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Ancient technology wins: Not only are quarantine and isolation measures useful, they’re the best tools we have.
Some people don’t seem to realize that the only reason the daily growth of infections is slowing anywhere, is thanks to drastic quarantine measures or changes in human behaviour. We can see this in graphs from Italy, Spain, Norway, South Korea, Switzerland, Germany, and China, but not in Sweden or Brazil where there’s not much quarantine and not much slowing of growth curves either. In all of the former, the big meaningful actions were followed around 12 days later by an obvious slow down.
Willis Eschenbach, for example, wondered If Lockdowns Worked, but counted subdivisions of any quarantine type action as a measure of the severity when it’s more a measure of the wordsmithiness or indecision of leaders.
To see if major action matters, it’s better to look at the dates that borders, schools and shops were closed. The graphs of daily new cases below show that around 12 days later in so many countries, the growth in cases slows too. The delay is due to both the incubation period of Covid-19 and testing. By the time a lockdown is declared (or […]
NEWS: A group say they have developed five antibodies from the old SARS antibody stocks that with tweaking can now bind well to the SARS-2 novel coronavirus.
An antibody is a long string of molecules that binds only to the exact target (we hope). Wikimedia Bioconjugator
If they get through all the testing phases and ramp up production, in theory, these could be ready for mass use in September (but everything would need to go right). They could be injected into patients and within 20 minutes these antibodies would bind to the virus and stop it entering cells. The protection might last 8 – 10 weeks before someone would need another dose.
This could be a gamechanger, but beware before anyone gets too excited, this is very early days — “protoplasm” days. There are a lot of steps to rush through.This group have searched and evolved the protein with their supercomputer which has a huge library of antibodies. They claim to be certain it binds to the virus — and to exactly the right part of the virus, but they haven’t actually done that yet — they’ll send the antibody to a military secure lab to do that. Then […]
It’s a big natural experiment
Swedish people are still going to schools, restaurants and gyms. Even the cinemas are running. Apparently Sweden is taking the punt that there are many asymptomatic infections out there, despite having no data, and not doing any structured screening to get some either. They are also betting that immunity to this form of coronavirus will last a lot longer than the coronavirus colds where herd immunity is irrelevant one year later.
All recommendations are made by the Public Health Agency. Apparently they are learning from the 1918 influenza spread, and thus successfully “fighting the last war”. Swedish doctors are reportedly not happy about it. Probably because their idea of being doctors is not where you choose which 60 year old mother lives and which one dies, or where the doctors work round the clock and many of them get sick themselves, and some die. Gruelling is not the word.
Gatherings of 50+ people are banned, and the 70+ age group have been told to avoid social contact.
I predict that as the ICU units overflow, or even before, they will move to serious measures like the rest of the world as the inhumanity of the […]
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.
UPDATE: Some readers ask whether one new study is even worth reporting, accusing me of “scare tactics”. I’ve been reading medical papers now for over 20 years, so forgive me if I found the results here so banal that I didn’t mention that this result is barely new, and very well […]
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).
Source: Australian government
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
Italy and South Korean demographics
Fortune
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 […]
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 […]
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. […]
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 […]
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 […]
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 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 […]
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 […]
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 […]
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 […]
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.
h/t Analitik
A Medical Worker Describes Terrifying Lung Failure From COVID-19 — Even in His Young Patients
by Lixzzie Presser, ProPublica
“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 […]
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 […]
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 […]
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?
https://www.livescience.com/small-italian-town-cuts-coronavirus-cases-testing.html
Italian village reports no new infections for days after blanket testing
Zoe Tidman, Independent
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”.
h/t Bill H
In one Italian town, we showed mass testing could eradicate the coronavirus
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 […]
Australian Medical Association WA President Andrew Miller said Western Australia was headed for a situation like Italy and are 8 – 10 days behind Sydney. Read his scathing comments below.
The tally in Australia is now about 900, the same as Italy had on Feb 28th, just three weeks ago. Now Italy has 41,000 cases and 3,405 people have died. Their population is three times larger than Australia and slightly older, it’s colder and packed in closer. At a guess, with the present SlowMo/SlowState response, maybe only 10-20,000 Australians will catch this in the next three weeks? “Great”.
UPDATE: Hospitals in Italy are no longer intubating anyone over 60 years old. h/t nezy
Italian politicians could have been better prepared, but there’s no excuse for the rest of the world now.
Coronavirus crisis: Australian Medical Association WA President Andrew Miller slams WA Government response to COVID-19 pandemic
John Flint The West Australian
[Miller said:] …“And we’re not doing any of the things that the countries that are being successful are doing like Hong Kong.
“They are using fever monitoring in public, they lock people down away from their families if they’re positive, whereas here we send […]
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