🦠Covid-19 - 07/03/20 The surges are coming | 🤕 106,490 | Deaths 3,600

📊 Daily Data Brief:

106,490 cases 

New Cases outside China: 4,005(+1,044)

New Cases in China:  50 

Total Death: 3,600 (+192)

Serious or Critical Cases:   6,040  (-232) 

Source: https://www.worldometers.info/coronavirus/

The headline is clear: the virus is everywhere and surging, but government action is also and finally surging - albeit unevenly, around the world. This is good news however temporarily disruptive it will be to our way of life and however big a toll it exacts on our economies. Rapidly implementing decisive actions will determine the severity of the outcome. We need to accept the inevitable and economic loss now, to be able to take the right decisions immediately to tame COVID19 faster.

At government level, Italy has imposed the most drastic and visible measures by ordering quarantine measures for 16 million of its people in several regions around Milan. Andrew Cuomo (governor of New York) has seized the powers he sought and was granted 2 days ago to declare a state of emergency in his state. Bill Blasio (Mayor of New York) has publicly urged New Yorkers with symptoms to come forward for testing announcing that even if they are undocumented or uninsured they will not be left to foot the bill. The US private sector is stepping up to remedy the growing political fiasco on lack of coronavirus testing ability in the US. Decentralisation is showing its benefit by increasing the US’s resilience against the outbreak.

The world’s Chief Index Officer is however still missing in action. Mission is not accomplished at all thus far. However, POTUS does care about the stock market and it will take a beating when it opens tomorrow. Lack of decisive action would undeniably lead to a rout. I expect that the Federal Government will step up as a result, and the powerful agencies that are CDC and the FDA also need to show more independence to saves lives and not risk losing the hard earned trust of the public going forward. The President and its fiercest ideologists against Obamacare have shown earlier in the week that they are ready to support the use of the Stafford Act for the president to mobilise federal resources by declaring an emergency or a disaster and temporarily provide health coverage for the needed (see my previous post “It’s the public health stupid!”). Some of the containment measures, such as closing schools, will work most effectively against the virus if accompanied with a surge of funding to provide for the most vulnerable . Bill Blasio (Mayor of New York) has shown the way by publicly announcing that testing cost will be covered for everyone. Even looking narrowly at the economic level, not providing this type of funding now would ultimately exact a much higher economic dislocation and loss of tax revenue than providing this insurance and reassurance straight away.

It’s time for decisive action, we have lost enough time. What happens to the virus is up to us.

“I've been working on epidemic preparedness for about 20 years and completely dispassionately without elevating the temperature or speaking hyperbolically this is the most frightening disease I've ever encountered in my career and that includes Ebola, it includes MERS, it includes SARS. And it's frightening because of the combination of infectiousness and a lethality that appears to be manyfold higher than flu”

Richard Hatchett (CEO of the Coalition for Epidemic Preparedness Innovations)”

🏛 The article “Coronavirus crisis calls for competence, clarity and courage at the top” by Steve Usdin, Washington editor of BioCentury, summarises what is needed now and provides a good summary of the how political interference has thus far hindered taking decisive action. He summarises what has worked in other countries when decisive action was taken. In his view, the delay in testing in the U.S. “was caused by incompetence at CDC and poor decisions at the FDA”. On a personal level, and in addition to the lack of leadership plainly exposed in the title, Usdin particularly singles out current FDA Commissioner Stephen Hahn’s lack of visible independence from POTUS while acknowledging that “not all the or even most of mess lies with him”. A good read. (Link)

🤕 Richard E. Besser (former acting director of the Centers for Disease Control and Prevention - CDC) writes an important editorial “As coronavirus spreads, the bill for our public health failures is due”. Besser was acting Director at the CDC at the time of the H1N1 (Swine Flu) outbreak in Mexico in the spring of 2009. He laments the pushback that he was hearing then and which is repeating itself potentially causing delay or outright stopping appropriate school closures in certain areas. He rightly writes that the economic cost in the US of such a predicament is self inflicted and does not need to be so. The US needs to make sure that short term economic consideration doesn’t hinder containment strategies by protecting the ones most in need. The lack of funding risks inflicting a vastly larger death and economic toll in the US and globally. More specifically Besser wrote:

“In the meantime, we could also consider a fund to compensate hourly workers without paid leave for their loss of income when sick; provide legal aid for those who are fired for not coming to work when ill; fund outreach to non-English speakers; ask insurers to waive co-pays for testing and treatment; supplement funding for community health centers that care for a large proportion of those without insurance; and ensure free meals are available for children when schools are closed.” 

