🦠Covid-19 - 09/03/20 Fasten your seatbelts | 🤕 114,549 | Deaths 4,028

Erratum: apologies for the early readers of my newsletter yesterday where the link for Tony Lin great thread was mistakenly pointing to a private link in my Cronycle board, the platform I use for my newsletter curation. For those of you who would also like to browse the most relevant stories in the last 24 hours, here is an open access feed which you can either bookmark or follow(Link)

📊 Daily Data Brief: NEW❗️

As the dynamic and spread of the epidemic changes, I have added a graphic from the New York Times data visualisation page

114,549 cases 

New cases outside China: 4,371

New Cases in China:  +22 

% cumulative cases outside China:  29.5% (NEW❗️)

Total Death: 4,028 (+154)

Serious or Critical Cases:   5,771 (-208) 

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

In the West the surge in Italy is happening right now: so far 9,172 cases for a death toll of 463. The government has decided to extend its lock down to the whole of Italy. It is following the Chinese model in a free society. COVID19 will inevitably spread in other places with identical containment strategies given that its intrinsic reproduction properties are the same across borders. And yet not every country appears to be following the Chinese model, mainly fearful of its economic consequences and its replicability. Some are advocating balance between pubic health and GDP growth (lives versus money) particularly given the rout in the financial markets yesterday. Communication styles vary between the sensible UK Chief Medical Officer Chris Whitty and Donald Trump: science versus populism. They could significantly impact trust going forward while we already live in the age of distrust when it comes to government.

The surges will continue regardless, and given the poor communication in most countries the anxiety will rise. There is however another argument surfacing to support the approach taken by the UK (and to some extent the US with at least much poorer comnunication). It is a risky one, and one you should only take with better data than we currently have (at least publicly) and which would require broader testing. The reasoning consists of getting part of the population exposed now so as to build some immunity amongst it to face the virus in the future. It is the second season of the famous Spanish Flu which was the deadliest. It poses a great moral conundrum: accept deaths now to lower death toll later. It would also potentially be an abdication from governments that we could not replicate what China has done (and then it begs the questions why? were we too slow to react?), and an assumption that COVID19 will not only be pandemic but will also become endemic (it’s here to stay and you will get flu and COVID19 vaccine shots every year as soon as the COVID 19 vaccine emerges in 12 to 18 months).

If these ‘balancing’ assumptions are wrong it will be a catastrophic death toll.

Fasten your seatbelts.

(can you please comment on this ‘conundrum’ in the section below the post today; I feel this requires a strong public debate)

🇮🇹 Thread of the day: from the frontlines in Italy

This is a Twitter thread from Jason van Schoor (Registrar in Anaesthesia & ICM | NIHR UCL), relaying a summary of the situation in Northern Italy from one of his “well respected friend and intensivist/A&E consultant there”. It describes what a surge of the virus past the local health capacity feels like to the medical staff, the resulting suboptimal level of care which and the ensuing demoralising fatality rise for the health workers in particular (including non COVID19 infected patients). A grim read. (Link)

📜 This is a great article from David Roos on the History website about “Why the Second Wave of the 1918 Spanish Flu Was So Deadly”. It is a fascinating tale, full of learnings for now. It recounts the lack of quarantine, the inability to develop a vaccine, health capacity shortages and the wartime imperative impeding proper public health policy at the time. In a chilling passage as we face the same conundrum and the then wartime imperative has been replaced by the economic growth imperative, Roos writes:

“Harris believes that the rapid spread of Spanish flu in the fall of 1918 was at least partially to blame on public health officials unwilling to impose quarantines during wartime. In Britain, for example, a government official named Arthur Newsholme knew full well that a strict civilian lockdown was the best way to fight the spread of the highly contagious disease. But he wouldn’t risk crippling the war effort by keeping munitions factory workers and other civilians home.

According to Harris’s research, Newsholme concluded that “the relentless needs of warfare justified incurring [the] risk of spreading infection” and encouraged Britons to simply “carry on” during the pandemic.”

