COVID-19 | science, damage limitation, NO POLITICS

[armand]

This shouldn't be about (international) politics, but it is good to see this level of cooperation. It also raises an interesting question about dealing with each country's limited hospital resources: what if we could shift doctors and supplies from country to country, as the virus spreads across the globe?

That could work only if you start and have separate units entirely staffed by those physicians. If you want to implant them only in the areas of needs, you risk worse. They have to know the system and work with the others, which is easier said than done.

In US I doubt this would be possible. When the family is unhappy, who are they going to threaten to sue?
Joke aside (more half joke), licensing is a combination of state and federal requirements. They dropped some restrictions now and for a limited time I hear that you can work in any state as long as you have a valid license in US, similar to what the VA system does. I guess if worse come worse they could drop the requirements even more, by having the foreign physicians work only in designated covid units and have some form of oversight from US licensed physicians. Somehow I doubt this will happen.

[Manoli]

From the Economist:

Editor’s note: The Economist is making some of its most important coverage of the covid-19 pandemic freely available to readers of <The Economist Today>, our daily newsletter. To receive it, register here.

Where 'here' is , I don't know, I can't find the link - but worth browsing for it.

[Guillermo Luijk]

Without a vaccine, it seems clear that only isolation (when a country or community still hasn't been infected by the virus) and social distancing (when it has) are the only valid strategies to stop proliferation of the virus.
When all this story started I wondered what's the point of isolation or very strong social distancing measures if eventually you're going to have to face the virus (vaccine is estimated to be no earlier than 12-16 months). With isolation or severe social distancing you are not exposing your population to the virus so in the end you are just postponing the problem but not its magnitude.

I have done some simulations to illustrate this:



Quickly a huge % of the population gets infected. The situation is unsustainable in all respects with a R0=2,4 mortal virus.



Severe social distancing for 6 consecutive weeks. Infection curve gets flattened and we gain time because the infection spread is delayed by more than 2 months. BUT after that you have to face the virus again (probably imported from other countries) and most of your population has never been exposed to it, so in practical terms you start from scratch like in scenario 1.



Same 6 weeks of social distancing as in the previous escenario, but spaced in time (2 weeks social distancing + 2 weeks open). The infection curve gets flattened in three ocasions. There are important infection peaks but much more affordable than in scenario 2. Economy gets closed for the same amount of time, but allowing activity periods. Most importantly a high % of your population has got exposed to the virus so you are much better prepared to face the virus again than in 2.

In my opinion the main conclusion of this exercise is that extremely severe isolation or social distancing could in the end be both economically and from a healthcare perspective, more harmful than allowing some periods of contact of the population with the virus.

Anyone wanting to play with the simulator you can find it in: coronavirus_simulator_STRATEGIES.xlsm, and a short article explaining a bit here: Flattening the coronavirus curve.



Regards

[Manoli]

Without a vaccine, it seems clear that only isolation (when a country or community still hasn't been infected by the virus) and social distancing (when it has) are the only valid strategies to stop proliferation of the virus ... With isolation or severe social distancing you are not exposing your population to the virus so in the end you are just postponing the problem but not its magnitude.
[...]
Same 6 weeks of social distancing as in the previous escenario, but spaced in time (2 weeks social distancing + 2 weeks open). The infection curve gets flattened in three ocasions....Economy gets closed for the same amount of time, but allowing activity periods. Most importantly a high % of your population has got exposed to the virus so you are much better prepared to face the virus again than in 2.

In my opinion the main conclusion of this exercise is that extremely severe isolation or social distancing could in the end be both economically and from a healthcare perspective, more harmful than allowing some periods of contact of the population with the virus.

I think your cocnclusion is on track but you make an assumption that, AFAIK, is NOT a given. China, Japan and South Korea have reported cases of people testing positive for the coronavirus, recovering, being released from care and then later testing positive a second time. Evidence suggests that the virus can persist in the body for several weeks after recovery, so it may be that these patients still tested positive but were not reinfected, However, we still know very little about how the human immune system responds to SARS-CoV-2, and whether those who have been infected develop lasting immunity.

[Manoli]

Among places where the death toll has reached three figures, Britain is an outlier, largely disregarding social distancing. On March 20th mobility in London, Manchester and Birmingham hovered around 25% of normal levels. New York was at 10%, with Rome, Paris and Madrid all at 5% or below.

[Manoli]

paywalled...

