🦠Covid-19 - 16/03/20 Catching up| 🤕 170,845 | Deaths 6,526

Link missing : apologies as I realised only latter on that the link for my “Article of the day❗️” was missing in yesterday’s post. Here is “Crisis Management for Beginners: Lessons from two World Wars” by Jonathan Boff. Well worth a read. (Link)

📊 Daily Data Brief: 

170,845 cumulative cases (+11,175)

Active cases: 86,529 (+8,777) (this is the number of currently infected patients)

% cumulative cases outside China:  52.6% ❗️more infected cases outside China

Total Death: 6,526  (+1,086) ❗️more death outside China now

Serious/Critical Cases:  5,927 (+273)

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

Case curves (update coming later once ECDC releases new data and new script to include more countries)

The gravity of COVID19 is sinking in as the death toll and the spread of the virus accelerate. There has now been more reported deaths outside China for this epidemic. It was only a matter of time from when the WHO decided to call COVID19 a pandemic. On the economic front, we are no longer talking about avoiding a recession. Bloomberg reports this morning that “EU finance ministers will seek to come up with a plan to steer the economy towards a hard landing rather than a catastrophic landing”. This is not “like the flu”.

How did we get there? I would argue that censorship (China), conflicting communication (“it’s like the flu”) from the top of governments, lack of public health funding and preparation are all factors which contributed. It is in great part due to government mistrust in their public (“Underestimating the public”). What are the consequences: the forced curtailing of people liberties will last longer and the human and economic cost will be larger. It is dishonest for some governments now to blame the public’s irresponsibility to justify the increasing harshness of their new measures when they are the ones responsible for not having prepared it adequately. Ultimately, this will continue to fuel the distrust in government from the public. It will need to change and new forms of governance will need to appear to build even greater resilience to tackle the complex problems of our time.

We are hearing measures and initiatives which are reminiscent of war. The fact that the army will be increasingly involved is maybe the more obvious one. The fact that “Marshall Plan”-like stimulus are being thought of as well. For me the most striking thought is calling on the private sector to re-focus their production on the shortages we have accumulated over the years to fight such a pandemic. Again, the private sector and philanthropy had turned up before the top of government did. Yesterday, LVMH announced that it will use its perfume production lines to start making hand sanitisers to protect people against the COVID19 outbreak.

Matters are improving and decisive action is on the rise. The days ahead will be challenging and the loss of life greater than most of us not living in proxy-war countries have ever experienced. I am encouraged by the response in most countries and the initiatives I see. More needs to be done and more quickly, particularly at the top of government. The public has already shown its virtues and capacity. There has been no ban on theatres in the US and yet the Box Office has had its worst numbers in 21 years. In the UK they have started a petition to protect NHS symptomatic health workers. Solidarity and responsibility are key in this fight.

We are where we are. We are catching up.

🦠 Simulation of the day: In Why outbreaks like coronavirus
spread exponentially, and how to “flatten the curve”
, Martin Stephens for the Washington Post does an excellent growth curve simulation with “simulitis” (a imaginary virus) and explain how “social distancing” works. He looks at two levels of “social distancing” compliance, a lock-down and open up scenario and a do nothing one. Well worth a watch and read. (Link)

🦠 Video of the day: this is a very short video (18 seconds) by Graham Medley (Professor of infectious disease modelling at LSHTM). It provides the solidarity argument for “social distancing” as opposed to the selfish one. Much better argument for building solidarity and resilience amongst the public. If you only have 18 seconds today. (Link)

❗️ There is a sobering article in the Guardian: “UK coronavirus crisis 'to last until spring 2021 and could see 7.9m hospitalised”. It provides a much needed reality check to the public about severity and timeline of the battle ahead:

“A senior NHS figure involved in preparing for the growing “surge” in patients whose lives are being put at risk by Covid-19 said an 80% infection rate could lead to more than half a million people dying. If the mortality rate turns out to be the 1% many experts are using as their working assumption then that would mean 531,100 deaths. But if Whitty’s insistence that the rate will be closer to 0.6% proves accurate, then that would involve 318,660 people dying.”

