--Another scary aspect: COVID-19 can cause blood clots, with horrible results. Broadway actor Nick Cordero went to the hospital with COVID; was put in a medically-induced coma; developed blood clots; and one of his legs was amputated. He's evidently still in the coma...and presumably doesn't know about his leg.
--More mentions in the news of kids getting very ill with COVID, and some dying. Like a little girl whose parents are first responders. That must be especially awful for them, if they feel they brought the virus home.
--A good thing: Two gangs in S. Africa have called a truce over the pandemic, and are delivering food to those in need!
I thought that relaxing a lockdown works when followed up by testing and tracing. Also, by quarantine for new cases. Otherwise, it all starts up again. I would say that the UK is not equipped for this.
I guess that, in theory, you can manage a small relaxation in restrictions if you consider your health service capable of dealing with the resulting increase in cases.
But, yes ideally you want to maintain self-isolation for people with any symptoms coupled with testing of anyone with symptoms and tracing and testing of anyone they've had contact with in the 7 days before symptoms developed. That needs two things: one a substantial capacity for testing, ideally with absolute minimum delay between test and result; two sufficient ongoing social distancing that you can trace people (so, family and immediate work colleagues ... but, you won't be able to trace a packed train carriage of people).
France plans only to test people who develop symptoms. The EU smartphone tracking project doesn't look very robust (not least because the Bluetooth technology it uses is not much good at calculating distances between people) and cannot be imposed because of civil liberties legislation; if it's opt-in, places like Singapore suggest it won't be very effective.
Interesting that Singapore, much vaunted as having beaten back the virus, has reimposed the lockdown, after new cases were found, in migrants' dormitories.
Also of interest that the WHO is arguing that the origin of the virus probably is in bats, not Chinese labs. This won't stop the China hate campaign. Also, they argue for an intermediate animal host. Bats - X - humans.
Having understood from a family member who lives in Taiwan, there are some procedures that allow riding out a pandemic with safety and do not require lockdown. Note that Taiwan is a very densely populated country. Density is not the key. It's behaviour and being obedient.
First, you have to give up personal freedom with your movements tracked and accounted for. Second you must submit to testing every time you are asked. Third, you do all the necessary behaviours as instructed re masks, where to walk, where to go.
Masks: health cards account for how many you have. You must have the right number each week, and they know in advance where and what you'll be doing.
Cell phone or internet check-in before going any where. Temperature and health questions answered. Includes children. Includes every time you leave home. You may not deviate from the permitted locations when you leave home.
Schools are open with plexiglass barriers. Food serving establishments are generally on the street, barriers. All businesses and offices are open, barriers. Everything that can be touched by multiple people is constantly cleaned. Everyone must behave properly or you'll be punished.
They've about the same number of cases as my province in Canada with 30 times the population.
Perhaps culture comes into it, but that sounds more restrictive than what we have here.
Having understood from a family member who lives in Taiwan, there are some procedures that allow riding out a pandemic with safety and do not require lockdown. Note that Taiwan is a very densely populated country. Density is not the key. It's behaviour and being obedient.
First, you have to give up personal freedom with your movements tracked and accounted for. Second you must submit to testing every time you are asked. Third, you do all the necessary behaviours as instructed re masks, where to walk, where to go.
Masks: health cards account for how many you have. You must have the right number each week, and they know in advance where and what you'll be doing.
Cell phone or internet check-in before going any where. Temperature and health questions answered. Includes children. Includes every time you leave home. You may not deviate from the permitted locations when you leave home.
Schools are open with plexiglass barriers. Food serving establishments are generally on the street, barriers. All businesses and offices are open, barriers. Everything that can be touched by multiple people is constantly cleaned. Everyone must behave properly or you'll be punished.
They've about the same number of cases as my province in Canada with 30 times the population.
Perhaps culture comes into it, but that sounds more restrictive than what we have here.
Depends on where "here" is. For example, the U.K. was already regarded by many as a surveillance state. I'm not sure there's as huge a difference as many claim.
Having understood from a family member who lives in Taiwan, there are some procedures that allow riding out a pandemic with safety and do not require lockdown. Note that Taiwan is a very densely populated country. Density is not the key. It's behaviour and being obedient.
First, you have to give up personal freedom with your movements tracked and accounted for. Second you must submit to testing every time you are asked. Third, you do all the necessary behaviours as instructed re masks, where to walk, where to go.
Masks: health cards account for how many you have. You must have the right number each week, and they know in advance where and what you'll be doing.
