Coronavirus notes: 2020/03/16

March 16, 2020: Technology Review: The UK is scrambling to correct its coronavirus strategy.

A new report issued by a group of experts advising the UK government offers a blistering assessment of the country's previous "herd immunity" approach to coronavirus, suggesting as many as 250,000 people could die as a result--and that it would do little to stop healthcare facilities from being overwhelmed....

Last week, UK Prime Minister Boris Johnson announced that his country would adopt a different coronavirus strategy than its European neighbors. Most governments have sought to suppress the spread of the virus by reducing mass gatherings, imposing quarantine restrictions, and encouraging social distancing. But Johnson said the country would forgo such measures with an unusual plan to prevent the outbreak from overwhelming the healthcare system and protect the most vulnerable groups during peak infection seasons. Under the strategy, at least 60 percent of the population were expected to contract the virus and get better--mostly younger individuals who would face only a mild form of illness. The government believed this would result in a "herd immunity" that would subsequently protect vulnerable groups from infection, while avoiding "behavioral fatigue" that would cause people to becoming uncooperative about safety measures over time....

The UK government seems to have realized its errors and is now scrambling to to do better. On Monday, Johnson asked people to avoid "non-essential contact" and refrain from going to crowded spaces and venues. A ban on mass gatherings starts Tuesday. Families were urged to stay home for 14 days should any members exhibit symptoms, "even to buy food or essentials."

March 16, 2020: Imperial College COVID-19 Response Team: Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand

We show that in the UK and US context, suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members. This may need to be supplemented by school and university closures, though it should be recognised that such closures may have negative impacts on health systems due to increased absenteeism. The major challenge of suppression is that this type of intensive intervention package -or something equivalently effective at reducing transmission -will need to be maintained until a vaccine becomes available (potentially 18 months or more) - given that we predict that transmission will quickly rebound if interventions are relaxed.

We show that intermittent social distancing - triggered by trends in disease surveillance -may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound.

Last, while experience in China and now South Korea show that suppression is possible in the short term, it remains to be seen whether it is possible long-term, and whether the social and economic costs of the interventions adopted thus far can be reduced.

March 16, 2020: Al Perotta, The Stream: Goofus and Gallant: Coronavirus Edition:

Watching the Coronavirus news over the past few days, I am reminded of Goofus and Gallant.

In the Highlights for Children magazine, Goofus acts improperly, while Gallant demonstrates the proper way to behave in a given situation.

Boy, have we seen some Goofuses! But thank God, we're seeing some Gallants.

March 15, 2020: CDC advises all gatherings of 50 people or more be cancelled for the next eight weeks.

Events of any size should only be continued if they can be carried out with adherence to guidelines for protecting vulnerable populations, hand hygiene, and social distancing. When feasible, organizers could modify events to be virtual.

This recommendation does not apply to the day to day operation of organizations such as schools, institutes of higher learning, or businesses.

March 15, 2020: Erick Erickson: A Sunday Evening COVID-19 Update

The US infection of confirmed cases has crossed 3,000 cases and stands (at this writing) at 3,244 and 62 people have died. Just as a snapshot, I'm in Georgia and last week we had 1 case. Now we have over 100. Just yesterday there were only 70 cases and the day before that there were 40. That gives you a sense of how this is rapidly increasing in spread. Also, more testing is happening so we should see the numbers going up considerably.

In Europe, way more people under the age of 60 are being hospitalized than anyone expected. It is very clear now that China did lie. While the virus is more deadly for those over 60, it is having effects on young healthy people....

In Italy, roughly 50% of patients need hospitalization. In most places, it is 10% need hospitalization. At the present rate of infection, the United States will be out of hospital capacity in the new few weeks if people do not change their behavior....

I realize some of you are reading this and thinking it is not that bad, or you have a relative who works in a hospital with no cases, or we cannot believe anything we hear. I get that. But get this -- the CDC has accurately modeled the spread of the virus and has not yet been wrong. The difference between you taking one for the team and staying home versus you ignoring the advice and hanging out in crowds is the difference between a few hundred dead and a few hundred thousand dead.

March 15, 2020: Anthony Fauci: Americans are 'going to have to hunker down significantly more' to fight coronavirus

Americans "should be prepared that they're going to have to hunker down significantly more than we as a country are doing" to fight the growing COVID-19 outbreak, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Sunday on NBC News' "Meet the Press."

