Update 6: Tuesday 2020-Apr-14 T11 am
All’s well. Got call that this story is also in “The Age”:
“Patients with COVID-19 could be quarantined in ‘medi-hotels’ instead of at home in a bid to prevent family members and housemates from being infected and ensuring compliance with isolation requirements.
Federal Health Minister Greg Hunt he was “very open” to the medi-hotel concept, which is being trialled in Tasmania at the behest of the state’s peak medical body and is based on the Singapore government’s approach.
…[more]…
Will still work on some submissions about it but can relax now and setup laptop and also do other work and write about other stuff.
Update 5: Tuesday 2020-Apr-14 T02:30a
The figures really needed is the daily new additions to “community transmission” (“locally acquired – unknown”).
Growth rate R_t for that is critical. Determined by lagged total infections and ratio of net new infections (including lagged “under investigation”) that are from unknown source of local transmission.
Guardian compiles its own up to date spreadsheet here from States and Territories:
https://docs.google.com/spreadsheets/d/1q5gdePANXci8enuiS4oHUJxcxC13d6bjMRSicakychE/htmlview#gid=0
https://www.theguardian.com/australia-news/datablog/ng-interactive/2020/apr/13/coronavirus-cases-australia-numbers-new-stats-graph-map-by-postcode-covid-19-death-toll
Guardian also links to a Google Docs spreadsheet of daily new cases by jurisdiction in 5 categories of source (including interstate)
Need additional breakdown of daily movements from “Under investigation” to each of the other categories or at least to “locally acquired – unknown” ie “community transmission”. From that can calculate lag on “Under investigation” to eventual “community transmission” for a more accurate estimate of trend in new additions to community transmission.
But numbers seem to be around 10 and so would need a few weeks to distinguish clear trend from noise.
https://docs.google.com/spreadsheets/d/115_BZLlrGcXcTU_Ogtl38BMr1yKKrXPSRr6JpPeSnME/htmlview
Need link to most recent versions and related background info.
“Please email nick.evershed@theguardian.com or australia.coronatracking@theguardian.com with suggestions or errors.”
Ask them for URLs to more raw data and/or help ask for additional above.
Update 4: Sunday 2020-Apr-12 21:30 pm
Current figures indicate that the number of new cases each day is stable or “flat” at around 100 per day from 5 to 10 April.
This has resulted in talk of being on the “cusp” of success with pressure to start planning for “exit” from restrictions, together with cautionary warnings from epidemiologists that we won’t actually know for a couple of weeks since data on “community transmission” is currently mixed together with data from overseas acquired cases and the different effects of recent measures on those two categories will not become clear immediately.
Either side might be right. Nothing is certain.
But my view is that both sides are wrong. To me the fact that the numbers look more or less flat at the moment almost necessarily implies that we are currently at the bottom of a sharp decline in the transmission rate that will be followed by a rise. A flat period is what you get at the bottom of a trough (as you do at the top of a peak).
Two measures were taken almost simultaneously.
- Incoming travellers enforced quarantine from midnite Saturday 28 March.
- Major increase in the level of “social distancing” with decision for 2 person limit on social gatherings Sunday 29 March (enforced by States over next few days).
At the time it was stressed by the committee of Chief Medical Officers in charge that:
“…there is a lag time of at least 7-14 days before the real impact of additional measures will be seen on case incidence, and longer for critical care requirements and mortality”.
But less than two weeks later, many people actually believe they can already see the real impact because the numbers look flat to them.
If the numbers are as flat as they look that is actually a strong indication that the measures are not sufficient to prevent community transmission continuing to grow exponentially rather than beginning to decline exponentially or remaining flat.
Certainly with the current levels of “social distancing”, the positive exponential growth rate will be much slower than the catastrophic doubling twice a week that occurred immediately after the daily new cases first reached the present flat level of around 100. That was the same trajectory as the overwhelming of hospitals in Italy, Spain, UK and USA which led to sudden imposition of essentially the current measures here in Australia (and much stronger measures in New Zealand).
But it is logical to assume there will be continued exponential growth at a slower rate because at present a sharp rate of decline in transmission from the large majority of new cases that were being acquired from overseas is being roughly balanced by the positive rate of growth in the small proportion of “community transmission” (less than 10% of total cases).
There are certainly grounds for optimism that this rate will be slow enough for further measures to succeed in preventing the hospital system being overwhelmed. But there is no basis for imagining that the figures do not ALREADY indicate that further measures are likely to be required, rather than providing grounds for speculating about “exit plans”.
Any rate of exponential growth at all necessarily happens first gradually and then suddenly. The decline in cases acquired from overseas will first be gradual and then sudden until they are an insignificant minority of cases. Likewise the growth in “community transmission” will first be gradual and then be sudden until what is now less than 10% of cases becomes the overwhelming majority.