Cell phone or internet check-in before going any where. Temperature and health questions answered. Includes children. Includes every time you leave home. You may not deviate from the permitted locations when you leave home.
Schools are open with plexiglass barriers. Food serving establishments are generally on the street, barriers. All businesses and offices are open, barriers. Everything that can be touched by multiple people is constantly cleaned. Everyone must behave properly or you'll be punished.
They've about the same number of cases as my province in Canada with 30 times the population.
Perhaps culture comes into it, but that sounds more restrictive than what we have here.
My thoughts exactly.
It's going to depend on who you are. For some, the thought of getting authorisation to go somewhere looks extremely restrictive, but that's also balanced against that meaning you have permission for your children to attend school and for you to go into your place of work ... which could seem a lot more liberating than spending all your days at home trying to simultaneously work from home and home school children.
A vaccine might be a year or so away. Before we have a vaccine, some fraction of people who catch COVID-19 will die, and more will be out of action sick in bed for a significant time.
Do you want to minimize the number of deaths? That implies continued lockdown, with only small relaxations for low-risk activities, with screening, contact tracing etc.
Or do you just want to keep the number of seriously sick people to a level that your healthcare system can cope with? In that case, once the prevalence of the virus is low, you can relax the lockdown a bit without testing - just allow low-risk activities, people maintaining distance etc., and use the number of sick and/or dead people to tell you whether you opened up too much or not.
Testing and contact-tracing is good, because it lets you have fewer restrictions on normal life in general, but achieve the same level of infections than a tighter lockdown with no testing or tracing.
Or do you just want to keep the number of seriously sick people to a level that your healthcare system can cope with? In that case, once the prevalence of the virus is low, you can relax the lockdown a bit without testing - just allow low-risk activities, people maintaining distance etc., and use the number of sick and/or dead people to tell you whether you opened up too much or not.
Does this actually work? I ask because there don't seem to be any examples of countries that have gotten COVID-19 under control without social distancing, testing, and contact tracing. Everyone who has tried to go without testing and contact tracing has seen a resurgence of (or no diminishment of) the virus.
Having understood from a family member who lives in Taiwan, there are some procedures that allow riding out a pandemic with safety and do not require lockdown. Note that Taiwan is a very densely populated country. Density is not the key. It's behaviour and being obedient.
First, you have to give up personal freedom with your movements tracked and accounted for. Second you must submit to testing every time you are asked. Third, you do all the necessary behaviours as instructed re masks, where to walk, where to go.
Masks: health cards account for how many you have. You must have the right number each week, and they know in advance where and what you'll be doing.
Cell phone or internet check-in before going any where. Temperature and health questions answered. Includes children. Includes every time you leave home. You may not deviate from the permitted locations when you leave home.
Schools are open with plexiglass barriers. Food serving establishments are generally on the street, barriers. All businesses and offices are open, barriers. Everything that can be touched by multiple people is constantly cleaned. Everyone must behave properly or you'll be punished.
They've about the same number of cases as my province in Canada with 30 times the population.
Perhaps culture comes into it, but that sounds more restrictive than what we have here.
Depends on where "here" is. For example, the U.K. was already regarded by many as a surveillance state. I'm not sure there's as huge a difference as many claim.
Freedom is as much an illusion as reality. Everyone having to wear clothing is not seen as the same as everyone having to wear the same clothing, despite most people choosing very similar things anyway.
If you are told you must do what you were going to do anyway, doing it feels oppressive.
Or do you just want to keep the number of seriously sick people to a level that your healthcare system can cope with? In that case, once the prevalence of the virus is low, you can relax the lockdown a bit without testing - just allow low-risk activities, people maintaining distance etc., and use the number of sick and/or dead people to tell you whether you opened up too much or not.
Does this actually work? I ask because there don't seem to be any examples of countries that have gotten COVID-19 under control without social distancing, testing, and contact tracing. Everyone who has tried to go without testing and contact tracing has seen a resurgence of (or no diminishment of) the virus.
I don't think anyone has tried it. If you get it wrong you end up killing thousands more of your citizens, which should be enough for any sensible government think three times before even contemplating it. It may well be the route the UK government takes, and I expect that Trump doesn't see any problem with that either ...
Or do you just want to keep the number of seriously sick people to a level that your healthcare system can cope with? In that case, once the prevalence of the virus is low, you can relax the lockdown a bit without testing - just allow low-risk activities, people maintaining distance etc., and use the number of sick and/or dead people to tell you whether you opened up too much or not.
