can we stop COVID-19 ?

[gsgs]

2020/04/07 , the pandemic has been stopped now. In almost all the affected countries who faught it with social distancing.
This is a new experience. All the modelers, all the pandemic plans all the flubies didn't consider this possibility.
It hadn't been done before.

http://magictour.free.fr/world.GIF

----------------------edit---------------
with "stopped", I meant the increase was stopped, the peak was reached. It's still there, still going on.

 

[gsgs]

https://covid19.healthdata.org/united-states-of-america
peak on Apr16
81766 COVID-19 deaths projected by August 4, 2020
prediction from Apr07

referred to by the White House coronavirus task force

 

[JJackson]

Can we beat this? Yes, probably, depending on what beat means - eradication may not be possible but making it manageable is do-able.
The path would be the current measures, which will have drastically reduced the R(e) (effective reproductive number), from an R(0) of nearly 3. If you reduce your contacts, likely to cause an infection, to a third of their level before then the R(e)=R(0)/3 = 1. The problem is the cost. Time will reflect this in the numbers and they will plateau and fall. While all this is happening we must do 4 things 1] Keep increasing PCR testing capacity. 2] Vastly increase rapid antibody test kits. 3] Train contact trace teams. 4] Set up national online self-reporting of suspect case data. Once hospitals have reduced loads and have available surge capacity restrictions can be lifted, by degrees, to ease pressure on the economy and the effect monitored. However this will be a new normal and all the hand hygiene and social distancing must stay. The IgM/IgG test should be used first for patient tests one week (or more) post symptom onset then healthcare workers and those who think they have had it and recovered. Anyone IgG positive are a now a valuable resource and if their skill set is good for getting the economy moving that is what they should do. Everyone else could contact trace or help out in high risk exposure healthcare areas like cleaning, moving bedding to the laundry etc. HCWs can cut down on PPE levels freeing up reserves for those who need them.
My points 1 to 4 are critical in making the right decisions on when and where to relax restrictions.
We need a disease time scale to look at why. Broadly from infection (day 0) to obvious symptom onset (day 0-7) mild to moderate (at home 7-14) hospitalisation and passive oxygen support (14-21) ICU mech. vent. (21-30). Obviously for most the immune system gets control at some point and this progression reverses direction. On this time line the peak viral shedding seems to ramp up from day 5, peaks around 10 with a longer tail but there is not much viral load by the time of ICU admission. The antibody response timing is IgM starts to build from day 10 (day 4 post symptom onset for detectable load) gradually being replaced by IgG which should test positive 4 or 5 days after the IgM. A week after IgG detection levels should be good enough to prevent reinfection (this bit would need careful monitoring). From this it should be clear that PCR test capacity (which needs expensive kit and highly trained staff) should be reserved for early detection (in conjunction with contact tracing) while the point of care tests are not cheap they can be mass produced and self-administered.
What China did, and I have seen some encouraging signs from the US Governors, is move capacity rapidly to where ever it was needed most. The epidemiology of respiratory disease burden is well characterised and this epidemic is sticking to the playbook. Clusters about a point leading to new clusters with their own geographic and temporal centres, the key is not to let this degrade into an amorphous mass where everywhere is swamped at once. We are a very long way from having the capacity to tackle a NY sized problem everywhere at the same time, a city's fire brigade can send one appliance to several small fires or all of them to one massive one but not deal with lots of big ones at the same time.
Well-structured large clinical trials should also help as a number of drugs are showing some benefit but they should be more beneficial once we have a better understanding of when to use them in the course of the disease, for how long at what dosage and in which combinations. Nothing is preventing or ending infection most are limiting impact or duration by immune modulation so may make matters worse at some points and better at others.
If the richer nations can achieve this then the problem shifts to the poorer countries which are behind us, and well behind China and S Korea, in outbreak timing. Outside of a Flutrackers audience this is going to be hard to sell but we need to include them in our plans and send healthcare resource abroad even when we have problems at home. You can call it compassion or enlightened self-interest but the reasons are beyond the scope of this post but are real. I would start looking through the FT archive at broader supply chain issues which are already happening but are not yet apparent as they also have a time lag between cause and effect.

 

[bertrand789]

La situation me semble dramatique, car, nous sommes face ? une gestion tr?s d?sordonn?e: chaque pays faisant sa propre cuisine, alors que cet agent a r?ussi ? aller partout. Cet agent permet des premi?res: arr?t des vols et de bien d'autres choses. ceci me semble signifier que les op?rateurs ont enfin admis que pour cet agent ils ne peuvent faire assez. Donc, elle est o? la strat?gie mondiale ?
Tout semble fait pour que pour seule l'?mergence d'un vaccin soit la seule bonne solution, c'est ? dire qu'en attente de la production avec un volume suffisant, il va y avoir plus ou moins de r?sultat ici ou l? , mais comme ce ne sera pas g?n?ral, d?s le moindre relachement, il y aura r?cidive.

Ce n'est pas le premier coronavirus ?mergent. Les pr?c?dents ont ?t? g?r? sans vaccin. Donc, c'est uniquement parce qu'en l'?tat actuel , il est plus malin ou que l'on est beaucoup plus b?te?
Maintenant, si l'on admet qu'en attente d'un vaccin et vu l'absence d'aucun m?dicament, au sens occidental, il est ou le planning de production des vaccins , pour une diffusion mondiale, vu que l'on passe le temps ? dire que d?sormais l'?conomie est mondialis?e?

