🦠 COVID-19 | The cost of distrust

📊 Daily Data Brief: June 22, 2020, 23:20 GMT (❗️Previous data: June 21, 2020, 00:07 GMT)

Cumulative case: 9,176,709 (+270,190cumulative cases 

Active cases:  3,799,304 (+91,804) (this is the number of currently infected patients)

Total Deaths:  473,420 (+7,167)

Serious/Critical Cases: 57,859 (+3,380)

Recovered:  4,903,985 (+171,209)

Source: Worldometers

1) Seven-day rolling average of new deaths (ECDC data)

Showing a chart from the FT today highlighting the worrying situation in Brazil, Mexico, India and Russia and Iran (NEW❗️). Also the FT comparative charts now allow up to 6 countries.

2) Rt estimate per State (US) and per country (NEW❗️). This is a new resource link in the data section from a team which has led accuracy in modelling fatalities in the US for the past few weeks. (Link)

This edition starts with a great article on trust or rather mistrust between the public, public health officials and policy makers.

A telling image of the day, on how countries which ramped up testing early fared particularly well.

A thread and video, on how the SARS-CoV-2 now seems to infect younger people in the US and whether it is a cause for celebration.

A Wall Street Journal article looking at the important question of whether the vaccines currently in development will be effective for ‘older adults’, and wha is being done to have a positive answer.

A deep look at the successful policy in Vietnam a country with a population of 97 million and 349 cases thus far…

Looking at the future of telemedicine and its shortfall as well as the dire ecomomical consequences for smaller hospitals.

A final thread of whether we are too lenient on manual contact tracing and harsh on tech-enable contact tracing. Need for a restart?

🏥 Article of the day: Davis Wallace-Wells writes “People Don’t Trust Public-Health Experts Because Public-Health Experts Don’t Trust People” for the New Yorker. (Link)

Very early on in the pandemic, it was clear that government leaders did not trust the public to do what was right for their health. On March 15, the Corona Daily was titled “Underestimating the public” discussing that issue, and highlighting that the more populist the government the less they trusted their public.

In a year of election in the US the polarisation of the debate and the politicisation of science, has made nuanced public messaging even more difficult, and this has most probably negatively affected the response and its effectiveness. It prevents the deep engagement with the public necessary to effectively fight an epidemic. As Wallace-Wells points out, he has seen a similar pattern (with similar outcome thus far) in the discussion around climate change.

“But taken together they suggest a perhaps concerning pattern, one familiar to me now from years of writing about climate change and its long-understated risks: Instead of simply presenting the facts — what they knew, how certain they were about it, and what they didn’t know — experts massaged their messaging in the hope of producing a particular response from the public (and with the faith that they can expertly enough massage it to produce that outcome).”

Lord Sumption in his Op-Ed is even more salient about the failure in messaging of the UK government and its deleterious effect on the public. Referring to Boris Johnson he writes:

“The Prime Minister, who in practice makes most of the decisions, has low political cunning but no governmental skills whatever. He is incapable of studying a complex problem in depth. He thinks as he speaks – in slogans.”

Slogans do not allow for the nuance required to rebuild trust with the public. Lord Sumption also rightly exposes the unhealthy relationship between the UK government and its advisers:

“Ministers press them for the kind of unequivocal answers that will protect them from criticism. Scientists cover themselves by giving equivocal answers, which reflect the uncertainty of the science. The Government responds by avoiding any decision for which it would have to take political responsibility, until the pressure of events becomes irresistible, when it lurches off in a new direction.”

It has resulted, for a very long time, in slogans like “following the science” by the UK government. As the president of the Royal Society powerfully argued there is no such thing. Instead there is complexity and uncertainty, particularly with a new virus, and the same way scientists built their trust on “honesty, openness and transparency”, governments and public health officials need to do the same. Public Health experts also need to resist politicisation in their messaging to avoid public distrust in politicians to rub off on them.

They need to refrain from being categorical, as Wallace-Wells write when the science is still evolving. They also need to trust “the public’s ability to process nuances and act responsibly”.

A few months into the pandemic the public debate still appears to be on whether to lockdown or reopen. What the public health experts together with the public need to get to is how to safely reopen and what are the current contamination risk appraisal in different every day settings.

While the title is a bit harsh on the public health experts, it is on point when it comes to their lack of confidence in the public. It needs to change fast to avoid further avoidable deaths by fostering deeper engagement, transparent information sharing and ultimately buy-in.