Does this actually work? I ask because there don't seem to be any examples of countries that have gotten COVID-19 under control without social distancing, testing, and contact tracing. Everyone who has tried to go without testing and contact tracing has seen a resurgence of (or no diminishment of) the virus.
You can go with one of the optimists, e.g., Heneghan, who seem to be saying that the virus may burn out. However, the nature of exponential growth means that if you get it wrong, thousands could die. Maybe Trump will gamble.
You can go with one of the optimists, e.g., Heneghan, who seem to be saying that the virus may burn out. However, the nature of exponential growth means that if you get it wrong, thousands could die. Maybe Trump will gamble.
He already did. I wouldn't put it past him to double down, though.
Regards the prevalence of the disease among a general population. Turns out sample testing in Los Angeles county shows that the number of people that have likely been infected with Covid 19 is 55 times more than the reported cases of in the county. In other words, while there are only 15,000 reported cases, there can be up to 441,000 people that have had it.
They're doing about 10k tests per million population where I live. But they don't bother testing everyone in a family. Why would they?
Testing happens fast these days. 10 minutes for call back and scheduling which happens within a couple of hours..
They're talking lock down relaxation in a week if our current 1 or 2 diagnosed cases per day is consistent. Provincial boundary patrols and road block checks are being set up for travellers from neighbouring provinces. We appear to be one of the lucky places so far. Even if spring isn't really here. 2 inches of snow overnight.
You can go with one of the optimists, e.g., Heneghan, who seem to be saying that the virus may burn out. However, the nature of exponential growth means that if you get it wrong, thousands could die. Maybe Trump will gamble.
Plus you are reacting at least 2/3 weeks behind. Even if 10,000 is an acceptable loss*, at that point the brakes need to be full on on at around 500.
*To be fair you have to offset it against other risks, but also that's Mr Jones, Mrs Smith ..... ..... ..... ..... .....
(Although in France it seems that if you're hospitalised, you have a much higher chance of dying than in comparable countries, which I suspect means that cases are being detected and treated only once complications have set in).
An article that includes a discussion about the efficacy of pulse oximeters in relation to that:
There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.
More deaths, no benefit from malaria drug in VA virus study
A malaria drug widely touted by President Donald Trump for treating the new coronavirus showed no benefit in a large analysis of its use in U.S. veterans hospitals. There were more deaths among those given hydroxychloroquine versus standard care, researchers reported.
The nationwide study was not a rigorous experiment. But with 368 patients, it’s the largest look so far of hydroxychloroquine with or without the antibiotic azithromycin for COVID-19, which has killed more than 171,000 people as of Tuesday.
The study is available online [PDF] for those who want to wade through the details. As the AP article notes the results aren't definitive but they are discouraging.
Annabel, one of the people behind the charitable provision of scrubs, Scrub Hub Ltd, put out an irritated statement today link to Instagram story. ScrubHub isn't the only organisation trying to co-ordinate scrub provision, so are For the Love of Scrubs
Hello I’m Annabel and I’m a co founder of Scrub Hub, we are a network of volunteers running production lines sewing scrubs for doctors, as like other equipment and PPE there is a severe shortage during this time.
It started when we had a plea from a local doctor who needed scrubs and couldn’t buy them, we knew we had the skills to help and haven’t looked back, setting up our own hub and helping hundred of others do the same. It’s important because the inaction of the government in the run up to this crisis and the austerity starved nhs in the last decade has meant sufficient supplies of such things were non existent. The NHS relied heavily on importing which become impossible and the government were slow to instruct UK businesses to fill the gap, so our grassroots movement in local communities became absolutely necessary”
FT trailing a story from tomorrow that the death toll in the UK from coronavirus could be anything up to double the current figure.
How do you access stories from tomorrow? Can you get the Lotto numbers?
Because tomorrow's paper actually appears on the streets late this evening, and is probably available on the web from 10 pm local time. 50+ years ago when I was in Toronto, I used to read the next day's Globe and Mail in a small greasy spoon to which I had repaired for a late night snack, from about 9:30 pm, purchasing said paper at the corner store passed enroute.
X. Country - [# of known cases] ([active] / [recovered] / [dead]) [%fatality rate]
Fatality rates are only listed for countries where the number of resolved cases (recovered + dead) exceeds the number of known active cases by a ratio of at least 2:1. Six countries now meet that criterion, including the new addition of Germany. Italics indicate authoritarian countries whose official statistics are suspect. Other country's statistics are suspect if their testing regimes are substandard.
