limited, we eat well, don’t […]

Governments say its safe but planes are grounded as thousands stay home

In the new pandemic era with a global social media, people are not waiting for governments to tell them travel is risky.

According to IATA’s press release, airlines are experiencing serious declines in demand:

A carrier’s 26% reduction across their entire operation in comparison to last year. A hub carrier reporting bookings to Italy down 108% as bookings collapse to zero and refunds grow. Many carriers reporting 50% no-shows across several markets. Future bookings are softening and carriers are reacting with measures such as crew being given unpaid leave, freezing of pay increases, and plans for aircraft to be grounded.

It almost gives me hope that people are smart enough to outwit their governments and protect themselves despite the incompetence at the top. But it doesn’t get the governments off the hook — it just shows how easy it would have been to stop the flights. The problem is that while the people who are afraid of getting sick are staying home, the people who are surrounded by the sick would want to fly in if they could. Therefore countries that want to stop their hospitals being overrun still need to stop those flights.

With only two cases of Covid-19 […]

China — only 20% of the economy working — the cost of inviting a virus to dinner

It’s too expensive to close borders, they say, but who can afford to import this virus?

Should we stop holidays and conferences, or most of the economy?

The monthly PMI figures show that in February about four fifths of China’s economy was shut down. Locking people in apartments and hospitals being not very productive. Strangely, all the economists watching the mainstream news and official Chinese figures did not expect this. They were shocked when the monthly PMI result was announced. The drop from 50 to 35 was more than twice as bad as the economists expected.

China PMI horror show to trigger Q1 downgrades

Umesh Desai, Asia Times

China’s Purchasing Managers’ Index in February plunged to 35.7 from 50 in January. This is the lowest reading since January 2005 when it was first released and even lower than November 2008’s figure of 38.8 during the Global Financial Crisis.

The market had expected a reading of around 46, according to a Reuters poll and this shocking data had analysts recalibrating their numbers.

The ANZ economists said this implied the utilization of only a fifth of the country’s full economic capacity, much lower than […]

Doc explains how Coronavirus kills. Jo points out obvious: Stop the Flights or Close the schools, lockdown everyone

Fun subject of the day: How Coronavirus kills

No seriously, this is matter-of-fact, youtube-at-its-best, concise, cartoony, and smart.

Think of doctors as Body-Engineers. The problem to solve today Engineer-readers — is how to keep blood supply oxygenated when lungs are highly inflamed, filling with fluid, and the delicate thin membranes of lung tissue can’t cope with the sheer forces of rapid collapse and expansion. As well, if oxygen levels drop, even unconscious patients will breathe involuntarily — out of synch with artificial ventilation machines. The sensation of suffocation creates the urge to breath faster and harder. . The great news is ICU staff are getting much better at keeping people alive when they get ARDS (Acute Respiratory Distress Syndrome) which can happen with other diseases (like Influenza). Seems, the ICUs can keep 84% alive while they wait for the inflammation to subside and the damage to heal. Though the DIY version at home probably won’t be so effective.

Not enough beds

Obviously, this explains my obsessive interest in the percentage needing ICU care and also the Ro (rate of reproduction or spread). With a shortage of ICU beds, slowing the spread makes a life-and-death difference to state the bleeding obvious. […]

Iran coronavirus crisis — the new epicentre of the world? Australia waits to get a case, then blocks flights

Amazing. Sinbad reports on the situation in Iran. He is a commenter here who speaks the language. I can’t confirm this except to say that #Coronavirusupdates Iran looks like everything he is describing. Officially there are only 388 cases and 34 deaths. But on twitter, just like China, censorship and denial and so much more. Mass graves. Corrupt officials. Mass spraying of the streets. But if there is no attempt to stop it spreading (no lockdown like China has done) this will truly run wild. Those poor people. Germany closed flights in January, related to other problems in Iran. In the last week Iraq, Oman, Turkey, Pakistan, Afghanistan, Tajikistan, UAE, Kuwait all closed borders with Iran. Australia, with lower medical standards imported a case from Iran today instead. – Jo

UPDATE: Finally, today the Australian government banned arrivals from Iran without a two week holiday stopover somewhere. That’s a lot better but should be mandatory proper quarantine. The government now has the arduous job of tracking the 40 people (or more) she may have infected and the people those victims may have infected (their families). Those 40+ people now have the stressful wait to find out if they got “lucky”. […]

Coronavirus: Now they get it. WHO says 1% mortality.

Overnight, people woke up to the real threat and markets crashed appropriately. Unless we take massive action immediately, the exponential curve is about to lift off. And if we don’t act now then massive action is coming anyway in a month, along with major disruption, pandemonium, and worse.

There are now 5,300 cases outside China. If it doubles every 5 days (as it just has) then 40 days from now 5 million people will be infected.

What does massive action look like? A bit like this:

Japan closes all its schools til early April 5 million people in Hakkaido in Northern Japan are told to stay home South Korea is preparing to test 200,000 people UK schools and offices are warned they could close for up to two months EasyJet and British Airways canceled many flights to Italy Iran has cancelled Friday Prayers in Tehran Italy has quarantined 11 towns Switzerland cancelled the Geneva Car Show UAE Canceled the rest of their bike race.

In Japan some are in uproar — they’re the ones who don’t understand how 226 infections becomes a national hospital crisis in weeks. Japan (like most nations) is theoretically only 19 […]

Reckless Greed: Our Universities driving coronavirus to Thailand and Australia. Israel has banned flights to Thailand. Are we next?

Trainwreck in process

Watch this interview. Write to your MP. Send letters to the Editor. Stop the flights at least for a few weeks.

80% of Australians think closing the border was right so why is Scott Morrison undoing that?

Join these dots. Our universities took a huge bet on Chinese students that is falling apart. They’ve creamed the profits, but taken no insurance and stand to lose billions if they can’t get students to Australia — An extraordinary 65,000 of whom got caught in China by the quarantine. In China, travel agents are marketing 14 day holiday stopovers in Thailand to students, who are then flying on to Australia to get around the ban. But this is not quarantine. Thailand is open to China, and considered so risky that Israel has already banned flights from Thailand. What’s next? Australia imports the virus, tens of thousands may die, and all so the ivory tower smug academics can make their profits, while weak politicians sell out the nations citizens — especially the senior, longest serving ones?

How long before Israel bans Australian planes? We could be one the highest value clean nations in the world, waiting out our first winter […]

Coronavirus: Australia, the island that could keep the virus out, is slowing the virus by flying it in?

Something does not add up

So the virus is on its way. Even though Australia has no known community transmission we are choosing to slow down the spread by actively importing it even though we are surrounded by a moat, and are pretty much self-sustaining. We have thousands of high risk people and the disease that’s coming is largely unknown — today there are reports a Japanese case of a woman medical experts had thought had recovered who tests positive again. Is this a biphasic disease like anthrax? That’ll be fun.

Winter is twelve weeks away for Australians, and we know the coronavirus potentially threatens to overwhelm our medical systems and could be a GDP-type hit on national economies. It’s highly infectious, and between 5 – 17% of current cases outside China require hospitalization, and probably 1 -3% will need intensive care. Inviting the virus to start spreading now will mean it will peak during winter — the worst possible time in Australia.

Australia is one of the easiest countries to protect from this scourge, yet we are obediently following policies of northern hemisphere nations in a different situation. Hmm?

As I keep saying, it’s easier to import a deadly […]