Asked whether the U.S. should consider a 14-day national shutdown similar to those in Europe, he said: "I would prefer as much as we possibly could. I think we should really be overly aggressive and get criticized for overreacting."...

Of the elderly and those with underlying conditions, Fauci said, "They should really hunker down."

March 14, 2020: Coronavirus: US shutdowns and working from home could last '8 weeks or more', top health official warns | The Independent

"It's certainly going to get worse before it gets better," Dr Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases with the the National Institutes of Health, said during an interview on Good Morning America [on Friday, March 13].

He continued to say Americans could see "eight weeks or more" of shutdowns and working from home as the virus surges in communities across the country.

March 14, 2020: Daily Telegraph: Italians over 80 'will be left to die' as country overwhelmed by coronavirus

Coronavirus victims in Italy will be denied access to intensive care if they are aged 80 or more or in poor health should pressure on beds increase, a document prepared by a crisis management unit in Turin propose.

Some patients denied intensive care will in effect be left to die, doctors fear....

More than 1,000 people in Italy have now died from the virus and the number is growing every day. More than 15,000 are infected.

Italy has 5,090 intensive care beds, which for the moment exceeds the number of patients who need them. It is also working to create new bed capacity in private clinics, nursing homes and even in tents. However, the country also needs also doctors and nurses - the government wants to hire them - and equipment.

March 14, 2020: Dan Kois: Policy changes in reaction to the coronavirus reveal how absurd so many of our rules are to begin with: Kois notes the TSA's rule change to allow 12-ounce bottles of hand sanitizer to travel onboard aircraft and other official acts of leniency in response to the virus exposes how most of these rules and fees are BS. I don't agree with all his examples: In ordinary times, costs and limits may make sense as a deterrent to bad behavior, but extraordinary times call for extraordinary measures.

March 14, 2020: Washington Post: Why outbreaks like coronavirus spread exponentially, and how to flatten the curve: Data editor Harry Stevens presents some interactive simulations illustrating how viruses spread through a population, and how extensive social distancing can keep that spread within a level manageable by our health care system.

March 13, 2020: Newt Gingrich: I Am in Italy Amid the Coronavirus Crisis. America Must Act Now--And Act Big

The former House Speaker writes from Rome, where his wife is ambassador to the Vatican.

As I write:

• All schools are closed in all of Italy.
• All churches are closed (including St. Peter's Basilica).
• All weddings and funerals are postponed.
• All restaurants are closed.
• In fact, all stores except grocery stores and pharmacies are closed.
• People are urged to work from home unless they work in special designated factories

The streets are almost empty.

These steps are not an overreaction. The coronavirus is out of control of in Northern Italy. As of 6 p.m. local/1 p.m. EST on March 10, there were 15,113 total cases in Italy, with 12,839 active cases, 1,016 deaths and 1,258 recoveries. And there were 162 total cases here in Rome.

The hardest-hit region around Milan has had to improvise as its health system has been deeply stressed by the sheer number of patients. In Milan and Brescia, field hospitals have been set up in the fairgrounds as the local hospitals have been drowned in patients.

Because the demand for respirators and intensive care has been beyond any previous planning, doctors have been forced into the kind of triage thinking developed for intense battlefield casualty situations. There are reports that emergency room doctors are allotting respirators to those with higher life expectancy due to the limited equipment in the hardest hit areas of the province. If you are older or have other illnesses, you may simply not be eligible for treatment....

We should be planning for a worst-case pandemic and using the kind of intensity of implementation which served us so well in World War II. Getting enough ventilators, masks, intensive care units, treatment medications and aggressive community-wide testing are the minimum steps to saving lives and stopping the pandemic.

March 13, 2020: Compared to what? by Heather Mac Donald in The New Criterion: MacDonald poo-poohs the dangers of COVID-19:

Comparing the relative value of lives makes for grisly calculus, but one is forced to ask: are we missing the forest for the trees? If the measures we undertake to protect a vulnerable few end up exposing them, along with the rest of society, to even more damaging risks--was it worth the cost?...