If American states were treated as individual countries seventeen of them would be on that list. New York would be ranked at #2, between "everywhere in the U.S. except New York" (#1) and Spain (#3). New Jersey would be between Turkey and Iran.
No new countries have joined the 10,000 case club since the last compilation.
FT trailing a story from tomorrow that the death toll in the UK from coronavirus could be anything up to double the current figure.
How do you access stories from tomorrow? Can you get the Lotto numbers?
They trail their front page in advance. In any case the story is now published and there is some breakdown behind the methodology by Chris Giles at the FT.
France Info has one of those "what we know, what we still don't know" articles this morning.
So far as I can see, our government's intention to start ending lockdown, provisionally, on May 11, is a total leap in the dark. There is no intention to develop universal testing, no reliable/legal phone tracing system, no vaccine, no consensus on treatment, and no clear consensus on how the virus is transmitted. I can't see social distancing measures being an adequate substitute for lockdown. (Ikea is planning to reopen on May 11).
As previously reported, the estimated total infection rate in France is about 6% and the estimated total exposure rate is about 12%, so nowhere near group immunity levels.
On current performance, if you reach ICU in France with covid-19 your chances of dying are about 50-50 (so not good). There are a number of potential explanations for this, but whatever they are, I can't see any reason why this is going to change soon.
Can anybody explain to me what I'm missing here? Where might the May 11 date have come from? Is there any reason why the epidemic might just subside of its own accord?
In the daily counting period used for all countries by the worldometer website (starts at 12 midnight GMT) there were over 2,800 deaths in the USA on April 21. The graphs show this as the highest daily total. Although some 1100 of these deaths occurred in New York and New Jersey, the remainder - a significant majority, are spread over many States.
Looking at the incidence of new cases, there were over 54,000 cases in the USA on 20 and 21 April combined, of which two thirds were spread over States other than New York and New Jersey.
Yesterday, 39 States recorded more than 50 new cases, 35 reported more than 100, 14 reported more than 500 and 6 more than 1,000. The minority of States relatively free so far from these levels of new infections represent a small proportion of the population of the USA.
The evidence is of a slow tailing off of new cases in New York. Elsewhere, patterns vary from not yet at peak, to plateauing to tailing off.
The incidence of new cases coupled with problems of testing kit availability shows quite clearly that tracing of possible other infections is impracticable in the great majority of States. Tests in various countries point to the ineffectiveness and possibly counterproductive effects of hydroxychloroquine as a treatment.
Testing, tracing and treatment are currently unachievable together in all but a very few States.
While there are some grounds for hoping that this doleful picture will get better over the next few weeks, that will only happen if a high level of lockdown is maintained and any easing is carried out with great caution.
There is zero justification for the President's rhetoric and a strong risk that those States proposing easement of restrictions will both live to regret it where they are and spread further infection and grief elsewhere.
I express my concern and sympathy to all US Shipmates and indeed citizens that at this most difficult time you are having to live with such appalling Presidential leadership. It is a very good thing that the great majority of State Governors are much more aware of the realities.
I think they're mainly doing it for economic reasons.
AFAICT the main reason for choosing this date is to keep us all at home for the May public holidays.
One of my friends has just suggested it's "la mise en place d'une immunité collective par étapes" (herd immunity in stages). A bit cynical but plausible?
There are a few scientists with left field theories, e.g., that many people have already caught the virus, or that it will burn out. I don't think any government is basing their strategy on such ideas, although Sweden is avoiding lockdown.
As previously reported, the estimated total infection rate in France is about 6% and the estimated total exposure rate is about 12%, so nowhere near group immunity levels.
Have you got a reference for those figures? I want to have a look at the methodology. It's very different to estimates I've seen elsewhere so I wanted to look at it more closely.
AFAICT there is a very strong consensus based on fairly decent data that to safely unwind the lockdown you need very robust testing and tracing and you do it step wise and cautiously.
AFZ
P.s. a 50/50 chance of survival in ICU is not a untypical, regardless of diagnosis. You may here a 70% chance of survival - the two measures are of different things. There are very good survival predictor tools for ICU admission based on multiple physiological measures. I haven't seen one specifically for Covid but I bet there is one by now. However a 50% average is not surprising.
Can anybody explain to me what I'm missing here? Where might the May 11 date have come from? Is there any reason why the epidemic might just subside of its own accord?
The date seems arbitrary (especially at this stage in the cycle - but agree with @la vie en rouge that maintaining lockdown over a period, such as a traditional holiday weekend, when otherwise social distancing wont be widely adhered to makes sense).
