COVID COVID-19 Coronavirus Containment Efforts

[kadiot]

According to latest study, COVID 19 virus died fast under direct sunlight.

 

[wukunlin]

But since this thread is about containment efforts I think it is relevant to ponder about why China established the largest and strictest lockdown in history according to the WHO and IA, to avoid spreading the epidemics inside China but it didn't include the logical measure of avoiding the virus spreading worlwide by closing all international departures of people from China to other countries. I mean talk about the most effective and efficient containment effort to avoid a pandemia at their disposal and just "forgetting" it, as one can read in the Wuhan lockdown timeline WP article: "23 January, transport in Wuhan, Huanggang and Ezhou severely restricted, including closure of public transit, trains, airports, and major highways. Wuhan airport was not closed for departures completely; flights still left to many destinations."
I haven't seen many people commenting on this. I think that, should a new virus outbreak arise, this should be a must from the first moment, basically because once the virus is globalized, the containment effort is orders of magnitude less effective whatever the measures a country takes, and orders of magnitude more costly.

Hmmmmm, very odd indeed. They only disallowed people with fever to board airplanes. There were people who took antipyretics to bypass that though...
Just guessing and throwing out some ideas here. There could be problems with closing down an international airport. Foreigners in Hubei would not be allowed to return to their home countries, doing that can lead to a huge diplomatic mess. If foreigners were allowed to leave (possibly defeating the purpose of the containment already), how about their Chinese spouses?
Did we have enough information to know that this virus was going to cause such a mess? I'd imagine disallowing foreigners from leaving as a precautionary measure can step on a lot of feet.

 

[atyy]

I mean talk about the most effective and efficient containment effort to avoid a pandemia at their disposal and just "forgetting" it, as one can read in the Wuhan lockdown timeline WP article: "23 January, transport in Wuhan, Huanggang and Ezhou severely restricted, including closure of public transit, trains, airports, and major highways. Wuhan airport was not closed for departures completely; flights still left to many destinations."

Is this true? Foreigners generally could not leave Wuhan unless their governments made special arrangements to evacuate them. Most governments quarantined the evacuees.
https://www.airport-technology.com/news/covid-19-wuhan-airport-opens/
https://edition.cnn.com/2020/02/05/us/coronavirus-wuhan-last-chartered-flights/index.html
https://www.scientificamerican.com/article/u-s-to-quarantine-195-americans-evacuated-from-wuhan/
https://www.nippon.com/en/news/yjj2...ation-flight-returns-to-japan-from-wuhan.html
https://www.theguardian.com/world/2...et-to-leave-quarantine-after-testing-negative
https://www.theguardian.com/world/2...ted-from-wuhan-regret-coming-home-coronavirus

 

[Ygggdrasil]

Oh, and when you say "Notably, the Stanford and USC studies share many authors (e.g. the first author of the USC study, Dr Sood, is also an author on the Stanford county study, the first author of the Stanford study is an author on the USC study, and the two studies have the same senior author) , so it is possible that they would share similar methodological flaws.", it contradicts the BuzzFeed article you linked to, which says both teams share a member.

Here is the author list from the Stanford study and the author list from an unofficial, leaked version of the USC study (available here)

Here's a good article from STAT news on some of the seroprevalence studies coming out that discusses some limitations: https://www.statnews.com/2020/04/24...to-be-released-heres-how-to-kick-their-tires/

Some are reporting much higher prevalence rates found in the two CA studies, e.g. 21% in New York City and 14% in New York State though we might expect these regions to have a higher prevalence because there were many more deaths there. The piece cites a study in Geneva numbers that gives a prevalence (5.5%) in the same ballpark as the CA studies. Given the lack of testing in the US and what we know about asymptomatic cases, it certainly is believable that confirmed cases could be an order of magnitude lower than actual infections. However, knowing the exact magnitude of this gap is important for determining policy, and the article does note uncertainty to these studies (I think this is the main criticism from statisticians of the CA studies, that the calculations were not properly accounting for uncertainties from the false positive and false negative rates), for example, writing:

The release from the state doesn’t disclose the sensitivity of the test used, but it does note the specificity is between 93% and 100%, a “huge range,” Ashish Jha, head of Harvard’s Global Health Institute, noted on Twitter. If the test performed at the low end of that range, New York’s infection rate would be closer to 7% — half the figure Cuomo announced — and nearly one out of every two positives would have been a false positive, Jha said.

