🦠Covid-19 - 14/03/20 Every day matters| 🤕 145,958 | Deaths 5,440

📊 Daily Data Brief: 

145,958 cumulative cases (+11,470)

Active cases: 67,965 (+7,362) (this is the number of currently infected patients)

% cumulative cases outside China:  40.19%

Total Death: 5,440 (+470)

Serious/Critical Cases:  6,082 (+88) Alert❗️2nd day it’s up

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

Animated atality curves (update coming later once ECDC releases new data)

The virus continues its inexorable exponential and lethal ascent as countries scramble with the right policy. At the moment in most countries, the number of deaths approximately doubles every 2.2 days. That is the nature of an exponential epidemic. To put it simply, very soon after an outbreak and unless urgent and immediate policies to curb it are put in place AND clearly communicated to the public, take the number of death today in your country and multiply it by 16: that is your country fatality number in 9 days. Ponder that and act accordingly.

Quality of communication and sense of urgency from the top of governments have been lacking at times in a number of countries to say the least. It is getting better. We have regrettably lost precious time with China censoring from its population and the rest of the world what was happening in Hubei. Since then, valuable data has come out from China to substantiate both the efficacy and urgency of implementing as strict a social distancing as your society and individuals are prepare to take. The more your society will avoid them the sooner you should start. Data suggests it takes about 3 weeks from then on to reach your epidemic peak. The more you wait, the more your health capacity will be breached sooner and more severely. Of course, questions remain about what happens when you lift these measures, but in the meantime our understanding of COVID19 will improve and we will be closer to therapeutic advances and/or vaccine. This might open other policy options.

What is there to lose: GDP growth and negative psychological effect of isolation for most of the population (telecommuting drinks and dinner parties are not exactly the same). What about the effect of overloading the health system if we wait. Very little regard seems to be given about the effect of overloading the healthcare workers (HCW). We talk about '“capacity” and “ICU”, but rarely about the humans who are making up that “capacity” or operating those “ICUs”. And yet we so need them in normal times and even more so in COVID19 times. HCWs do not make the calculations either about whether you are under 20 and have x% chance or you are 80 and will have y% chance when you arrive. Once you are admitted to hospital they take care of you: it is two patients. We need to think about the doctors and nurses wellbeing. The likely walkout or burnout is not something you apprehend with numbers only and we need to avoid at all costs.

Making up for the inevitable GDP loss should be trivial. You counter it with fiscal stimulus. Who will be the “Marshall” to put his name on the plan which will follow? That should be the only outstanding question. The EU, the UK and the US both have already earmarked funds to combat the pandemic. Again the sooner we act the smaller the plan. It requires some courage and foresight but above all humanity. Feelings for the people, friends, family who will lose their life and the suffering on the overwhelmed healthcare worker. As some have said it is money versus people.

There seems to be consensus now around the world as to what is the best approach. One country stands out: the UK. In my post yesterday (“We are not sheep”), I argued for a democratic debate on the UK government’s policy as it wants to break away from the consensus and proceed with a herd immunity-based approach. From what I had read and even after what was posted yesterday, I cannot see a smoking argument for it. The UK government should publish its assumption and model, particularly as it is a policy outlier.

Fortunately, and away from the top of the government we continue to see individuals, businesses, philanthropy, region governors and mayors communicate and implement decisions to support social distancing. Individuals take their kids out of school even though they are not close. It is not Extinction Rebellion’s level of civil disobedience but it is reminiscent of it. As I argued yesterday cooperation and governance are key to combating this global pandemic the same way it will be to combating the climate risk. There again we learned yesterday that the G7 will meet on Monday to coordinate.

What happens to the virus is still up to us but every day matters.

🇨🇳 Video of the day: Again if you watch one video today it is this one. Rachel Maddow in conversation with Donald McNeil. The COVID 19 testing fiasco i the US is real. However the test in question is not the first testing step in isolating potentially infected patient as practiced in China and outlined in the video. The video shows how China was able to use its experience from SARS in its successful COVID19 isolation strategy. There is nothing that smacks of authoritarianism in the steps described here. A great interview (Link)

📊 The Nicholas Kristof and William Thompson at the New York Times have made available an educational simulation to help understand the objective of social distancing and the urgency to implement it.

“What’s at stake in this coronavirus pandemic? How many Americans can become infected? How many might die?

The answers depend on the actions we take — and, crucially, on when we take them.”

Very well done and worth playing with. Every day matters. (Link)

🐑 Robert Peston who got #herdimmunity trending on Twitter with his article included in yesterday’s newsletter does a follow-on titled: “The most important fact about coronavirus that the government does not know”. Although it is undeniable the the political decision which needs to be taken is complex (this twitter Thread is a good explainer), it does not absolve the government from a vigorous public debate given the mortality of COVID19. (Link)

🐑 On the same topic in The Conversation, Jeremy Rossman - Honorary Senior Lecturer in Virology and President of Research-Aid Networks, University of Kent, pens “Coronavirus: can herd immunity really protect us?”. Using the numbers the government has put forward in terms of percentage of the UK population which would need to develop personal immunity for its strategy to work Ross write:

“Achieving herd immunity would require well over 47 million people to be infected in the UK. Current estimates are that COVID-19 has a 2.3% case-fatality rate and a 19% rate of severe disease. This means that achieving herd immunity to COVID-19 in the UK could result in the deaths of more a million people with a further eight million severe infections requiring critical care.”