In terms of the "subside of its own accord", the reasoning is as follows:
There is a replication rate R0, the number of people each person infected infects
If R0>1 then the number of infected people in the population increases, if R0<1 then this number decreases
There's some evidence that the lockdown restrictions in most countries have resulted in an R0<1; thus the number of people now infected is less than when the restrictions were introduced (the number of hospital admissions rising is a result of the lag between infection and symptoms)
That is, the lockdown is causing the epidemic to subside (I'm not sure I'd say "of its own accord"), and that easing restrictions will mean people are less likely to encounter someone who's infected than they were just prior to restrictions being introduced.
However, easing restrictions will almost certainly result in an R0>1, and hence a renewed increase in the number of infections. If this is an easing and there are still some restrictions (eg: if schools stay closed, if most people still stay home most of the time, if those at work still practice social distancing) then R0 may not rise to the pre-restriction value (which seemed to be somewhere between 3 and 4, though without extensive testing this is not well known) and hence the rise in number of infections won't be as fast.
If restrictions, with R0<1, are held in place long enough then the number of people infected in the population will be small enough that a test and trace method to contain the virus could be effective, even without a vaccine. Whether anyone will hold restrictions in place for that long remains to be seen, especially as I'm not sure anyone yet knows how long that will be.
As previously reported, the estimated total infection rate in France is about 6% and the estimated total exposure rate is about 12%, so nowhere near group immunity levels.
Have you got a reference for those figures? I want to have a look at the methodology. It's very different to estimates I've seen elsewhere so I wanted to look at it more closely.
The figures were given by France Info; I didn't see any sources, but France Info is usually reliable. I'll try and find the article and/or sources.
P.s. a 50/50 chance of survival in ICU is not a untypical, regardless of diagnosis.
Sorry, I think I meant of survival once hospitalised and I'm not sure about the figure. A significantly larger proportion of those hospitalised in France seem to die compared to other European countries. The immediate explanation might be that people are only being hospitalised once they have developed more serious complications.
@Alan Cresswell I think I understand R-rates. What I don't understand is whether there's some natural mechanism in epidemics that causes them to subside apart from any intervention (and apart from a large total exposure). Or, to put it another way, how a 12% exposure rate could sensibly inform a decision to relax lockdown measures.
France Info has one of those "what we know, what we still don't know" articles this morning.
So far as I can see, our government's intention to start ending lockdown, provisionally, on May 11, is a total leap in the dark. There is no intention to develop universal testing, no reliable/legal phone tracing system, no vaccine, no consensus on treatment, and no clear consensus on how the virus is transmitted. I can't see social distancing measures being an adequate substitute for lockdown. (Ikea is planning to reopen on May 11).
As previously reported, the estimated total infection rate in France is about 6% and the estimated total exposure rate is about 12%, so nowhere near group immunity levels.
On current performance, if you reach ICU in France with covid-19 your chances of dying are about 50-50 (so not good). There are a number of potential explanations for this, but whatever they are, I can't see any reason why this is going to change soon.
Can anybody explain to me what I'm missing here? Where might the May 11 date have come from? Is there any reason why the epidemic might just subside of its own accord?
The data I can see shows that new infections in France are slowing. But it's not a country that's doing exceptionally well at getting the rate down (compared to, say, Austria which does seem to have achieved this) and certainly all the advice here is that you need weeks and weeks of low case numbers before you can ease off a touch.
Australia and New Zealand seem to have done better than most (yes, being islands probably helps a bit), and here in Australia there's almost no relaxation, and New Zealand's notion of 'easing' is moving from severe lockdown to something more in line with Australia (NZ case and death rates aren't any better than ours).
The view here in Australia is that elimination is unlikely to be achievable, and in any case is hard to sustain unless all your borders are rigidly shut. So the aim is 'suppression', with the number of cases kept low enough that treatment will definitely be available for anyone that needs it and that tracing cases is manageable. France is still having a couple of thousand new cases a day on the data I can see, which doesn't sound to me like a state of being able to manage any new spikes that might occur.
@alienfromzog projected infection rate of 5.7% in France as of 11 May, source, Institut Pasteur, uncertainty interval 3-10% prepublication (in English!) yesterday:
Population immunity appears insufficient to avoid a second wave if all control measures are released at the end of the lockdown
It turns out that since I read it yesterday, the France Info article that linked to it has been edited to remove the reference to the approx 12% exposure ratio said to inform public policy! I'll see if I can find another reference...