That is simply too difficult for journalists to understand themselves, let alone explain to the general public. Nor can they understand that there will necessarily be subsequent waves after the first peak, since the large majority of people will not have been infected and therefore will still have no immunity until a vaccine at least 12 to 18 months away.
It requires “Explorable Explanations” with widgets so that people can “feel” for themselves what happens as you vary different parameters.
At present careful tracking of each case to determine the date of infection and the individual contact that caused infection is still feasible in Australia.
As at Saturday 2020-04-11 results are:
6,292 cases tracked of which the proportions acquired from different categories is approx:
- 65% overseas from a known contact (previously including tourists, students etc new additions mainly returning Australian residents).
- 24% local transmission from a known contact (mainly from known overseas acquired cases but also from other known locally acquired)
Both the above categories are controlled by tracking and isolating contacts of the previous source of transmission as well as contacts of the particular case. Only a small proportion of contacts of known cases are not successfully isolated. These together with the unknown numbers of people infected who never become known as cases because they have no symptoms that result in being classified as a case result in the additional categories below.
- 9% “community transmission” from an unknown local contact whose other contacts cannot be tracked and isolated. Only the subsequent contacts can be tracked and isolated so the rate of transmission is inherently much higher than from the fully tracked categories above. But the numbers are initially small.
- 2% “under investigation” as at 3pm on each date of reporting. Eventually each of these cases becomes one of the other three categories above. Those that do not become “overseas” or “local” end up classified as “community” when the attempt to track the original contact that resulted infection fails to identify anyone in particular whose contacts could then be tracked and isolated.
The new additions from overseas have been dramatically curtailed to an actual decline of less than 1 new infection per each arrival isolated under guard in a hotel room for 14 days. Otherwise there would not have been a sharp decline in total new infections each day.
Existing tracked local transmission and untracked “community transmission” has been substantially reduced because of greater “social distancing”. But that substantial reduction is not likely to result in less than 1 new infection from each existing infection. If it did then the overall result would be a continuing decline, not a “balance”.
When you see a pendulum travelling horizontally at the bottom of its swing, expect it to start rising unless further measures are taken to restrain it.
I expect those further measures to be taken. That could result in a “reasonable worst case” of the peak being delayed and limited so that it is within the capability of the hospital system to not be overwhelmed. Maintaining restrictions at the level required to prevent that growing could result in a prolonged peak with far more cases than now under far more restrictions than now.
That is called “flattening the curve”. It is a “reasonable worst case”.
That is what the public should be preparing for. In particular it will need a large roll out of short term quarantine isolation accommodation for both new cases and their contacts to help avoid the transmission rate rising to overwhelm the hospitals.
Further reductions in the death rate will also require long term quarantine isolation accommodation for vulnerable people living together with essential workers etc.
Update 3: Wednesday 2020-Apr-08 11 am
Very important guidance on Home Isolation from AHPCC. Study this carefully. Clear medical criteria that will necessarily require extensive rollout of accommodation (but not their function to organize that).
Also a separate government web page now has all links to the actual models of theoretical scenarios that simply confirm ICU capacity would be overwhelmed without measures already taken and might not be if those measures do work sufficiently:
https://www.health.gov.au/news/modelling-how-covid-19-could-affect-australia
Also has PM transcript:
https://www.pm.gov.au/media/update-coronavirus-measures-070420
As well as papers on the actual models the Doherty Institute page includes a short video with explanations from the two lead authors that should also be studied carefully. If anyone can get a transcript from the closed captions please do provide it. I don’t have time but it is worth quoting. Ends with:
Doherty Institute modelers are “now in transition from scenario analysis to data science driven situational awareness”
https://youtu.be/rhNrhGMog38
via https://www.doherty.edu.au/news-events/news/covid-19-modelling-papers (which also links two papers)
The above links are central to any work related to the post below and greatly simplify what needs to be said and done. Work towards preparing documents to persuading relevant people to say and do it will be at (and figure out how to reach the right people) will be done at link below. Please help there:
https://github.com/dentarthur/next-waves
Update 1: Tuesday 2020-Apr-07 17:25
I just read the two files released as “Australian government models”:
Even the media will quickly grasp that the Australian government simply does not have any local modeling capability and is being advised by people working blindfolded on their basis of models for vaccine controlled pandemic influenza.
Despite relying almost entirely on international models, such as those from Imperial College response team and belatedly drawing basically correct conclusions from those models (much slower than New Zealand) they have not even grasped the fact that there will be multiple waves and are primarily focussed on boasting about how well they are doing and how important the models will be. Its grim reading. Don’t worry about it being too technical to read. It is PURELY intended as a PR exercise with a derisory appendix with “parameters” on last page. Read it now.
Best hope for improvements is to bypass them via States and New Zealand.
Update 2 T20:15: Actually the Doherty Institute did release some modeling papers. The government web site URL just did not include any link to it but only some PR bullshit.