In France, Le Monde newspaper has had a similar article (in French - “Coronavirus : les simulations alarmantes des épidémiologistes pour la France”) urging people to social distance to avoid a death toll of up to 500,000. The article was a bit less alarmist but both point to a death toll which the “it’s like flu” narrative had failed to prepare the public for. Anthony Fauci, in Trump's COVID19 task force, was quoted over the weekend as saying: “"We'll be thankful that we're overreacting". Governments need to be more transparent with the public, share the epidemiology models that they are seeing. The “leakages” in the press are just a sign of them catching up in their communication with us. (Link)

👶 Too often we are hearing in conversation and reading in chat rooms that young people are not dying from the virus. Both Italy and France have been careful to point out that the disease affects everyone. An article (in French) stated that 61% of patients infected in France with COVID19 were between 18 and 64 years old. Anthony Fauci also stated the following in one of his interviews on Sunday:

"Younger people should be concerned for two reasons. You are not immune or safe from getting seriously ill. Even though when you look at the total numbers, it's overwhelmingly weighted toward the elderly and those with underlying conditions. But the virus isn't a mathematical formula. There are going to be people who are young who are going to wind up getting seriously ill. 

So protect yourself, but remember that you can also be a vector or a carrier. And even though you don't get seriously ill, you could bring it to a person, who could bring it to a person, that would bring it to your grandfather, your grandmother or your elderly relative. That's why everybody has to take this seriously, even the young."

As the 18 seconds video above, we will win faster and save more lives if the young practice social distancing as responsibly as the rest of the population (Guardian article)

🏺 As noted in the summary above, LVMH has announced that it will use its perfume production capability to make sanitiser gel. Obviously, the decision of the French government preceded such a decision but re-directing production and human resources to make up for our shortages in fighting COVID19 is a powerful symbol that we are at war with the virus. Others need to follow LVMH’s lead without waiting to be asked. (Link)

🦠 In yesterday’s newsletter, we looked at a WIRED article on the “airborne” properties of COVID19 to inform us on how best to curb its virality. WIRED published another article “How Long Does the Coronavirus Last on Surfaces?”. Err on the side of caution until we get more definite answers (Link)

💊 A number of you might already have heard the term “cytokine storm” in relation to COVID19. As Wikipedia states it is the result of your immune system “gone wild” and can be deadly. It also occurs in patient undergoing cancer immunotherapy. The Lancet article notes that a sub-group of patients with severe COVID19 might have a cytokine storm syndrome. It is an interesting article covering what we know about the use of corticosteroids in treating patients with other coronaviruses such as SARS and MERS:

“As during previous pandemics (severe acute respiratory syndrome and Middle East respiratory syndrome), corticosteroids are not routinely recommended and might exacerbate COVID-19-associated lung injury. However, in hyperinflammation, immunosuppression is likely to be beneficial.”

As with a number of aspects of COVID19 we are in the early days. Technical read (Link)

🦠 David Sinclair, a Harvard Professor working on ageing, has taken advantage of his lab closing to look at the current literature on COVID19: why it could particularly affect diabetics, why Chloroquine might be an effective treatment,... Again a technical thread of information, with David’s interpretation, links to sources & his predictions. Another reallocation of resource to the urgent scientific or our times. (Link)

👨‍⚕️ Two portraits: the official and un-official coronavirus czars. Anthony Fauci is he head of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH).  He is also a member of the White House Coronavirus Task Force. He is the real official deal and was on all major broadcast shows yesterday preparing the public. There has been a great curation of articles on him from Jon Cohen for Science.

But there is also someone who has been dubbed “The shadow coronavirus czar” in an article by Sarah Owermohle and Dan Diamond for Politico: Scott Gottlieb (ex-FDA director under Trump). He has been a great voice since the beginning of the outbreak. potentially more outspoken and less hindered political than Fauci.

Both are great to follow and are assets in the fight against COVID19 (Fauci and Gottlieb)

📊 A picture is worth a thousand words

  1. NEW❗️A great resource put together by Ben Kuhn and Yuri Vishnevsky. At a time when we need solidarity and cooperation, I prefer their subtitle “We need stronger measures, much faster” than their title. It’s a simulator on what case growth looks like depending on your community’s measures. The screenshot below explains what options you can look at:

    Fantastic resource to stir communities and governments to action (Link)

  2. A helpful guide by VOX of the “9 coronavirus pandemic charts everyone should see” (Link)

  3. 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)

  4. 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)

  5. 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)

  6. 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)

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

🎬  Two videos

  1. A short video from Anthony Fauci appearing in “Face the Nation” on CBS and answering whether he would go to a restaurant in the US right now. (Link)

  2. A long podcast COVID19 FAQ with Peter Attia, MD and Paul Grewal, MD. It covers a broad range of topics which covers gravity of COVID19, potential drug therapies, their view on containment versus management, what we know about transmission (Link)

🙌 (NEW❗️)There are many ways in which you are giving back to our newsletter: comments, thank yous, links and sharing. One of yesterday’s one, was Martin Tsine (Managing Director of the Luminate Group - Luminate is a global philanthropic organisation focused on empowering people and institutions to work together to build just and fair societies)

Martin tweeted the following, quoting our recent “We are not sheep” post:

📈 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)