This needs to happen quickly at all levels of government to avoid a cataclysm particularly as Trump has the powers needed to do so at his level. (Link)

🍏 As noted in the introduction, Bill Blasio (Mayor of New York) has shown the way in New York by removing as much as possible the economic burden of COVID19 testing from the decision-making of the most vulnerable. This is the leadership we need globally. At state level, the governor Andrew Cuomo has declared a state of emergency as the number of coronavirus cases in New York rose to 89 on Saturday. The declaration of emergency will allow New York to speed up the purchasing of supplies and the hiring of workers to assist local health departments handling the monitoring of thousands of self-quarantined patients. Bravo New York! (Link)

👨‍⚕️ Jon Cohen from Science conduct an interview of Clifford Lane (Deputy Director for Clinical Research and Special Projects at the NIAID) who took part with 13 other experts in the recent World Health Organisation in China and is now in quarantined at home. Lane recalls the sense of cohesiveness in China’s response in fighting COVID19 as the common enemy as well as the dynamism and agility of the Chinese authorities in fighting the outbreak. He also praises their intensive care capabilities focusing particularly on the use of ECMO (Extracorporeal Membrane Oxygenation) a method that artificially oxygenates blood. He then speculates on how potentially countries with high ECMO capacity could potentially lower fatality rate for the disease.  The availability of such technique in the US is not definitely known but points again to the capacity level factor I wrote about yesterday. He praises the efficacy of lockdown which in some parts of China was more akin to severe restrictions rather than a literal and full lockdown, as well as the importance of contact tracing. The former has not been implemented yet in the US and the latter will only be able to happen at scale once testing finally gears up after the initial missteps. (Link)

🇮🇪 As its death toll jumped to 230 and it added 1,200 deaths to a total of 5,883 on Saturday, Italy has announced the most drastic measures in the West by imposing quarantine on 16 million of its people. There are a number of reports of capacity stress in the health system. These measures were therefore inevitable and should be welcome and heeded elsewhere when the situation warrants. (Link)

🇨🇳 Shanghai has tightened airports check as it faces a new type of threat from migrant workers returning to China. Whilst number of cases has come significantly down, it faces a potential resurgences in COVID19 cases as it attempts to put people back to work and particularly as migrant workers also return. Of the 25 new cases that were outside Hubei, China claims that 24 were imported from outside China. (Link)

🧪 Potentially in response to Alexis Madrigal’s hard hitting article in The Atlantic on the testing fiasco in the US including his own sourcing of testing numbers nationwide, the FDA came out with the numbers: “As of Friday at 6 p.m. ET, 5,861 tests for coronavirus have been completed by the US Centers for Disease Control and Prevention and public health labs.” It is a reminder of the role of the press in applying pressure and potentially driving the right action from the top of government. (Link)

🧬 Trevor Bedford keeps doing useful and stellar work (while hopefully putting genetic epidemiology firmly on the funding map going forward). He continues to estimate how widespread is community spreading of COVID19 by analysing the gene ancestry of the various strains of infected patient in King and Snohomish counties. He predicts that we will reach 2,000 cases in these counties by March 10 if trends continue which is the starting assumption of the analysis in the link below. (Link)

❗️This is fantastic thread by Liz Spetch (Associate Director of Science & Technology at the Good Food institute). She runs the numbers to convince us of the risk of systemic health capacity failure we face with COVID19. MUST READ (Link)

📊 The New York Times updates us of what we know and don’t know about the deadliness of the virus. Good read with helpful infographics (Link)

📊 A picture is worth a thousand words

  1. NEW❗️ This is a GitHub made by my friend Francois Lagunas (co-founder and CTO extraordinaire of Stupeflix, a company we backed). He has written a script to scrape deaths and number of cases in order to visualise the rate of growth on a logarithmic scale. He has taken a time offset for countries assuming that South Korea and Italy are 36 days behind China’s outbreak, and France and the USA a further 9 days behind. You can clearly see that South Korea is an outlier (as already shown in my newsletter “Better safe than sorry” and that the severity of this outbreak will depend on the behaviours of the governed and the decisive action of our respective governments. (Link)

  2. NEW❗️This is a visualisation of how exponentially cases are growing outside China using WHO data. Shared by Jonathan Ball (Professor of Virology at University of Nottingham) (Link)

  3. Singapore remains the gold standard of dashboard. Here is an article with the Best and Worst of all dashboard in the world, with Pros and Con prepared by Neel V. Patel for MIT Technology (Article)

  4. This is a data visualisation page by Joel Selanikio (MD) on COVID19 (Link)

  5. This is the New York Times data and graph page on COVID19 with an update map of the US alone (Link)

🎬  Two videos today:

  1. Interview on Channel4 of Dr Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations". Apart from the ominous quote at the beginning of the newsletter, Dr. Hatchett also said: “what happens to the virus is up to us” (Link)

  2. Bill Blasio (mayor of New York) has announced to New Yorkers: “If you think you have the symptoms of COVID-19, do not worry about the cost of testing or treatment. We will take care of you even if you have no insurance or cannot pay. Call 311 for assistance.” (Link)