The false positives are a major concern when using the test to tell individuals whether they are immune or not, but these should be able to be corrected for in population studies as long as the samples are actually representative or useful, which seems to be true for some studies (e.g. the New York study that sampled people at grocery stores) but may not be true for others (e.g. Stanford recruiting people from Facebook).

Again, no single study will be perfect or definitive. I've been studying biology long enough to learn not stake anything on just a single study. If more studies come out corroborating the estimates of these initial studies, we can begin to feel more solid about the results and use these to guide policy going forward.

 

[atyy]

And sometimes the false positivity rate of an antibody test that was working well can change. In Singapore, we had Dengue and COVID-19 going around at the same time. An expert was interviewed on the radio, and she was asked how likely it was to get both diseases at the same time, and she said that both are rare, so it'd be unlikely. Amazingly, a few days later, it was reported that someone did have both diseases. It was said the person was first diagnosed to have Dengue, then later diagnosed for COVID. It was also announced that the Dengue diagnosis was not incorrect, and the person in fact had both diseases.

The Dengue diagnosis was based on an antibody test, which had been working well for years. But this turned out to be wrong in the presence of COVID-19, which gave false positives on the Dengue antibody test. So the initial Dengue diagnosis was wrong, and the person had COVID-19 without Dengue. But this took quite a bit of figuring out.

Covert COVID-19 and false-positive dengue serology in Singapore
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30158-4/fulltext

 

[Tendex]

Is this true? Foreigners generally could not leave Wuhan unless their governments made special arrangements to evacuate them. Most governments quarantined the evacuees.

Certainly from the 23rd of January flights from Wuhan were restricted but it is difficult to know how strictly, and what exceptions were made besides the evacuation cases you mention just going by the Wikipedia quote. The regular flights to Europe I mentioned in my first post likely stopped the 22nd so most of the international spread from Wuhan directly to other countries was until then rather than during the rest of January and February, but I do know that regular flights from other areas of China where the virus might have already spread before the lockdown were still flying to most countries in Europe after the 23rd of January.

 

[DennisN]

A new WHO initiative:

World leaders launch plan to speed COVID-19 drugs, vaccine; U.S. stays away (Reuters, April 24, 2020)

GENEVA/ZURICH (Reuters) - World leaders pledged on Friday to accelerate work on tests, drugs and vaccines against COVID-19 and to share them around the globe, but the United States did not take part in the launch of the World Health Organization (WHO) initiative.

French President Emmanuel Macron, German Chancellor Angela Merkel and South African President Cyril Ramaphosa were among those who joined a video conference to launch what the WHO billed as a “landmark collaboration” to fight the pandemic.

The aim is to speed development of safe and effective drugs, tests and vaccines to prevent, diagnose and treat COVID-19, the lung disease caused be the novel Coronavirus - and ensure equal access to treatments for rich and poor.

[...]

Leaders from Asia, the Middle East and the Americas also joined the videoconference, but several big countries did not participate, including China, India and Russia.

[...]

Macron urged all G7 and G20 countries to get behind the initiative, adding: “And I hope we’ll manage to reconcile around this joint initiative both China and the U.S., because this is about saying ‘the fight against COVID-19 is a common human good and there should be no division in order to win this battle’.”

Merkel said: “This concerns a global public good, to produce this vaccine and to distribute it in all parts of the world.”

Ramaphosa, chairman of the African Union, warned that the continent - with its generally poor standards of healthcare - was “extremely vulnerable to the ravages of this virus and is in need of support”.

