Covid-19 – Don’t Panic – Do Self Isolate

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It is reasonably certain that Australian governments will take measures for “social distancing” fairly soon.

It is difficult to determine the optimum time as such measures are extremely disruptive and cannot be maintained for very long. The aim is not to contain the outbreak but to spread out the peak to reduce the number of people who die because intensive care such as mechanical ventilators are unavailable during the peak case load.

Italy moved too late according to this article for GPs from their main professional organization, dated 11 March:

6.2% case fatality rate

Italy is now one of the worst-affected nations, with a high elderly population where the virus spread undetected for several weeks.

The entire nation has now been placed into quarantine in an effort to get on top of the virus. All public gatherings are banned, restaurants and bars have restricted hours, and cinemas, theatres, libraries and museums have been ordered to close. Schools, daycare and universities have also been closed.

The national quarantine may be effective, as it was in China, but it will take time to have an effect.

In the interim, large numbers of serious or critical cases have swamped hospitals, leading to top Italian health official Professor Giacomo Grasselli to dub the virus ‘worse than a bomb’.

Dr Daniele Macchini, an intensivist in Lombardy, has described the impact of the virus as an ‘epidemiological disaster’ and a ‘tsunami’ that is threatening the ability of the hospital to offer care.

‘Suddenly the E.R. is collapsing … Every ventilator becomes like gold: those in operating theatres that have now suspended their non-urgent activity become intensive care places that did not exist before,’ he wrote on a Facebook post that has been translated.

The concerning account is echoed by another anonymous Lombardy intensivist, whose comments were posted by UK doctor Jason Van Schoor on Twitter.

The intensivist said that despite Lombardy’s wealth and excellent healthcare system, the virus has overwhelmed hospitals.

‘The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by COVID-19, they are running 200% capacity,’ the intensivist wrote.

‘There are hundreds of [patients] with severe [respiratory] failure and many of them do not have access to anything above a reservoir mask.’

Due to the shortage of ventilators – which are essential to keeping critical patients alive through the severe pneumonia – China has now offered to send Italy 1000 ventilators, as well as large supplies of personal protective equipment and testing kits.

The RACGP has more information on coronavirus available on its website.

Going too early might perhaps be as bad as going too late if it merely delays the peak rather than widening it. But the idea of Australian governments moving too rapidly seems implausible.

Here’s a simple journalistic explanation about “flattening the curve”, same date:

China sending ventilators to Italy confirms that social distancing in China has been successful. This is confirmed in a detailed statistical analysis published in British medical journal, The Lancet on the same date:

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30144-4/fulltext

Other medical information can easily be accessed via the links at that site’s resource center, including links to many other resource centers:

https://www.thelancet.com/coronavirus

The absurd delay resulting in the Grand Prix being cancelled only at the last minute suggests that Australian governments will not act too early.

That means the public needs to be mobilized to shut down social contacts and self isolate before official announcements and publicity campaigns.

In particular the more older people self isolate now the more that will surive the shortage of intensive care for severe cases at the peak.

Inevitably triage for access to Intensive Care Units must allocate them to severe cases among younger people more likely to survive than among older people less likely to survive a severe case.

Pretty well everybody will eventually get the flu when it becomes endemic. There is no chance of vaccines being developed quickly enough to prevent this and little likelihood of effective anti-viral drugs being available to help soon. What matters is whether the small minority of mainly older people who get a severe case needing intensive treatment such as mechanical ventilators, need such treatment during the peak or more slowly after the main peak has subsided.

Detailed advice on hygiene, social distancing, self isolation etc has been available from US and EU Centers for Disease Control for some time, although that availability of advice has not been matched by implementation. The Australian equivalent has not yet fully caught up even on advice:

https://www.cdc.gov/coronavirus/2019-ncov/community/

https://www.ecdc.europa.eu/en/publications-data/considerations-relating-social-distancing-measures-response-covid-19-epidemic

https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert

12 thoughts on “Covid-19 – Don’t Panic – Do Self Isolate”

  1. Same day as above article (13 March) the committee in charge announed following:

    “Recommendation for public gatherings and testing

    AHPPC notes emerging evidence of community transmission in localised areas within Australia, current issues limiting the capacity to do widespread COVID-19 diagnostic tests and emerging international evidence that, for best effect, social distancing measures are best introduced at the earliest stages of community transmission.

    AHPPC considers that, for these reasons, the time has come to put in place social distancing measures to mitigate spread, rather than a strategy based primarily on case finding. These include:

    limiting non-essential organised gatherings to fewer than 500 people

    limiting non-essential meetings or conferences of critical workforce eg healthcare professionals and emergency services

    encouraging all Australians to exercise personal responsibility for social distancing measures

    initiating measures to protect vulnerable populations, such as reducing visitors to all residential care facilities and remote Aboriginal and Torres Strait Islander communities.

    These measures are of most importance for people over 60, particularly those with chronic disease.
    AHPPC will meet again on 14 March to consider the implementation issues arising from these measures which AHPPC recommends should commence on Monday 16 March or as soon as practicable thereafter.

    The diagnostic testing issues are related to an emerging global shortage of several reagents used by pathologists to diagnose COVID-19. A more targeted testing strategy is now necessary. The case definition is being reviewed but the current situation emphasises the need for testing to be limited to the current recommendations.”

    https://www.health.gov.au/news/australian-health-protection-principal-committee-ahppc-coronavirus-covid-19-statement-on-13-march-2020

    Note: the initial measures are only for gatherings of 500 people medical workers. No general shutdown yet, just advice to health workers and people over 60 “for personal responsibility”.