🧪 Image of the day: “Countries which ramped up testing earlier fared better” by Max Rozer (Founder of Our World in Data). This graph does not necessarily show causality, but the government which implemented testing program early probably got a lot of other policy decision right…

🧪 Thread of the day: “The age shift” by Dereck Thompson at The Atlantic (Twitter Thread)

The first tweet in the Thread lays it out:

Derek Thompson @DKThomp
The most important COVID story right now is the age shift. In Texas: Young adults driving the spike.
texastribune.org/2020/06/16/tex… In Arizona: COVID cases growing 2X faster among ages 20-44 than 65+. In Florida: Median age of new COVID cases fell from 65 in March to 35 this week —>

This is quite an interesting realisation, as whilst case were surging in a number of states in the US, death curves did not yet show an increase as expected (even accounting for time lag between recorded cases and deaths). This could be the explanation as the infection fatality rate (IFR) is lower for younger people. This drop in IFR could also have resulted in part from better patient care saving lives. This could be a trend which continues if drug dexamethanose’s promising results are confirmed and it is increasingly able to be administered.

The increased positive test amongst younger people might result from either 1) young people taking more risk of being contaminated than older people, and/or 2) better policy implementation aimed at protecting the elderly.

As Thompson points out, it is no cause for celebration (particularly until we understand better the reasons behind the data and its persistence):

There was also a good article on this topic in NPR titled “Younger Adults Are Increasingly Testing Positive For The Coronavirus” focusing also on how public messaging for this age group might need to be tailored to avoid having a resurgence of the pandemic amongst more vulnerable people and seeded by this younger group.

🇺🇸 Video of the day: Scott Gottlieb commenting on why we should not be celebrating the spread of the virus amongst younger populations:

💉 Jared S. Hopkins writes “Efforts for Coronavirus Vaccine Focus on Vulnerable Group: Older Adults” in the Wall Street Journal.

It is not only in public health guidelines that public messaging has failed to be nuanced and the public ill informed. Vaccine development messaging, which since the beginning of the pandemic has been hailed as the only viable route to returning to normal life, has been lacking in honesty and transparency from public officials, with companies receiving large sums of money from government and happily singing along.

It feels at times that there is a deliberate lack of details on what to expect in the fall from a number of phase 3 vaccine trials which will start in late summer or on how good the first vaccine are likely to be and how widely they will be available.

Hopkins focuses on the issue on how protective the coronavirus vaccines are likely to be for older adults and what work is being done now to ensure that it protects the most vulnerable group against SARS-CoV-2.

Francis Collins, director of the National Institutes of Health, lays the problem clearly in the article:

“It would not be particularly encouraging if we have a vaccine that’s capable of protecting 20-year-olds who probably have a pretty low risk anyway of getting sick, and doesn’t work at all for people over 65.”

It is probably not widely known to the public but Dr. Kawsar Talaat, deputy director of clinical research for the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health, focusing in this issue with pharmaceutical companies working on the vaccine is quoted in the article:

“We hadn’t been designing vaccines for the elderly for a long time.”

It might be that new mRNA-based vaccine technology (such as the one used by Moderna), produces a better immune response in older adults.

Hopkins’s article is helpful in highlighting an important issue. Older patients, more than anyone else, are counting on the vaccine to resume normal life. The more they and their children and grandchildren are aware of the uncertainties surrounding vaccines’ potential effectiveness the more motivated they will be to follow the current public health guidelines aimed at suppressing the virus. (Link)

👩‍⚕️ John Seabrook writes “The Promise and the Peril of Virtual Health Care” in the New Yorker. Early on, Seabrook asks the questions which the article attempts to answer:

“If virtual care is the future of health care, is it a future that we want?”

Going from its NASA origin to now Seabrook write a well-researched article including also his personal experience with telemedicine. Until COVID-19, telemedicine was only burgeoning, with minor adoption from patients and skepticism from some doctors. The economic consequences of telemedicine adoption will also be daunting. COVID-19, particularly with shortage of PPE, accelerated adoption:

“Medicare claims for telemedicine jumped from ten thousand a week in March to well over a million a week in April.”

Seabrook also outlines some of the shortcoming, and the inapplicability of telemedicine for certain conditions particularly as physicians face the same liability issue as with in-person visits. Some of these telemedicine sessions also last longer than in-person visits, and result in a loss of productivity for the doctor.

