📊 Daily Data Brief:
New Cases outside China: 3,852
New Cases in China: +44
Total Death: 3,874 (+274)
Serious or Critical Cases: 5,979 (-61)
I ended yesterday’s newsletter summary by: “What happens to the virus is up to us.” I was welcoming the increase in quarantines, school closures, and new declarations of state of emergency. These are all measures we need to apply to saves lives. The spread of the virus is surging, and we need to collectively match it with the right intensity to win. We need more decisive actions followed by thorough implementation. It cannot only be a PR exercise. You cannot announce a quarantine on 16 million people in Italy on Saturday and then have dozens of flight landing Sunday evening in Britain and elsewhere from these quarantine regions without any checks on the passengers.
We are now able to reasonably predict what the curves of future cases and fatalities look like if they follow the same corrective measures as China for example who enforced a strict lockdown (or against that of another country). The numbers are grim. Some countries have done better than China but some commentators are worried that in our free societies we will not be able to match the same rigour as China’s lockdown. Freedom is a precious gift but it comes with great responsibilities. We need to apply our freedom to save lives. This time the enemy is not another country but a zoonotic virus called COVID19. It works 24/7, does not care about frontiers and loves our interconnected economies.
A number of people feel that a lot of recent wars have been unnecessary and have come at a high human and economic cost. They are indirectly responsible, together with lack of foresight in some leaders, for the budget cuts in public health. Lack of foresight because the enemy was changing, and security for citizen in an interconnected world was more about public health that national adversaries and competing ideologies. If leaders were able to mobilise for unnecessary wars, they should be able to do so for the necessary battle we are facing with COVID19. Not doing saw should be sanctioned. We have a tribunal in The Hague for War crimes but have not set one up for public health crimes. In free and democratic societies the sanction can still be no re-election. There are important ones coming up. Let us be informed and educated to effectively mobilise and make the top of our government accountable.
In most countries, and particularly in Britain with Brexit, we have a greater familiarity with the WTO than the WHO. It is a reflection of our misplaced priorities. The WHO has played a great and important role in coordinating against and communicating on the epidemic since the beginning of the crisis. Dr Tedros at its helm with his very experienced team (HIV/AIDS, SARS, H1N1, MERS, Ebola) have to navigate a very political charged environment to be effective. They have been impressive and not always listened to. We should all hope it changes fast.
In the US, the private and philanthropy sectors play a greater role in societies than other parts of the world. These sectors have turned up in this crisis and continually provide resilience to the US economy when its leaders falter. Their existence should however not absolve the Federal government of its responsibilities. The financial markets are opening down this morning with oil crashing over 30%. It should stir the world’s Chief Index Officer into action. It will not absolve him of past public health cuts under his watch and unfortunately Americans will have to pay a heavy price for it. Let us first hope that he shows leadership this week to curb the epidemic in the short term and that this crisis does not drive a more divisive and isolationist re-election rhetoric going forward.
Past this crisis, the problems which we are globally facing by their increasingly complex nature and global scope, require more global cooperation and openness (starting will climate change). Both of these can only happen with adequate trust between governmental parties and between government and their citizens. Both of these from the outset of the crisis have been lacking. Greater transparency (as opposed to censorship) and better public information (as opposed to disinformation) will need to improve. The scientific and academic community are showing us the way starting with data and research openness to better understand and combat COVID19.
Let’s get serious about the crisis. Let us use our freedom wisely to change our personal behaviour and hold our leaders accountable.
📊 Chart of the day
As we all mobilise to urge our respective governments to do more while continuing to adapt our personal social behaviour to contain the virus, here is a chart prepared 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 more data about your country)
🏥 In a very informative Twitter thread, Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, lists 9 measures implemented around the world as countries step up their containment and preparedness to stop & slow transmission of COVID19. A useful reference to benchmark the level of action of your government whilst reminding yourself that all of these are situation-dependent. (Link)
🏥 In a great blog, Trent McConaghy (Founder of the Ocean protocol, more to do with blockchain than oceans) asks and models his answer to the critical question: “When does Hospital Capacity Get Overwhelmed in USA? Germany?” This is a critical question to answer, which I covered in my previous newsletter (“Flatten surge, increase capacity”) as overwhelming hospital capacity, reduces level of care and increases case fatality rate (CFR) of COVID19.
“We found that a USA’s hotspot (Washington state) could hit capacity constraints in March 25. In Germany, Berlin could hit capacity constraints on about April 5.”
Worth a read. (Link)
🤕 This is a great Twitter thread by Tony Lin - recovering academic and producer at Quartz. Its aim is to mentally prepare and explain what is to come partially based on what has happened in Chinese society following the outbreak. (Link)
🎖 The Seattle area, home of Microsoft and the Melinda and Bill Gates Foundation (it was International Women’s Day yesterday so let’s reverse the order of the first names in the foundation name) have been hard hit by COVID19. In an analysis published over the week-end, genetic epidemiologist Trevor Bedford at FredHutch updates us on his estimate of the outbreak and now forecasts that we will most probably reach 2,000 cases in King and Snohomish counties (with a confidence range of between 370 and 5,000 cases). In addition to the experience of the Melinda and Bill Gates Foundations in epidemiology and its funding of initiative around the world, it is no surprise but nonetheless very welcome to see the article by Sandi Doughton in the Seattle Times “Gates-funded program will soon offer home-testing kits for new coronavirus”. It shows both the corrective role that philanthropies and private sector can play in a country in the US. In this case, it could potentially help remedy the COVID19 testing fiasco which I been previously reported on. Kudos to Gates and the team behind this initiative (Link)
🤦♂️ The title of Christopher Hope article in the Telegraph says it all. “Coronavirus farce as dozens of planes fly to UK from Italy's quarantine zones with no checks”. (Link)
📃 This is a good paper potentially giving some insight about why Italy’s epidemic numbers seem to accelerate so fast, on top of the intrinsic viral properties of COVID19 but also the ageing Italian population. It estimates 72% of non-identification of cases in the early stage of the outbreak.
“When all cases were considered we estimated a true outbreak size of 3971 cases (95% CI 2907-5297), as compared to a reported case count of 1128 on February 29, 2020, suggesting non-identification of 72% (61-79%) of cases.”
Great pre-print paper (as not yet peer-reviewed) (Link)
📃 Another interesting and fantastic preprint looking at modelling “Adjusted age-specific case fatality ratio during the COVID-19 epidemic in Hubei, China, January and February 2020”. The authors estimate overall CFR at 1.6% taking into account underreporting (also know as the “denominator issue” in the CFR discussion).
“We estimated the age-specific case fatality ratio (CFR) by fitting a transmission model to data from China, accounting for underreporting of cases and the time delay to death. Overall CFR among all infections was 1.6% (1.4-1.8%) and increased considerably for the elderly”
📊 A picture is worth a thousand words
NEW❗️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 Page 6, 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)
Update❗️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)
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)
This is a data visualisation page by Joel Selanikio (MD) on COVID19 (Link)
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 former FDA commissioner Scott Gottlieb in the video section. Here is his interview in CBS “Face the Nation” yesterday. Powerful, incisive and to the point. Quote of the interview as Scott Gottlieb explains inevitability of economic shutdowns: “China didn't shut down their economy because they had a bad flu season”. (Link of video + transcript)