Oh, and 12% exposure is nowhere NEAR enough to assist in reducing the spread of infection. That still means that on average 7/8 of the people an infected person meets are at risk.
As per Eutychus, I keep reading that the peak will be reached, "and then the virus will subside". But how does this happen? If you release the lockdown, cases will rise, unless you have extirpated the virus, which is unlikely.
@Alan Cresswell I think I understand R-rates. What I don't understand is whether there's some natural mechanism in epidemics that causes them to subside apart from any intervention (and apart from a large total exposure). Or, to put it another way, how a 12% exposure rate could sensibly inform a decision to relax lockdown measures.
You'll probably need someone knowledgable in fields of virology and biochemistry to answer that. I've been working on an analogy with a very similar concept in nuclear fission - each 235U nucleus that fissions releases 3-4 neutron which can go on to induce fission in another 235U nucleus. That ratio of number of fissions induced by each fission is equivalent to the R0: if it's <1 the reaction ceases, if >1 then things go bang in a manner that no-one other than Dr Strangelove would want.
@alienfromzog projected infection rate of 5.7% in France as of 11 May, source, Institut Pasteur, uncertainty interval 3-10% prepublication (in English!) yesterday:
Population immunity appears insufficient to avoid a second wave if all control measures are released at the end of the lockdown
It turns out that since I read it yesterday, the France Info article that linked to it has been edited to remove the reference to the approx 12% exposure ratio said to inform public policy! I'll see if I can find another reference...
Hmm. Interestingly, this page all about R-rates indicates that France is doing exceptionally well right now. However it looks to me like a couple of specific blips and it's not clear that it's going to keep staying that way for the next 2-3 weeks. There's basically been 2 excellent days in the last week.
Hmm. Interestingly, this page all about R-rates indicates that France is doing exceptionally well right now. However it looks to me like a couple of specific blips and it's not clear that it's going to keep staying that way for the next 2-3 weeks. There's basically been 2 excellent days in the last week.
I didn't look at how they calculated that figure, but the obvious explanation for that is that we only test people once they're really ill.
Hmm. Interestingly, this page all about R-rates indicates that France is doing exceptionally well right now. However it looks to me like a couple of specific blips and it's not clear that it's going to keep staying that way for the next 2-3 weeks. There's basically been 2 excellent days in the last week.
I didn't look at how they calculated that figure, but the obvious explanation for that is that we only test people once they're really ill.
No, that's only relevant if your testing strategy has changed.
Maybe next time look at how the figure is calculated before offering obvious explanations?
Comments
--Another scary aspect: COVID-19 can cause blood clots, with horrible results. Broadway actor Nick Cordero went to the hospital with COVID; was put in a medically-induced coma; developed blood clots; and one of his legs was amputated. He's evidently still in the coma...and presumably doesn't know about his leg.
--More mentions in the news of kids getting very ill with COVID, and some dying. Like a little girl whose parents are first responders. That must be especially awful for them, if they feel they brought the virus home.
--A good thing: Two gangs in S. Africa have called a truce over the pandemic, and are delivering food to those in need!
But, yes ideally you want to maintain self-isolation for people with any symptoms coupled with testing of anyone with symptoms and tracing and testing of anyone they've had contact with in the 7 days before symptoms developed. That needs two things: one a substantial capacity for testing, ideally with absolute minimum delay between test and result; two sufficient ongoing social distancing that you can trace people (so, family and immediate work colleagues ... but, you won't be able to trace a packed train carriage of people).
Also of interest that the WHO is arguing that the origin of the virus probably is in bats, not Chinese labs. This won't stop the China hate campaign. Also, they argue for an intermediate animal host. Bats - X - humans.
My thoughts exactly.
Depends on where "here" is. For example, the U.K. was already regarded by many as a surveillance state. I'm not sure there's as huge a difference as many claim.
A vaccine might be a year or so away. Before we have a vaccine, some fraction of people who catch COVID-19 will die, and more will be out of action sick in bed for a significant time.
Do you want to minimize the number of deaths? That implies continued lockdown, with only small relaxations for low-risk activities, with screening, contact tracing etc.
Or do you just want to keep the number of seriously sick people to a level that your healthcare system can cope with? In that case, once the prevalence of the virus is low, you can relax the lockdown a bit without testing - just allow low-risk activities, people maintaining distance etc., and use the number of sick and/or dead people to tell you whether you opened up too much or not.
Testing and contact-tracing is good, because it lets you have fewer restrictions on normal life in general, but achieve the same level of infections than a tighter lockdown with no testing or tracing.