 

[bhobba]

I have been doing a lot of posts in our local paper (digital version). Many are correctly pointing out the death rate is likely now about .1% and on that basis say the lockdown needs to be lifted. I point out that is true, and is similar to the flu death rate. It's not the death rate that is the worry - its we as yet have no vaccine and its R0 is 2.3 (maybe as high as 3) compared to the Flu's 1.3 - it really does explode if we do not try to lower that R0. A vaccine will of course do that, and if it's like the Flu vaccine, which is not 100% effective, still lowers the death rate of those that are unlucky to get it. Meanwhile we need to lower the R0 by other means such as even more testing (Australia pretty much leads the world in that - and is going to increase it even further - our current R0 is about .5 - it will die out) and simple measures like hand washing, basic social distancing etc. If it gets out of control potentially 24,000 Australians will die. Sure I think our level 3 lockdown can be significantly reduced, but we still must keep testing and tracing, plus the other sensible measures until we get the vaccine. Others however want it totally lifted which IMHO is 'madness'. Oh and they are going bonkers about the tracing app the government wants people to use due to privacy. I just don't get it - they already use Google maps etc.

Thanks
Bill

 

[bhobba]

I just read Trump's latest about not participating in the WHO world vaccine initiative:
https://thehill.com/changing-americ...18-world-leaders-kick-off-initiative-to-fight

Good thing we have Bill Gates:
https://www.businessinsider.com.au/...ifferent-vaccines-to-fight-coronavirus-2020-4

The WHO may have issues - but they still have a vital role.

Thanks
Bill

 

[DennisN]

A quite long article on BBC today about Sweden's strategy:

Coronavirus: Has Sweden got its science right? (BBC, 25 april 2020)

It includes differing opinions and also touches on quite many things that I have previously posted about in this thread. To me it seems one of the main reasons for the strategy has been to enable a long period of social distancing:

In addition, the Swedish Public Health Agency pushed the idea early on that a large proportion of cases were likely to be mild.

But it denied its strategy was based on the overall goal of herd immunity.

A core aim was to introduce less stringent social distancing measures that could be maintained over a long period time. Schools for under-16s have remained open to enable parents to keep working in key areas.

(my bolding)

Sweden, with a population of 10 million, remains amongst the top 20 in the world when it comes to the total number of cases, even though it mostly only tests those with severe symptoms. More widespread checks on key workers are now being introduced.

It has higher death rates in relation to its population size than anywhere else in Scandinavia.

Unlike in some countries, Sweden's statistics do include elderly care home residents, who account for around 50% of all deaths. Dr Tegnell admits that is a major concern.

I just quoted two parts of the article regarding the reasons for the strategy and the difficulty in comparing countries directly due to various differences in counting cases and deaths. Please read the entire article for more details.

As I've said before, I think time will tell, and be the ultimate judge how well this has worked out. It seems the government and the health agency in Sweden have currently got strong approval and strong support from the public.

Personally I expect there will be very tough political consequences for the government in the future if it turns out that our strategy and result was considerably worse than the other scandinavian countries.

EDIT 1:

Another new article by The Guardian on the topic, and about different lockdown exit plans in Europe:
Sweden queries basis of lockdowns as Germany keeps its guard up (The Guardian, 24 april 2020)

EDIT 2:

A new article by The Guardian about the comparison of death rates in Europe:
Is comparing Covid-19 death rates across Europe helpful? (The Guardian, 24 april 2020)

Belgium appears hardest hit on paper, but not all countries count non-hospital fatalities

[...]

The comparison game has been especially marked in Belgium, which on paper has the unhappy title of highest number of Covid-19 deaths per capita in Europe. Belgium – population 11.5 million – has counted at least 6,675 deaths since the start of the outbreak, more than Germany, which is nearly eight times more populous.

But such comparisons can be misleading. Unlike the UK, Italy or Spain, Belgium counts all Coronavirus deaths outside hospitals in its daily statistics: deaths in care homes account for 53% of the total. Belgium’s official toll also includes people suspected of having died of coronavirus, without a confirmed diagnosis. Nearly all deaths in care homes (94%) are suspected Covid-19 cases, rather than confirmed – an approach that has led some to complain Belgium is overestimating the number of fatalities.

[...]