The numbers involved show the importance of a public debate if the government pursues this strategy. There has been a lack of clarity on what strategy it was exactly pursuing particularly as it postponed the local election for a year and is about to ban large public gathering. At the very least you cannot communicate that you want 60% of the population and convince people that social distancing is urgently required. (Link)

📃 Adam Kucharski has been a clear voice since the beginning and has just published a very good book (“The Rules of Contagion - Why things Spread - and How They Stop”). In light of the backlash which a herd immunity-based strategy provoked, he wrote a very good thread on Twitter explaining (a) “How does mathematical modelling analysis feed into UK government COVID-19 policy”, (b) the existence and diversity of opinions in the Scientific Advisory Group for Emergencies (SAGE) which the UK Chief Medical Officer and Chief Scientific Adviser take advice from and (c) listing some of the members and relevant publications. It shows the openness from an esteemed epidemiologist in sharing how science can guide (but not absolve of responsibility) a political decision. The same attitude from the government (the same one who has yet to release the report on Russian interference in UK elections) leading to a democratic debate has yet to materialise. The SAGE members cannot make it happen on their own and they know too well how dependent they are on public funding to continue their valuable research.

I want to focus on the paper (published on 28 February in The Lancet) which Kucharski lists in his thread from his group at the London School of Hygiene and Tropical Medicine (LSHTM): “Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts”. It highlights one of the arguments that SAGE would have heard to support not solely relying on trace and isolation of contacts as feasible to contain the COVID19 pandemic and coming up with another strategy. It focused on two key variables in its modelling to assess the probably of success of such a strategy. The reproduction number (R0) of COVID19 and the days of asymptomatic transmission of the virus (for how many days a person with no symptoms is contagious).

The finding are interesting:

  • R0 of 1.5 and 0% transmission before symptom appears: control possible even with low contact tracing probability

  • Probability of control decreased with the number of initial cases rising when R0 is between 2.5 and 3.5 and when there was more transmission before onset of symptoms

  • With a R0 of 1.5, control could happen with only 50% of the population successfully traced

  • To control the majority of outbreaks, for R0 of 2·5 more than 70% of contacts had to be traced, and for an R0 of 3·5 more than 90% of contacts had to be traced

  • “The delay between symptom onset and isolation had the largest role in determining whether an outbreak was controllable when R0 was 1·5. For R0 values of 2·5 or 3·5, if there were 40 initial cases, contact tracing and isolation were only potentially feasible when less than 1% of transmission occurred before symptom onset.”

You can see how such a research would have been key in evaluation whether contact tracing (also know as surveillance testing) could have played a role in the UK Prime Minister’s political decision looking at cost, feasibility and probability of success of such strategy. BUT that would be an easy escape for the UK government (and for that matter a number of governments around the world who have thus far failed to protect their citizens). The research ALSO points that if you act early and if you have a low R0 (which is negatively affected by social distancing measures) you have a better chance of success.

This research was published on 28 February. This research should in due course lead to an enquiry for failure to act, but it also supports strict and urgent social distancing measures while we globally build up testing capability. (Link)

🐑 As I have argued before acting WHO directors have limited capacity to speak given the political nature of their work. Retired ones have more freedom of expression. In a Twitter thread, Anthony Costello, retired WHO Director, ask 8 questions on herd immunity. Good to kickstart the democratic debate urgently needed in the UK (Link)

📃 The US CDC has published a good paper on “Evaluation of the Effectiveness of Surveillance and Containment Measures for the First 100 Patients with COVID-19 in Singapore” one of the success stories so far in containing COVID19 for a City-State. (Link)

🇰🇷 This is also a very good article on South Korea another success story. “Why are Korea’s Covid-19 death rates so low?” looks at how preparation, experience, robust healthcare capacity, aggressive testing and a bit of luck all played a part in the success so far. (Link)

🧪 In positive news highlighting the key role that the pharmaceutical and diagnostic industry will play in helping us in this epidemic, the FDA approved yesterday a COVID19 test developed by Roche which is 10 times faster than current test. (Link)

🇺🇸 In the US Trump declared a state of emergency, and Congress passed a broad coronavirus bill with welcome sick-pay and health benefit measures and fiscal stimulus. The bill will go to the Senate next week. It was also noteworthy in the press conference that a number of large private were present at Trump side. They will have a key role to play in containing the virus. A welcome development. (CIDRAP Link and New York Times Link)

📊 A picture is worth a thousand words

  1. 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)

🎬  A TED bonus podcast with Adam Kucharski in the TED interview series: “Head of TED Chris Anderson speaks with some of the world’s most interesting people to dig into the provocative and powerful ideas of our time”.

The podcast title: “What should -- and shouldn't -- worry us about the coronavirus” (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)