🦠Covid-19 - 13/03/20 We are not sheep| 🤕 134,488 | Deaths 4,970

📊 Daily Data Brief: 

134,488 cumulative cases (+7,845)

Active cases (NEW❗️): 60,603 (this is the number currently infected patients)

% cumulative cases outside China:  40.19%

Total Death: 4,970 (+332)

Serious/Critical Cases:  5,994 (+288) Alert❗️1st day in a while that this is up 

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

Fatality curves (update coming later once ECDC releases new data)

Democracy and science are good bedfellows. As COVID19 continues its exponential growth in most countries, the strategies which country select will have a massive impact on the severity outcome of this pandemic. Ignoring science at the top of government is unacceptable. However, science must not equally be a shield under which leaders absolve themselves of their political responsibility. Understanding the interaction between the two is critical. Given that in a nascent epidemic, knowledge gaps inexorably exist and therefore public debate is what we expect in a democracy in such circumstances. In the case of an epidemic and given our interconnectedness, what a country decides has global ramifications for others and globally. Until COVID19 exploded in the public scene, we thought climate change was the only complex problem that had similar characteristics: central role of science, interconnectedness of effect and solution, inadequacy of current governance. Zoonotic pandemics now need to be added to the list, and there might be more we need to address.

Yesterday, #HerdImmunity started trending on Twitter. On my previous post on Tuesday (“Fasten your seatbelts”), I had highlighted the moral conundrum that basing a strategy on herd immunity poses particularly for the elderly: “accept deaths now to lower death toll later”. Since then a narrative has emerged in the media that there were spikes of cases in both Singapore and South Korea, and hinting that China might see a resurgence of cases once it loosens up its draconian lockdown. These are events worth monitoring to inform the best course of action. The success or failure of herd immunity is equally uncertain particularly given our current knowledge gaps on the virus. Choosing one or another to start with is a complex decision and although it must be guided by “science” it will ultimately be a political one.

Unlike foreign policy, the science of epidemiology has a strong modelling component to it. These models depend on data and confidence levels in this data. In the early stages of an epidemic key data on the on the virus are not known and the 95% confidence level range of R0 (the reproduction number) or CFR (case fatality rate) of the virus remain broad. Remember that in SARS the World Health Organisation reported initially that 4% of cases were dying in April 2003, until ultimate CFR of SARS was put at 9.6% in July 2003. Virus also mutate and can become more or less aggressive as they evolve. Any government, in choosing this course of action (or another) will rely on science and modelling. These should be shared and submitted to public scrutiny.

Going to war and fighting an epidemic should have the same democratic scrutiny giving the death implications of both. I am sure that the science community would welcome given that in their daily life as researchers their findings are peer-reviewed before they are published. Governments seem more reluctant but they need to evolve given the threat we are facing. Other governments (peer) should equally demand it given our interconnectedness.

We can consider herd immunity after a transparent and democratic debate, but we are not sheeps.

🇬🇧 Video of the day: Christiane Amanpour interviews Rory Stewart (Candidate for Mayor of London): “Government is not being transparent with the public”.

If you only watch one thing today watch this❗️ (Link)

🐑 The article from Robert Peston at ITV which made #herdimmunity trend on Twitter in the UK (Link)

🐑 Matt Reynolds in WIRED is on the side of Rory Steward and pens an article “The problem with using herd immunity to fight coronavirus”. It highlights how the UK is departing from the rest of the world in its strategy to fight coronavirus, led by Dominic Cummings and the UK’s Nudge Unit (!). Reynolds puts forward Jeremy Rossman, a virologist at the University of Kent, who advocates for a testing and isolate at scale strategy. It shows how different scientific opinions co-exist when we still have knowledge gaps. While we should welcome when the top of government relies on science as opposed to solely on guts, we should question whether there are different opinions. If there are, government should be transparent, share and debate them. (Link)

🐑 This is a twitter thread I started yesterday to demand a democratic debate if the UK government was indeed contemplating a strategy based on herd immunity (confirmed later). There are link to papers which are very relevant to this debate including one which models different strategies and resulting delays for eradicating the disease. As you will see from it, how quickly we can test and how quickly people get immunity (either through personal immunity or vaccine) has huge incidence on the timeline and consequently on death numbers particularly for the elderly (and depending on actual CFR). Also looking at MERS (another coronavirus), we do not know how long personal immunity remains. Adam Kucharski, Mathematician/epidemiologist at @LSHTM also did a twitter thread yesterday. He highlighted the risk of resurgence in countries who chose a strict lockdown strategy as soon as they lift it, as well as reported spikes in countries like Singapore and Hong Kong who did testing at scale and isolation. He ends his thread by stating:

“Among some extremely difficult options, we have to pick the most effective, sustainable way to minimise risk of overwhelming health system - and impact on the people most at risk”

I fully agree with this statement, but in a democratic society when so many lives are put at risk (as in wars) there is a need for public debate. The number of additional deaths we are talking about if we get this wrong urgently requires it.