Smaller hospitals face the same demise than small shops experienced with the likes of Amazon:

“At the same time, the economic losses caused by fewer in-person visits are likely to force smaller hospitals into bankruptcy, a trend that began before the pandemic. By one estimate, as many as sixty thousand physicians in family medicine may lose their practices because of the coronavirus crisis.”

Beyond the economic costs, there are also societal consequences of a broader adotpion of telemedicine. At a time where our society needs more resilience and cohesion, is telemedicine the next frontier in a dystopian digital future. A great and well researched article. (Link)

🇻🇳 Todd Pollack et al. write “Emerging COVID-19 success story: Vietnam’s commitment to containment” in EXEMPLARS in Global Health. Vietnam’s success, particularly given its proximity and close ties with China, is not often referenced. A number of countries would benefit from looking more closely at its policies and that is what Pollack et al. offer to them in this article.

For context:

“Although Vietnam reported its first case of COVID-19 on January 23, 2020, it reported only a little more than 300 cases and zero deaths over the following 4 months. […]

Everyone must wear a mask in public. […]

Since April 16, Vietnam recorded no new cases of COVID-19”

A detailed case study which will make most readers wonder why their respective leaders were not able to do the same. (Link)

🚔 A great assessment of manual contact tracing and its limitations and unknowns, as well as why we should be so dismissive of technology in assisting in this important area. At a time where the UK contact tracing app is postponed, France’s STOPCovid app is a failure, Albert Girady (Privacy Lawyer) attempts to provide a new perspective on this in his Twitter thread:

It is a complex issue, and Gidari laments the level of scrutiny on the tech version of contact tracing relative to the manual version:

Given that if successful both will need to scale, it is a fair comment. Part of the failure of most contact tracing apps to date, have come from a botched messaging and a distrust of the governments launching them from their own citizens. If they are to be given a second life as Gidari hopes a different approach and more humility from government will be required.

📊 A picture is worth a thousand words:  Global (🌎) and local (with relevant flag) visualisation and forecasting tool

  1. 💉 (❗️NEW) “Coronavirus Vaccine Tracker” by Jonathan Corum and Carl Zimmerfrom the New York Times.

    “The status of all the vaccines that have reached trials in humans, along with a selection of promising vaccines still being tested in cells or animals.”

  2. (Link)

  3. 🇺🇸 (NEW❗️) “The COVID Racial Data Tracker

    “The COVID Racial Data Tracker is a collaboration between the COVID Tracking Project and the Antiracist Research & Policy Center. Together, we're gathering the most complete race and ethnicity data on COVID-19 in the United States.”


  4. 🦠  “Science Forum: SARS-CoV-2 (COVID-19) by the numbers” (Link)

    “The COVID-19 pandemic is a harsh reminder of the fact that, whether in a single human host or a wave of infection across continents, viral dynamics is often a story about the numbers. In this article we provide a one-stop, curated graphical source for the key numbers (based mostly on the peer-reviewed literature) about the SARS-CoV-2 virus that is responsible for the pandemic. The discussion is framed around two broad themes: i) the biology of the virus itself; ii) the characteristics of the infection of a single human host.”

  5. 🇺🇸🌎 This model has led accuracy for several weeks in the US. It also does projection for Europe and Rest of the World. (Link)

  6. 🇺🇸  “Is your community ready to reopen?”: A map of the US (50 states and 2,100+ counties) looking at reopening risks with metrics around 3 criteria: 1. Is COVID in retreat? 2. Are we testing enough? 3. Are our hospitals ready? (Link)

  7. 🌎 The Financial Times (visualisation) has a data tracking page which is in front of the paywall, looking at cases and fatality curves for selective countries and metropolitan areas/region. It is not as extensive as the Madlag link below, where you can see static as well as animated images for a greater number of individual countries. (Link)

  8. 🇺🇸  The Johns Hopkins University resource center was the first one I used back in January they have now made available in their latest iteration a county by county dashboard in the US including information about health capacity, insurance coverage, ethnicity and age breakdown of the populatio (Link)

  9. 💊 The "Map of Hope" provides a geographical overview of planned, ongoing and completed clinical trials. It is put together with data from WHO Clinical Trials Search Portal by the Heidelberg Institute for Geoinformation technology. (Link)