Variations in counting of Covid-19 deaths, different testing strategies and lockdown policies make international comparisons a minefield. “A comparison between [EU] member states is difficult and should be done with extreme caution,” said a spokesperson at the European Centre for Disease Prevention and Control, the EU agency to tackle infectious diseases.

The agency is urging governments to count everyone who dies of coronavirus, irrespective of whether they die in hospital, a care home or private residence, as well as recording deaths where Covid-19 was “the main or contributing cause”.

EDIT 3:

Sweden to shut bars and restaurants that ignore Coronavirus restrictions (Reuters, 24 april 2020)

STOCKHOLM (Reuters) - Sweden warned on Friday it would shut restaurants and bars in the capital that did not comply with guidelines aimed at preventing the spread of the novel coronavirus, amid signs Stockholm residents were beginning to ignore the rules.

[...]

“As the sun begins to shine, we are beginning to see some worrying reports of open-air restaurants full of customers, of places packed with people, and we have to take this seriously,” Damberg told a news conference.

“I don’t want to see any full open-air restaurants in Stockholm or anywhere else. Otherwise, businesses will be closed.”

He said this would apply to bars and restaurant around the country, not just Stockholm.

[...]

 

[DennisN]

Worrying news reports about Brazil :

• Brazilian city health systems on verge of collapse (The Guardian live update, 25 april 2020)
• Brazil threatens to become COVID-19 hotspot with health system on verge of collapse (ABC News, 25 april 2020)

Cases of the new Coronavirus are overwhelming hospitals, morgues and cemeteries across Brazil as Latin Americas largest nation veers closer to becoming one of the world’s pandemic hot spots.
[...]

[...]
Medical officials in Rio de Janeiro and at least four other major cities have warned that their hospital systems are on the verge of collapse, or already too overwhelmed to take any more patients.
[...]

 

[mfb]

The claim that Belgium overestimates its deaths is very questionable, given that their excess deaths are twice the COVID-19 deaths. What is the cause of death of all these other people? Here is the article again.
I can't tell how reliable the baseline curves are (here is a comment by V50), but the increase is clearly much larger than the official COVID-19 deaths.

I just read Trump's latest about not participating in the WHO world vaccine initiative:
https://thehill.com/changing-americ...18-world-leaders-kick-off-initiative-to-fight

Meanwhile he was suggesting bleach injections...

After the Wuhan lockdown started many countries were interested in flying their people out. What options did China have? Say no, keeping foreigners in the country against their will? As far as I understand these people were quarantined on arrival. But it was too late already.

 

[Vanadium 50]

I have been doing a lot of posts in our local paper

Perhaps you could use that position to initiate a discussion on goals. Is the goal

1. To flatten the curve?
2. To extinguish the disease in humanity now?
3. To save every life, no matter the cost?

I don't think the goals have been articulated clearly. As late as yesterday, I was seeing PSA's saying that the goal was flattening, but as Russ keeps reminding me, that's all changed and the goal is actually extinction.

It seems to be that the cost a society is willing to pay depends on the goals' benefits and probability of success, so a discussion of that would be beneficial in a democratic society.

 

[bhobba]

I don't think the goals have been articulated clearly.

That one is being discussed endlessly. Let's just say it's far from clear what the goal is, except Australia is in a good position to decide it's next step. Our lockdown must be relaxed slowly and carefully, that's all that nearly everyone (not all though) agrees on. I am a believer in the tracing app the government wants to deploy, but there is fierce debate about it.

Thanks
Bill

 

[bhobba]

Meanwhile he was suggesting bleach injections...

I gave up trying to figure him out long ago. So has a very seasoned and successful ex politician here in Australia, called Graham Richardson. He just notes, somehow, and even he does not know how, it seems to work for him. He confounds even the experts.

Thanks
Bill

 

[mfb]

Perhaps you could use that position to initiate a discussion on goals. Is the goal

1. To flatten the curve?
2. To extinguish the disease in humanity now?
3. To save every life, no matter the cost?

A couple of island countries are on a good way to local extinction, I expect them to aim at that if they don't depend too much on tourism.
Australia is down to 10-20 new cases per day after 6700 total cases.
New Zealand is down to 5 new cases per day after 1500 total cases.
Iceland found zero new cases on Thursday and a single new case on Friday (1800 total cases). Overall they tested 13% of their population now.
Malta is down to 1-2 new cases per day (450 total cases).
Not a country, but Hawaii's new cases are very low as well (600 total cases). They might depend too much on tourism to keep that up, however.