At this point, more people have recovered from the virus than are still sick. But the damage to people's livelihoods through the resulting economic contraction is real and widespread. Its health consequences will be more severe than those of the coronavirus, as Steve Malanga shows in City Journal. The people who can least afford to lose jobs will be the hardest hit by the assault on tourism. Small entrepreneurs, whether in manufacturing or the service sector, will struggle to stay afloat. Such unjustified, unpredicted economic havoc undermines government legitimacy....

Rather than indiscriminately shutting down public events and travel, we should target prevention where it is most needed: in nursing homes and hospitals.

Ms. MacDonald seems to have forgotten that not all elderly and immuno-compromised people live in nursing homes and hospitals. I think she's going to regret this column. The a href="https://www.city-journal.org/coronavirus-and-the-economy">Steve Malanga column mentioned by MacDonald, from March 8, 2020, cites only depression, anxiety, suicide, and drug abuse as potential health problems resulting from an economic downturn.

March 11, 2020: Scientific American: How China's "Bat Woman" Hunted Down Viruses from SARS to the New Coronavirus

In Shitou Cave--where painstaking scrutiny has yielded a natural genetic library of bat viruses--the team discovered a coronavirus strain in 2013 that came from horseshoe bats and had a genomic sequence that was 97 percent identical to the one found in civets in Guangdong. The finding concluded a decade-long search for the natural reservoir of the SARS coronavirus....

In many bat dwellings Shi has sampled, including Shitou Cave, "constant mixing of different viruses creates a great opportunity for dangerous new pathogens to emerge," says Ralph Baric, a virologist at the University of North Carolina at Chapel Hill. And in the vicinity of such viral melting pots, Shi says, "you don't need to be a wildlife trader to be infected."

March 11, 2020: Inside Higher Ed: Colleges Ask Students to Leave Campuses

Harvard University, in Massachusetts, was one of a rapidly growing number of colleges that announced on Tuesday it would transition from in-person to online instruction and ask students to depart campus in an effort to help contain the spread of the new coronavirus, which causes a respiratory illness known as COVID-19. Harvard instructed students not to return after spring break, which starts this weekend, and said students would complete their coursework remotely "until further notice."...

The Massachusetts Institute of Technology also is transitioning to online instruction on March 30 and requiring undergraduates to leave the campus by next Tuesday, March 17.

March 11, 2020: Young and Unafraid of the Coronavirus Pandemic? Good for You. Now Stop Killing People

A doctor in a major hospital in western Europe issues a stern warning:

Put aside statistics. Here is how it looks in practice. Most of my childhood friends are now doctors working in north Italy. In Milan, in Bergamo, in Padua, they are having to choose between intubating a 40-year-old with two kids, a 40-year old who is fit and healthy with no co-morbidities, and a 60-year-old with high blood pressure, because they don't have enough beds. In the hallway, meanwhile, there are another 15 people waiting who are already hardly breathing and need oxygen....

We are still awaiting the peak of the epidemic in Europe: probably early April for Italy, mid-April for Germany and Switzerland, somewhere around that time for the UK. In the U.S., the infection has only just begun.

But until we're past the peak, the only solution is to impose social restrictions.

And if your government is hesitating, these restrictions are up to you. Stay put. Do not travel. Cancel that family reunion, the promotion party and the big night out. This really sucks, but these are special times. Don't take risks. Do not go to places where you are more than 20 people in the same room. It's not safe and it's not worth it.

But why the urgency, if most people survive?

Here's why: Fatality is the wrong yardstick. Catching the virus can mess up your life in many, many more ways than just straight-up killing you. "We are all young"--okay. "Even if we get the bug, we will survive"--fantastic. How about needing four months of physical therapy before you even feel human again. Or getting scar tissue in your lungs and having your activity level restricted for the rest of your life. Not to mention having every chance of catching another bug in hospital, while you're being treated or waiting to get checked with an immune system distracted even by the false alarm of an ordinary flu. No travel for leisure or business is worth this risk.

Now, odds are, you might catch coronavirus and might not even get symptoms. Great. Good for you. Very bad for everyone else, from your own grandparents to the random older person who got on the subway train a stop or two after you got off. You're fine, you're barely even sneezing or coughing, but you're walking around and you kill a couple of old ladies without even knowing it. Is that fair? You tell me.