    The “evidence of community transmission” includes the fact cases are doubling every week despite extensive border controls.

    BTW the links in above main post are ALL worth following, even to Twitter.

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  2. Pingback: covid-19 update Sunday 2020-03-15 | C21st Left

  3. What shits me about coronavirus is that Australia is an island and a few months ago had zero coronavirus. The government could have tested everyone entering the country and killed this thing cold dead but no we are ruled by idiots. Worst government since the 1939 Menzies government insisted on supplying Japan with war making material.

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    • Everywhere had zero a few months ago. Testing does not catch all cases (some estimates say not even most cases) nor does voluntary self isolation and contact tracking.The point of the “containment” phas was merely to slow it down for more time to prepare for flatterning the curve. Government was told it was a likely pandemic in late January by Chief Health Officer declaration activating pandemic plans. Government focus has been on “tough” border controls instead of actually using the few weeks extra delay to prepare for real social distancing in multiple waves over a very prolonged period. They haven’t even got enough test kits and PPEs for health workers and have not even mentioned quarantine accommodation for individuals separated from their households either because they are infected and the rest of the household only needs to self isolate or because they are especially vulnerable.

      There never was any possibility of avoiding an epidemic. They have chosen, as Italy did, not to take adequate measures to spread out the peak so there will certainly be far more deaths from unavailable ventilators etc than were unavoidable.

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  7. I don’t want to be totally negative the people of Vo did a great job, the kids in Wuhan when sent home and told to do school work on an app realised that the app would be removed from the store if it got enough negative reviews so they gave it thousands of negative reviews and it was removed.
    I would pluck Alan Joyce out of his Qantas job and make him the pandemic Zsar he’s a guy who looks at a problem and just fixes it and hang the consequences.

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  8. Pingback: Covid-19 – The Impending Catastrophe and How to Combat It | C21st Left

    • Update: Today’s Australian (Tuesday 2020-03-24) also has confirmation from Singapore PM that further waves are expected. I did not notice it last night:

      https://www.theaustralian.com.au/inquirer/singapores-prime-minister-says-earning-the-peoples-trust-is-the-key-to-fighting-the-virus/news-story/39bc4f1de8eccbc09982af49ca43d2c7

      “We are under no illusions that the problem is over at all,” he says.

      “If I made an analogy, it is not that the tide has turned, it is that we put the dykes up. We are watching very carefully to see where water may leak in, and if you take your eyes off it for a ­moment, suddenly I have an outbreak, like what happened in South Korea, and I will be in a perilous situation. It can happen to us at any time.

      “Australia is grappling with the same problem. The countries around us in Southeast Asia are also facing the problem. It (the outbreak) is going to catch fire in many countries and is going to take a long time to burn out.”

      …

      “I would not say we have successfully prevented it,” Lee says carefully. “I think I would say so far we have reasonably successfully hindered the transmission.”

      The key, Lee explains, is checking out all the people any infected person may have unwittingly infected before diagnosis.

      “We work very hard to contact-trace,” he says. “Who are the people you have met within the last two weeks, where have you been, what have you done, who may have been exposed to you?

      “We make every effort to trace those people down as well and put the immediate contacts either on notice or in quarantine, depending on whether they have symptoms. It is very labour-intensive. We have 300-plus cases now, but we have contact-traced several thousand people already, at least.

      “It is labour-intensive but it is helpful in preventing a single case from becoming many hundreds of cases, if you catch it in time.”

      …

      “Looking at the behaviour of the disease and the way it is jumping from country to country, you can push it down within a country, but it has not disappeared worldwide,” he says.

      “I think this is going to be with us for quite some time.”

      …

      “Their population is not immune to it yet, in very large numbers. Because even if a million Chinese have got the virus so far, that still leaves almost 1.4 billion people who have not yet, and are still, in immunological terms, naive and at risk.

      “So, what you can hope for is that you control the spread of the disease, you hold the position, and hope and pray that the scientists come up with either a treatment or a vaccine within a year or two — and in time for us to exit this without the doomsday scenario, namely that the disease goes through the whole population, and then eventually we have herd immunity. Either it is going to leave you with huge casualties, or it is going to take forever to lock down.

      “I think it is an enormous economic cost, and a human cost too.”

      Note: Like South Korea the proportion of the population that remains susceptible to infection in the next wave is even higher than in China where one province, Hubei did have an initially uncontrolled outbreak so are substantial proportion of that province now does have at least short term immunity so there is a fair chance the next wave there will be smaller.

      The proportion still fully susceptible in Singapore and South Korea is as close to 100% as makes no difference. So whether the next outbreak is smaller or larger depends largeely on how effectively long term “social distancing” can be maintained until a vaccine. The initial success was “containment” using tracking and quarantine. When actual “Community Transmission” develops rigorous quarantine becomes far more important as then tracking merely confirms that most of the new cases were infected from “the community” rather than from a specific known contact who can be promptly isolated.

      Unlike any other statements I have seen from national governments Singapore is clearly stating what the media and pretty well everyone who thinks they don’t need to know more, does not yet understand.

      But it still needs “Explorable Explanations” of the model for even a small minority to not be surprised when subsequent waves happen.

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