Does this actually work? I ask because there don't seem to be any examples of countries that have gotten COVID-19 under control without social distancing, testing, and contact tracing. Everyone who has tried to go without testing and contact tracing has seen a resurgence of (or no diminishment of) the virus.
If you are told you must do what you were going to do anyway, doing it feels oppressive.
I think France is going to find out on May 11...
He already did. I wouldn't put it past him to double down, though.
Testing happens fast these days. 10 minutes for call back and scheduling which happens within a couple of hours..
They're talking lock down relaxation in a week if our current 1 or 2 diagnosed cases per day is consistent. Provincial boundary patrols and road block checks are being set up for travellers from neighbouring provinces. We appear to be one of the lucky places so far. Even if spring isn't really here. 2 inches of snow overnight.
*To be fair you have to offset it against other risks, but also that's Mr Jones, Mrs Smith ..... ..... ..... ..... .....
An article that includes a discussion about the efficacy of pulse oximeters in relation to that:
The Infection That’s Silently Killing Coronavirus Patients:
The study is available online [PDF] for those who want to wade through the details. As the AP article notes the results aren't definitive but they are discouraging.
Annabel, one of the people behind the charitable provision of scrubs, Scrub Hub Ltd, put out an irritated statement today link to Instagram story. ScrubHub isn't the only organisation trying to co-ordinate scrub provision, so are For the Love of Scrubs
Of course nobody actually does the maths -- that's why God made computers.
How do you access stories from tomorrow? Can you get the Lotto numbers?
--Calif. gov. Gavin Newsom is starting Californians For All, a volunteer army to get people to pitch in and help in the crisis, as needed. It was just rolled out today at Gavin's daily news conference, and has a very energetic leader.
--San Franciscans now must wear masks whenever they leave home. So Scott Wiener, state senator for the area, is making it fun in true San Francisco fashion...with some help...
Fixed first link which was broken. BroJames Purgatory Host
Because tomorrow's paper actually appears on the streets late this evening, and is probably available on the web from 10 pm local time. 50+ years ago when I was in Toronto, I used to read the next day's Globe and Mail in a small greasy spoon to which I had repaired for a late night snack, from about 9:30 pm, purchasing said paper at the corner store passed enroute.
The listings are in the format:
X. Country - [# of known cases] ([active] / [recovered] / [dead]) [%fatality rate]
Fatality rates are only listed for countries where the number of resolved cases (recovered + dead) exceeds the number of known active cases by a ratio of at least 2:1. Six countries now meet that criterion, including the new addition of Germany. Italics indicate authoritarian countries whose official statistics are suspect. Other country's statistics are suspect if their testing regimes are substandard.
If American states were treated as individual countries seventeen of them would be on that list. New York would be ranked at #2, between "everywhere in the U.S. except New York" (#1) and Spain (#3). New Jersey would be between Turkey and Iran.
No new countries have joined the 10,000 case club since the last compilation.
Have you seen the TV series "Early Edition"? Fits with what you said.
They trail their front page in advance. In any case the story is now published and there is some breakdown behind the methodology by Chris Giles at the FT.
So far as I can see, our government's intention to start ending lockdown, provisionally, on May 11, is a total leap in the dark. There is no intention to develop universal testing, no reliable/legal phone tracing system, no vaccine, no consensus on treatment, and no clear consensus on how the virus is transmitted. I can't see social distancing measures being an adequate substitute for lockdown. (Ikea is planning to reopen on May 11).
As previously reported, the estimated total infection rate in France is about 6% and the estimated total exposure rate is about 12%, so nowhere near group immunity levels.
On current performance, if you reach ICU in France with covid-19 your chances of dying are about 50-50 (so not good). There are a number of potential explanations for this, but whatever they are, I can't see any reason why this is going to change soon.
Can anybody explain to me what I'm missing here? Where might the May 11 date have come from? Is there any reason why the epidemic might just subside of its own accord?
Looking at the incidence of new cases, there were over 54,000 cases in the USA on 20 and 21 April combined, of which two thirds were spread over States other than New York and New Jersey.
Yesterday, 39 States recorded more than 50 new cases, 35 reported more than 100, 14 reported more than 500 and 6 more than 1,000. The minority of States relatively free so far from these levels of new infections represent a small proportion of the population of the USA.
The evidence is of a slow tailing off of new cases in New York. Elsewhere, patterns vary from not yet at peak, to plateauing to tailing off.