"Selon lui, la marche du monde ne pourra revenir ? la normale que lorsqu'un tel vaccin sera accessible globalement. Le sc?nario le plus optimiste table sur douze ? dix-huit mois."

https://korii.slate.fr/tech/bill-gat...ires-recherche

certains avaient propos? d'autre chose, mais d?sormais on en est l? : donc 12 ? 18 mois, c'est cela ?

 

[JJackson]

Having a vaccine and having it in quantity are very different problems. There is an RNA vaccine which I expect to work and be first to market (it uses an approved platform so clinical trials need only verify the chosen RNA is not a problem) but I can not see a path to scale it. Others may be more scalable but will take longer. We should not be planning based on a vaccine for all scenario as we have to find a way live over the next year or two and we may never have one. The common cold is an enormous economic burden but we have never managed to create a vaccine. China has managed to release restrictions while at the same time holding down the case numbers but they trained vast numbers of contact tracers who could enter patient data into a central database in real time. They also only started lifting restrictions when they had a few hundred cases and the ability to PCR test 50,000/day and contact trace for all 200. Their numbers are still falling and they recorded 75 new cases and 2 deaths in the current WHO sit-rep. There are a number of eminent scientists who think vaccine, or post infection immunity, will not be life long but wain after a year or two but the residual protection will result in a much milder disease akin to colds or flu symptoms. OC43 and the other corona viruses that cause colds may have been just as dangerous at emergence but as this occurred 100s of years ago we do not know about it.

 

[bertrand789]

Merci,
indique moi comment on re permet aux avions de reprendre sans vaccin ?

on fait test, au d?part, ? l'arriv?e ( quand on a pas confiance) , quatorzaine syst?matique et nettoyage int?gral de l'avion avec les r?sultats que l'on sait ?

Ce qui va re-circuler en premier, ce sont les marchandises , les humains cela devra attendre le vaccin, ou ?


* inclure la composante vaccinale dans la vaccination anti grippe, ce me semble le but, apr?s la phase de primo vaccination ?

 

[JJackson]

Human movement is going to be a problem for the foreseeable future. Do not travel if you do not have to. Arrivals from areas with cases many need to be quarantined but at some point we will have to accept that we are going to get some level of seeding from area to area. If contact tracing, testing and the hospitals have capacity then this will just have to be accepted as a cost of doing business. Everything has risks, this is introducing a raft of new ones, and all we can do is quantify them as accurately as possible and take what ever measures are open to us to minimize them and look after those who do catch it. Cars are dangerous but we have improved brakes, tyres, lights, crumple zones and seat belts but we still use them.
N.B. I was careful to talk about areas not countries. This needs to be thought of as global phenomenon and in terms of populations. Looking at it from a National or regional standpoint is likely to be counterproductive but due to the way we are conditioned to think and our activities and decision are made hard to do.

 

[gsgs]

we may get countries/regions/groups which had a full wave and regions which avoided it.
These groups will separate from each other ... earnings and measures and contacts will be different in the groups.

 

[JJackson]

Agreed. This is not going to help. From a national level China would be best served in the short term to seal its boarders and return to work while clearing all cases from its territory. In the longer term they need the rest of the world functional for fuel, raw materials and as a market. From a global perspective they would probably best sending all the help they can to poorer states so we do not have a sharp divide between areas with weak health systems continually reseeding everywhere else. It is not a mindset that we are used to and will need a higher level of intellectual capacity and Statesmanship than I have witnessed to-date.
Thanks for the thread, it is timely, as we need to be thinking seriously about what comes next and how we deal with it from a personal, nation state and planetary perspective.

 

[etudiant]

we may get countries/regions/groups which had a full wave and regions which avoided it.
These groups will separate from each other ... earnings and measures and contacts will be different in the groups.

I strongly disagree with JJackson's perspective, as it only applies if the virus remains effectively untreatable for years.
A vaccine would change the calculus. Chine would not want to be seen as a completely self centered entity when it requires the rest of the world to be a customer as well as a supplier.

 

[JJackson]

etudiant
I obviously did not make my self very clear, apologies. I do not think China will act like that, in fact they are doing as I hoped and giving support to Iran and various African countries. I was trying to make the point that closing in may look like a good idea in the short term but just makes matters worse and is unsustainable. The US position regarding not allowing 3M to fulfill its obligations to non US customers or threatening India if it does the same with chloroquine exports is a recipe for disaster. Every country has something someone else needs and a tit-for-tat trade war is just pouring fuel on the fire.
re the vaccine I do not think we will have enough vaccine for years, we may have a working vaccine in a year but we are going to need billions of vials and there is no capacity for anything like that. How do we structure society in the interim? If you see a route to fast vaccine in volume or a safe way for us all to work until then I would love to hear it!
Serum is the only volume prophylaxis I can see becoming available but again we have only 0.01% infected so far, so even if all of it is collected it is not enough.

 

[gsgs]

Would China or Europe as class-S want to mix with other class S people ?
Better import workers from class I (India ? Indonesia ? Mexico ? Turkey ?) for sensitive jobs
like merchants,sellers,nurses,waiters,hairdressers,pang ulin-butchers.
And that's a chance for those people with an antibody-passport to get a job
and an immigration chance. A chance for which they may risk their life.
We may even send our elderly into retirement homes in class-I countries
(S for susceptible,I for immune)