(Link and Link)

🏛 This is a critical article by David Wallace-Wells in New York magazine (“America is Broken”). It is slightly partisan against Trump as a lot of writings around COVID19 in a US election year, but the points articulated are worth reading. It echoes the lack of leadership at the top, the fact that state, schools, state governors and city mayors have done more than the top. That is a good thing as I have argued before. Decentralisation of prerogative and decision making build resilience in a society. It also laments how in our societies economic growth trumps other considerations in decision making at the top:

Our leaders have spent so long focused on the value of economic growth they are likely to try to respond to any crisis, even a deeply urgent humanitarian one, as an economic problem to be solved with stimulus. What about hospital beds?

Well worth a read (Link)

🔬 The article above links a very interesting survey of epidemiologists on key forecasts. This is an excellent initiative by Thomas McAndrew at University of Massachusetts Amherst. Science is important but as we continue to have knowledge gaps on key properties of COVID19 this type of surveys are critical. When we hear politicians say that they rely on scientific evidence, we need to ask ourselves how broad are the opinions that they have consulted.

The first finding of the survey is below:

“Experts predict a four-fold rise in reported cases in the US over the next week. They predict 1819 total cases (80% uncertainty interval: 823-6204 cases) of COVID-19 will be reported by the CDC on Monday March 16th, more than 4 times the CDC reported number of cases as of Monday, March 9th.”

It should encourage you to read the rest to get a broad assessment of what the scientific community currently thinks about COVID19 (Link)

🇺🇸 Important thread from Andy Slavitt (Former Medicare, Medicaid & ACA head for Obama). Slavitt makes a damning attack on Trump and his administration. He starts with:

“Currently experts expect over 1 million deaths in the U.S. since the virus was not contained & we cannot even test for it. This will be recorded as a major preventable public health disaster. I will try to relate what I learned from a long day of calls about what is happening.”

He advocates for putting this aside and pulling together with practical suggestion in a new thread at the end. (Link)

🇫🇷 French President did his address to the nation yesterday less than 24 hours after Trump. Macron started by warning and preparing the public that the numbers will continue to increase inexorably over the coming weeks.

Macron was hitting all the right message, but one: going ahead with the first round of the municipal elections this weekend.  I think postponing the election would have given a stronger message and it could be that the thirst of power trumped reason, responsibility and the public interest.  It will be important to see whether the opposition parties criticise him for not postponing. If not, it might be that they were also the ones opposing it. It would not necessarily absolve Macron from responsibility as President to do what’s in the best public interest.

Apart from that it was in sharp contrast with Trump’s address on a number of points. Macron was advocating solidarity and cooperation, more than dominant unilaterism.  On the fiscal policy side, he prones for an expansion of already generous health and sick-pay regime by putting in place temporary and extraordinary unemployment benefit to “preserve skills” while activity significantly slows done. Like Trumps, France will differ payroll tax due at the end of March. Macron was careful to put science at the heart of his speech often referring that their opinion/advice was central to the policy measures announced. 

He singled out the elderly and the citizens as the one being particularly at risk.  Because children are super spreaders he advocated for school closures from Monday onwards.  A bit of cacophony when talking about day care for working parents... isn’t that like school?  Overall a good speech, which could have been much better had he postpone the elections. It could be that elderly people who make up most of the National Front and Conservatives will not show up which will be a boost for him. Misplaced electoral opportunism in my view given the public health risk. Let us see from the response today if the opposition had a hand in this controversial decision (Video Link)

🇮🇹 In a sobering article (“Italy’s Health Care System Groans Under Coronavirus — a Warning to the World”), Jason Horowitz looks at how what’s happening in Italy with overload of Lombardy’s health care capacity is an indication of what its to come for other countries who are a few days behind in their epidemic curve (Link)

📊 A picture is worth a thousand words

  1. NEW POSITION❗️I have moved this up today given my focus on herd immunity versus testing at scale and isolation. 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)

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

🎬  Two videos today from the Singapore PM and Boris Johnson. Two leaders who are on different path to contain COVID19 and with very different communication styles:

  1. Prime Minister Lee Hsien Loong of Singapore latest address as the country faces new spikes and clusters of COVID19 (Link)

  2. Prime Minister “Take it on the chin” interview to prepare the public for his herd immunity-based strategy (Link)

📈 Exponential growth and epidemics (permanent video)

This is an excellent video explaining “exponential growth” and epidemics. Although we are all familiar with the phrase, its authors rightly says that “yet human intuition has a hard time recognising what it means”. This is a ❗️MUST WATCH❗️to understand fully what is upon us but also how early behavioural changes at scale can have a massive impact on the level of exponential growth of COVID19 (Link)