Keeping the case count low is an option you didn't list.

Interesting things found on the way: Puerto Rico reduced its total number of cases (double counting error).

 

[StevieTNZ]

New Zealand is down to 5 new cases per day after 1500 total cases.

Today it is reported we have nine new cases, although that is pretty good.

 

[mfb]

I took the average over the last days. The exact range doesn't matter: 39 cases in 7 days, 30 cases in 6 days, 25 in 5 days, 22 cases in 4 days are all consistent with "5 per day". In two weeks this might be 0-1 cases per day if the trend continues, and maybe 0 per day in three weeks? Iceland could reach that point in 1-2 weeks already.

 

[StevieTNZ]

In two weeks this might be 0-1 cases per day if the trend continues, and maybe 0 per day in three weeks?

I hope so! I'm sick of this lockdown.

 

[bhobba]

Today it is reported we have nine new cases, although that is pretty good.

It does vary in both Aus and NZ - the main thing is to keep R0 less than 1. I think NZ is like Aus at about .5 - at that level it will go away - eventually. It is now being considered lifting travel restrictions between Australia and NZ and sporting competitions returning eg cricket. But that's a bit down the track.

Queensland is now lifting restrictions, but I will do a separate post about that.

Thanks
Bill

 

[bhobba]

The lifting of restrictions is now starting. Queenslanders will be allowed to go on picnics, bushwalks, go shopping more freely and take a leisurely drive or go boating from next weekend. Three new cases of Coronavirus were recorded overnight, taking the state’s total to 1030 cases. There have been 98,000 tests conducted in Queensland alone and it's going to increase markedly using the new tracing app. If enough people do not take it up then restrictions will be greater. I think we are eventually heading towards the Taiwan model.

What do I think is the objective? I do not think anyone really knows, but my objective would be to slowly lift restrictions ensuring R0 remains reasonably under 1 - say not greater than .8. That way it will smoulder on at a very low level or even be eradicated until the vaccine comes. It's what I would do.

Thanks
Bill

 

[bhobba]

Here is some early, and perhaps surprising research, due to economic, hygiene and behavioural changes, on what life in Australia will be like when the virus is well under control.

A push towards suburban living with big backyards instead of compact high density living.

Overconsumption “will feel obnoxious” and loyalty will return as employees seek financial security.

Workers who felt trapped in insecure jobs will be desperate and motivated to upskill.

Restaurants buffets are likely to be scrapped, as will plastic menus, communal cutlery and the ubiquitous pub food “buzzer”, according to the hospitality industry. There goes my trips to Sizzler's, at least as I know it.

Cinemas have revealed moviegoers will sit in a chequered pattern – instead of side-by-side – to enforce social distancing when they first reopen.

Public hugs and handshakes are predicted to be socially unacceptable for at least three years.

Homeowners will be more likely to have adult children and elderly parents living with them admit the economic downturn, leaving houses packed to the rafters.

Gardening, boardgames, baking and DIY will increase and there will be no more running up the credit cards to buy “keeping up with Joneses” superficial items.

Children will thrive as they enjoy more time with their parents and kids are learning resilience — a vital life skill psychologists say has been missing in recent times.

One so called 'social expert' said many of us will look back on this pandemic and realize that it has changed our lives for the better. The new normal will not look anything like our old normal but in many ways that’s a good thing,

Interesting to see exactly what does eventuate.

Thanks
Bill

 

[Vanadium 50]

Here is some early, and perhaps surprising research, due to economic, hygiene and behavioural changes, on what life in Australia will be like when the virus is well under control.