Apparently not any more ...
https://www.ft.com/content/a26fbf7e-48f8-11ea-aeb3-955839e06441

[Manoli]

CGTN America

Coronavirus Vaccine - early summer (June) for first human clinical trials ?
INOVIO California (note: she's Scottish)

https://youtu.be/5hn5Vjrq_wY
https://www.thetimes.co.uk/article/the-scientist-racing-to-find-a-vaccine-to-the-coronavirus-g5qjkj8q6
Google search 'Kate Broderick' - plenty on her

[Manoli]

Updated:

[armand]

I think your cocnclusion is on track but you make an assumption that, AFAIK, is NOT a given. China, Japan and South Korea have reported cases of people testing positive for the coronavirus, recovering, being released from care and then later testing positive a second time. Evidence suggests that the virus can persist in the body for several weeks after recovery, so it may be that these patients still tested positive but were not reinfected, However, we still know very little about how the human immune system responds to SARS-CoV-2, and whether those who have been infected develop lasting immunity.

You are right, still many unknowns.
The long lasting immunity is a question without a clear answer yet.
Regarding being positive again, I think those cases were just tested again too early (or maybe it's wishful thinking on my part). It appears many are still shedding viral RNA, not necessarily being infected or infectious.

[Robert Roaldi]

You are right, still many unknowns.
The long lasting immunity is a question without a clear answer yet.
Regarding being positive again, I think those cases were just tested again too early (or maybe it's wishful thinking on my part). It appears many are still shedding viral RNA, not necessarily being infected or infectious.

During Sam Harris's podcast interview (No. 191) Dr. Amesh Adalja mde 2 statements about this. This is now 2-week old information, it may have been superseded by now.

He thought that the very early reports that it was possible to be re-infected by Covid-19 very soon after a first infection appear to be false negatives and have not been borne out over time. His opinion was that if you get it, you're protected for some period.

He also thought that the immunization against it from having been sick once is likely to be long-lasting, more akin to the behaviour of measles than of seasonal flu or colds.

That part of the podcast was an abbreviated conversation and so did not give details about why he thought this. It's on-going of course, it would be interesting to hear his opinions today, assuming we have enough new valid data on the subject.

[armand]

I think we are surpassing Italy, as expected (based on total population at least)

[Manoli]

I think we are surpassing Italy, as expected (based on total population at least)

Both USA and UK entering a critical phase. Next 10 days ...

[armand]

https://www.cnbc.com/2020/03/16/who-considers-airborne-precautions-for-medical-staff-after-study-shows-coronavirus-can-survive-in-air.html?fbclid=IwAR0LPGCmP1B7GMxZCxS1t_riDcyQLdjWqYQrbYyYKldrLkqi7fr31dKZiII

Aerosolization is a bitch

[Manoli]

Thanks , Armand. Reading thru it seems there’s a new dynamic.
KEY POINTS
1/ The coronavirus can survive on surfaces for up to 17 days, a study published Monday by the Centers for Disease Control and Prevention says.
2/ The study examines two public health responses to COVID-19 outbreaks on the Carnival-owned Diamond Princess ship in Japan and the Grand Princess ship in California.
3/ The virus “was identified on a variety of surfaces in cabins of both symptomatic and asymptomatic infected passengers up to 17 days after cabins were vacated...” the researchers wrote.

Bummer.
17 days ...

[LesPalenik]

Lasting 17 days is good for the virus, but a real quagmire for the humanity.

[Alan Klein]

Virus increasing rapidly in Italy, Spain and UK. Indeed, and also the death curves are steepening.

Interestingly, Taiwan has it under control. They instituted early the tests, and they have also the necessary protective equipment. So far, only 162 cases with 2 deaths. All this without any lockdown. The stores and restaurants are still open and kids still go to school.

What do tests with low rates of infection?  If there is no lockdown, and stores and restaurants are open, what accounts for no or little transmission and infection?

[Alan Klein]

I read a technical paper the other day from a group of Italian and Greek data analysts and they are looking at the end of May for a fade out of new cases.  It's very math heavy but if you are interested, here is the link: https://www.medrxiv.org/content/10.1101/2020.03.17.20037689v1

Forget the math.  Can you summarize in a short statement why it's ending in May?

[LesPalenik]

What do tests with low rates of infection?  If there is no lockdown, and stores and restaurants are open, what accounts for no or little transmission and infection?

Testing is the first step in isolating virus carriers. Once you have the results, you can decide what to do with the test subjects.

[Alan Klein]

Testing is the first step in isolating virus carriers. Once you have the results, you can decide what to do with the test subjects.

Les, they only tested a tiny portion of the whole population.  So that does 't address the main issue.  If there is no lockdown, and stores and restaurants were open, what accounts for no or little transmission and infection?

[LesPalenik]

Les, they only tested a tiny portion of the whole population.  So that does 't address the main issue.  If there is no lockdown, and stores and restaurants were open, what accounts for no or little transmission and infection?

Taking the virus carriers out of circulation is the best way to prevent further spread of infections. It seems to work for them.
If they isolate the carriers, the lockdowns are not required.