My personal as well as professional view: we all have a duty to stay put, except for very special reasons, like, you go to work because you work in healthcare, or you have to save a life and bring someone to hospital, or go out to shop for food so you can survive. But when we get to this stage of a pandemic, it's really important not to spread the bug. The only thing that helps is social restriction. Ideally, the government should issue that instruction and provide a financial fallback--compensate business owners, ease the financial load on everyone as much as possible and reduce the incentive of risking your life or the lives of others just to make ends meet. But if your government or company is slow on the uptake, don't be that person. Take responsibility. For all but essential movement, restrict yourself.

March 10, 2020 (updated March 13): Tomas Pueyo: Coronavirus: Why You Must Act Now

Pueyo offers dozens of charts tracking the spread of the virus in China, Iran, and Italy, as well as the historical spread of Spanish Flu in 1918, and offers a Google spreadsheet decision model for CEOs to decide when to close their businesses.

March 10, 2020: Richard Hobday: Coronavirus and the Sun: a Lesson from the 1918 Influenza Pandemic

Fresh air and sunlight helped patients recover from the Spanish Flu. We're beginning to understand why that worked, and why it might help COVID-19 patients. This article has a lengthy bibliography appended.

During the First World War, military surgeons routinely used sunlight to heal infected wounds. They knew it was a disinfectant. What they didn't know is that one advantage of placing patients outside in the sun is they can synthesise vitamin D in their skin if sunlight is strong enough. This was not discovered until the 1920s. Low vitamin D levels are now linked to respiratory infections and may increase susceptibility to influenza.

March 9, 2020: Nigel Farage: Yes, Protecting Us All from an Epidemic Should be Prioritized Over the Economy

The first duty of any government is to protect the wellbeing of its citizens and their country. In times of crisis, the economy must always come second....

It has been reported that the coronavirus death toll in Italy soared by 133 cases yesterday to 366 fatalities. At the time of writing, it is understood that the number of people in Italy with coronavirus jumped from 1,492 to 7,375. The Italian prime minister, Giuseppe Conte, has placed severe quarantine restrictions on the 16 million people who live in Lombardy and in other provinces as well.

Yet despite this, both British and Italian citizens jetting in from the affected areas have continued to land at Heathrow, Gatwick and Bristol airports. It is understood that 17 flights left Milan Malpensa on Sunday [March 8] alone. Upon arrival in the UK, there were no medical checks of any kind whatsoever, no advice was given to anybody, and not a single passenger was put into quarantine.

All of this happened--or rather, did not happen--on the same day that it was confirmed the UK's third coronavirus death occurred. The victim was a man in his sixties who had recently returned from northern Italy. (His death was soon followed by a fourth, announced Monday afternoon.)...

I cannot remember in my lifetime a level of such concern about a public health matter in this country. It is the one topic that everybody is talking about. That is not to say that the British have lost their reserve, or are panicking. It is simply that most people have elderly relatives or friends and because older people are thought to be most at risk of infection, concerns are running high.

March 4, 2020: MIT Technology Review: Gene sleuths are tracking the coronavirus outbreak as it happens

As a virus spreads, it mutates, developing random changes in single genetic letters in its genome. By tracking those changes, scientists can trace its evolution and learn which cases are most closely related. The latest maps already show dozens of branching events.

The data is being tracked on a website called Nextstrain, an open-source effort to "harness the scientific and public health potential of pathogen genome data." Because scientists are posting data so quickly, this is the first outbreak in which a germ's evolution and spread have been tracked in so much detail, and almost in real time.

Nextstrain's radial view shows a family tree of the disease, colorcoded by geography. The Washington state cluster emerged from the Grand Princess cruise ship, while other samples of US cases show genetic ties to cases in far northern France, southern Netherlands, and Iran. All genetic roads lead back to Wuhan.

February 28, 2020: Coronavirus Disease 2019 (COVID-19) Risk Assessment and Public Health Management Decision Making: CDC flowchart identifying levels of risks and appropriate actions for symptomatic and asymptomatic patients. The previous link goes to a local copy; here is the original URL for the chart, which will no doubt be updated at some point, as this February 28 version focuses on Hubei, China, as the risk focus, although it hasn't been updated as of March 16.