A great read as we need to publicly debate and hold our leaders’ current decision making on fighting COVID19 to account (Link)

🧪 Alexis Madrigal and Robinson Meyer in The Atlantic follow up on their previous hard hitting article exposing the COVID19 testing fiasco in the US with “The Dangerous Delays in U.S. Coronavirus Testing Continue”. It is journalism at his best like Alexis is accustomed to. A very good read which highlights the debilitating consequences this fiasco has both at an individual level to decide one’s best course of action and at a country level to slow the outbreak. (Link)

💰 Annie Lowrey in the Atlantic writes “The viral recession” on the different nature of the upcoming recession. The supply-side nature of the recession COVID19 is being caused by disruption in supply chains and labor supply through quarantine. Lowrey questions the adequacy or effectiveness of central bank cutting interest rates to tamper the inevitable recession to come. Only fiscal policy remains and this will be a very politically charged policy change in the US. At a press briefing yesterday, the US government announced that Trump will outline measures for American worker today. As advocated in this newsletter before, this temporary Keynesisan approach to preserve the economy is inevitable. Let us see what the administration announces given its strong fiscal ideology on deficits and Medicare. More sooner is better and needs to include better health coverage at least temporarily (Link)

🤕 The Wall Street Journal reports on the findings of disease analyst at John Hopkins University on a large study (181 patients) looking at the timing of symptoms occurence and contagiousness of patients infected with COVID19. Symptoms appear mostly after 5 days and “97.5% of those who develop symptoms will do so within 11.5 days of exposure”. It confirms the 14-day isolation recommendation to contain the virus although 100 out of 10,000 will show symptoms after 14 days. Helen Branswell at STAT News also reports in a study conducted in Germany on 9 patients looking at contagiousness of COVID19. The findings also point to COVID19’s superior contagiousness versus SARS. The study finds that patients viral shedding (the expulsion and release of virus following infection) happens in large quantity early on and before developing symptoms:

“early and potentially highly efficient transmission of the virus occurs before clinical symptoms or in conjunction with the very first mild symptoms.” Michael Osterholm, Head of Cidrap

COVID19 peak shedding is 1,000 times that of SARS shedding likely explaining its higher spread (114,000 versus 8,000 cases for the SARS epidemic) (Link and Link)

🎖 Mark Suzman (CEO of the Bill and Melinda Gates Foundation) announces the COVID-19 Therapeutics Accelerator in partnership with Wellcome and Mastercard. The initiative is aimed at replicating for therapeutics what the Coalition for Epidemic Preparedness Innovations (CEPI) has done for vaccines research. The accelerator has already received $125mm from its early founders compared to $650mm for CEPI at inception. (Link)

🦠 Kai Kupferschmidt in Science (“Mutations can reveal how the coronavirus moves—but they’re easy to overinterpret”) looks at the current limit of the emerging genetic epidemiology field. I have previously reported on NextStrain and Trevor Bedford’s work at FredHutch estimating the spread of the virus in the Pacific Northwest and Bavaria through this technique. It is a good read showing the challenges of discovery when working on the edge of a field and in particularly the necessity to correctly caveat the publishing of any findings. Kupferschmidt made sure in tweeting his article that it should not be perceived as an attack on Trevor Bedford work (which he had acknowledged himself in the previous peer-tweet-reviewed comments he had received on his excellent threads). A good insight in scientific discovery and publishing (Link)

📊 A picture is worth a thousand words

  1. NEW❗️Data and chart regularly updated by the Centre for the Mathematical Modelling of Infectious Diseases at the London School of Hygiene & Tropical Medicine. It maps the effective reproduction number (also known as R0) of COVID19. You want to get it below 1 as fast as possible to contain an epidemic. (Link to see charts and more data about your country)

  2. Updated❗️This is a great COVID19 Dashboard prepared by Andrzej Leszkiewicz. Andrzej has also written an introductory and explanatory blog for it (“Coronavirus disease (COVID-19) fatality rate: WHO and media vs logic and mathematics”). It is a very extensive dashboard with 28 pages. I particularly like the country comparison tab, which allows you to track and benchmark the curve of the epidemic (number of cases and deaths) in your country with that of another. Very well done and informative. (Link)

  3. Updated❗️ (new narrative) 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)

  4. 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)

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

🎬  Second time I feature Chris Whitty (UK Chief Medical Officer). It is a short video of him explaining alongside Boris Johnson what is to come in the UK and in particular that within 10-14 days people with a minor respiratory tract infection will be advised to self isolate at home for 7 days. While sensible advice it also highlights and confirms the health capacity problem overwhelming risk which I have been writing about (Link)