I suspect any sort of societal changes will depend more on the response to the next pandemic than this one. Shutting down society for 3 months every century is a different thing than doing it every decade. (The last WHO-declared pandemic was H1N1 in 2009-2010)

 

[WWGD]

NYT suggesting there is an undercount by comp

LA Times reports, "Autopsies reveal first confirmed U.S. Coronavirus deaths occurred in Bay Area in February," which is repeated by other media, e.g., Yahoo, Washington Post, NBC, . . . .Santa Clara County press release - https://www.sccgov.org/sites/covid19/Pages/press-release-04-21-20-early.aspx The victims were tested posthumously, and the results returned 75 days and 64 days, respectively, after death! Date of autopsy (specimen collection) is not mentioned.

Clearly early detection (and testing) is necessary.

"The County of Santa Clara is reporting a total of 1,922 cases and 83 deaths." on April 20.
https://www.sccgov.org/sites/covid19/Pages/press-release-04-20-2020-dashboard-cases-reporting-process-update.aspx

"Santa Clara County has so far reported 88 coronavirus-related deaths, including five new deaths reported Tuesday. The county now has 1,948 confirmed cases."
https://www.mercurynews.com/2020/04...s-in-bay-area-occurred-in-february-not-march/

Also, I read a brief headline that the government of Wuhan had revised their number up by the end of last week.

Belgian prime minister and others are claiming Belgium's poor performance is the result of a liberal attribution to Covid of several deaths. It seems he's being asked to tighten the rules used to attribute a death to Covid19.

 

[Ygggdrasil]

Belgian prime minister and others are claiming Belgium's poor performance is the result of a liberal attribution to Covid of several deaths. It seems he's being asked to tighten the rules used to attribute a death to Covid19.

As mentioned previously in this thread by @mfb, analysis of the number of excess deaths in Belgium suggests that deaths are being undercounted to a similar extent as in other regions.

 

[mfb]

One caveat: That analysis ends April 5. Maybe things changed in the three weeks since then. It would need a pretty strong change, however, and actual deaths peaking before hospitalizations - an odd behavior.

 

[Astronuc]

It does vary in both Aus and NZ - the main thing is to keep R0 less than 1. I think NZ is like Aus at about .5 - at that level it will go away - eventually. It is now being considered lifting travel restrictions between Australia and NZ and sporting competitions returning eg cricket. But that's a bit down the track.

Queensland is now lifting restrictions, but I will do a separate post about that.

Thanks
Bill

According to a NY Times article, Australia and New Zealand are aiming to eliminate the virus.
https://www.nytimes.com/2020/04/24/world/australia/new-zealand-coronavirus.html?
The two countries, led by ideological opposites, are converging on an extraordinary goal: eliminating the virus. Their nonpolitical approach is restoring trust in democracy.

Both nations are now reporting just a handful of new infections each day, down from hundreds in March, and they are converging toward an extraordinary goal: completely eliminating the virus from their island nations.

it may end up being a mirage or temporary triumph in Australia and New Zealand. Elimination means reducing infections to zero in a geographic area with continued measures to control any new outbreak, and that may require extended travel bans. Other places that seemed to be keeping the virus at bay, such as China, Hong Kong and Singapore, have seen it rebound, usually with infections imported from overseas.

 

[Vanadium 50]

A couple of island countries are on a good way to local extinction, I expect them to aim at that if they don't depend too much on tourism.

Kosrae, a state of the FSM, has as far as I know zero cases. However, their connection to the rest of the world is primarily by air, and there haven't been flights in or out for about a month. It looks like to get people or cargo on or off takes a 350 mile boat trip to Pohnpei and a charter to or from Port Morseby. (Which has Covid cases)

 

[Vanadium 50]

Atty, what are you skeptical of? That Kosrae has zero cases?

 

[Astronuc]

BBC reports: Coronavirus: Australians download COVIDSafe contact tracing app
https://www.bbc.com/news/world-australia-52433340

More than a million Australians have downloaded a Coronavirus contact tracing app within hours of it being released by the government.

The COVIDSafe smartphone app uses a Bluetooth wireless signal to exchange a "digital handshake" with another user when they come within 1.5m (4.9ft).

The app then logs this contact and encrypts it.

Are folks ready for this?And in the UK, the 'good outcome' that never was
https://www.bbc.com/news/stories-52419218