The incidence of new cases coupled with problems of testing kit availability shows quite clearly that tracing of possible other infections is impracticable in the great majority of States. Tests in various countries point to the ineffectiveness and possibly counterproductive effects of hydroxychloroquine as a treatment.
Testing, tracing and treatment are currently unachievable together in all but a very few States.
While there are some grounds for hoping that this doleful picture will get better over the next few weeks, that will only happen if a high level of lockdown is maintained and any easing is carried out with great caution.
There is zero justification for the President's rhetoric and a strong risk that those States proposing easement of restrictions will both live to regret it where they are and spread further infection and grief elsewhere.
I express my concern and sympathy to all US Shipmates and indeed citizens that at this most difficult time you are having to live with such appalling Presidential leadership. It is a very good thing that the great majority of State Governors are much more aware of the realities.
AFAICT the main reason for choosing this date is to keep us all at home for the May public holidays.
One of my friends has just suggested it's "la mise en place d'une immunité collective par étapes" (herd immunity in stages). A bit cynical but plausible?
Have you got a reference for those figures? I want to have a look at the methodology. It's very different to estimates I've seen elsewhere so I wanted to look at it more closely.
AFAICT there is a very strong consensus based on fairly decent data that to safely unwind the lockdown you need very robust testing and tracing and you do it step wise and cautiously.
AFZ
P.s. a 50/50 chance of survival in ICU is not a untypical, regardless of diagnosis. You may here a 70% chance of survival - the two measures are of different things. There are very good survival predictor tools for ICU admission based on multiple physiological measures. I haven't seen one specifically for Covid but I bet there is one by now. However a 50% average is not surprising.
In terms of the "subside of its own accord", the reasoning is as follows:
There is a replication rate R0, the number of people each person infected infects
If R0>1 then the number of infected people in the population increases, if R0<1 then this number decreases
There's some evidence that the lockdown restrictions in most countries have resulted in an R0<1; thus the number of people now infected is less than when the restrictions were introduced (the number of hospital admissions rising is a result of the lag between infection and symptoms)
That is, the lockdown is causing the epidemic to subside (I'm not sure I'd say "of its own accord"), and that easing restrictions will mean people are less likely to encounter someone who's infected than they were just prior to restrictions being introduced.
However, easing restrictions will almost certainly result in an R0>1, and hence a renewed increase in the number of infections. If this is an easing and there are still some restrictions (eg: if schools stay closed, if most people still stay home most of the time, if those at work still practice social distancing) then R0 may not rise to the pre-restriction value (which seemed to be somewhere between 3 and 4, though without extensive testing this is not well known) and hence the rise in number of infections won't be as fast.
If restrictions, with R0<1, are held in place long enough then the number of people infected in the population will be small enough that a test and trace method to contain the virus could be effective, even without a vaccine. Whether anyone will hold restrictions in place for that long remains to be seen, especially as I'm not sure anyone yet knows how long that will be.
@Alan Cresswell I think I understand R-rates. What I don't understand is whether there's some natural mechanism in epidemics that causes them to subside apart from any intervention (and apart from a large total exposure). Or, to put it another way, how a 12% exposure rate could sensibly inform a decision to relax lockdown measures.
The data I can see shows that new infections in France are slowing. But it's not a country that's doing exceptionally well at getting the rate down (compared to, say, Austria which does seem to have achieved this) and certainly all the advice here is that you need weeks and weeks of low case numbers before you can ease off a touch.
Australia and New Zealand seem to have done better than most (yes, being islands probably helps a bit), and here in Australia there's almost no relaxation, and New Zealand's notion of 'easing' is moving from severe lockdown to something more in line with Australia (NZ case and death rates aren't any better than ours).
The view here in Australia is that elimination is unlikely to be achievable, and in any case is hard to sustain unless all your borders are rigidly shut. So the aim is 'suppression', with the number of cases kept low enough that treatment will definitely be available for anyone that needs it and that tracing cases is manageable. France is still having a couple of thousand new cases a day on the data I can see, which doesn't sound to me like a state of being able to manage any new spikes that might occur.
It turns out that since I read it yesterday, the France Info article that linked to it has been edited to remove the reference to the approx 12% exposure ratio said to inform public policy! I'll see if I can find another reference...
Thanks. I'll take a look.
Which, if you'll pardon the language, is fucking fantastic. The peak in late March was 460.
I didn't look at how they calculated that figure, but the obvious explanation for that is that we only test people once they're really ill.
No, that's only relevant if your testing strategy has changed.
Maybe next time look at how the figure is calculated before offering obvious explanations?