Here is the actual model:
https://www.doherty.edu.au/news-events/news/covid-19-modelling-papers
It does show an actual attempt rather than the derisary stuff above. I am still studying it but I would now say it is nowhere near the level of serious modelling as from Imperial College rather than being pure PR bullshit as above.
But it doesn’t look far beyond what anybody could produce by just feeding parameters into a web page and in particular this web page below which is a simple SEIR model at about the same level of sophistication and as distant from serious microsimulation and/or agent based modelling on HPC GPU clusters.
Situation still grim. But my guess now is that the Doherty Institute was asked to model ICU and other hospital capacity and the actual epidemiologists working with the public health authorities on current data simply don’t have time to chat with them about stuff for government media releases. There must be others working with better models.
Original post below:
I just watched the latest Four Corners. It did successfully highlight dangers that were obvious a full month ago and calls for actions that were needed earlier than that. But it rigidly avoided looking to the future and discussing the measures that are needed now and are still not being announced and prepared. Instead it repeated most of the actual video footage at least 3 times each. At one point I had to check whether I was watching a repeat loop of the video. They repeated exactly the same thing so many times to emphasize how little they had to contribute to actual thinking. But it is certainly worth watching to understand the state of public consciousness in Australia:
As far as I know the only places that may have got their initial outbreaks under temporary control are those that did move infected people to quarantine accommodation until 80% recovered from mild or moderate illness while not passing on infection and the other 20% or so became more severely ill and needed transfer to emergency hospitals. Since many cases are unreported with very mild or no symptoms they still initially lost control but recovered faster. These are Asian economies – China, Taiwan, Singapore, South Korea – with experience from SARS and MERS and very different social conditions to Anglosphere countries – Australia, NZ, Canada, US and the UK
By now other countries on the same trajectory to catastrophe as Italy and Spain should have at least announced an intention to follow the successful examples as rapidly as they can in order to avoid the looming catastrophe already occurring in some countries which did not. Instead Dr Birx, US coronavirus coordinator has announced that the US learned much from China’s experience as well as the UK Imperial College models, but that this Chinese approach of quarantine accommodation for people infected is not being followed. Instead of home self-isolation is more appropriate to American social conditions. The US and UK, like Australia are of course now adopting other, even more urgent, emergency measures for “social distancing” etc.
The conditions are different. Those Asian societies all have more crowded accommodation in which self isolation in homes shared with others not yet known to be infected is less feasible and a culture in which people are more likely to comply quickly with intrusive government health directions.
But those are grounds for careful preparation and rollout, which requires early announcement and offering the option of separate accommodation first on a rationed basis for those most likely to need it (including in the package of measures to maintain contact with households, school children and people especially vulnerable, to support mental health and coping generally). There should be announcements now about how to apply for such accommodation and apologies that it may have to be initially limited.
An obvious consequence of the different culture in countries like Australia is that it is far better to have people clamouring to be accommodated in quarantine than threatening them with compulsory quarantine (even if the latter also becomes necessary later). Therefore early announcements of not having the facilities ready yet are all the more important.
That would set the scene for rapidly ramping up the logistics operation currently dealing with a couple of thousand people returning to Australia each day and moving them to the larger hotels. That stream will dry up fairly soon but the capacity to handle accommodation for 50,000 cases and to increase it at 2000 per day will have been established in about two weeks and should be able to provide an “officer and NCO corps” for a larger mobilization following immediately.
The new stream of much larger numbers of people infected for a couple of weeks may soon completely dwarf incoming travellers in both numbers and significance.
Since so many activities have been shutdown, there is a much larger workforce available and lots of space available to roll-out whatever is needed. But it does take time to ramp up. Instead of just telling people to stay home to “fight the war” they should be told how to “sign up”. If a real mobilization will be ramped up over the next few weeks there should be announcements already and discussion about it even among people as detached from reality as ABC journalists.
On the positive side, at least Four Corners was not still twittering about such totally irrelevant issues as toilet paper panic buying and the relatively minor incompetence in managing supply chains for groceries and pharmaceuticals. The focus now is on the actual impending catastrophe rather than trivia that in any developed country will be quickly resolved and is unlikely to become a central cause of death even in poorer countries. Even if 10% of the population anywhere dies suddenly, essential services can and will be restored and maintained with any problems doing so being insignificant relative to the actual underlying catastrophe.
But Four Corners interviewed nobody about ANY measure that has not ALREADY been announced.
It was a “no-brainer” to point out that strict quarantine for 14 days should be enforced for anyone arriving from places with higher levels of community transmission and any contacts with people already infected. That has just been done. Most transmissions are still being seeded from international arrivals and tracking and isolation is still effective for more than half of all known cases. So it makes sense to do that before other things.
Likewise it makes total sense for those arrivals and other contacts who appear likely to be already infected to be isolated separately from others who are only being isolated as a precaution (whether those assumed to be infected are confirmed by test or not).
It does not require much in the way of brains to understand that with community transmission already under way in the largest three States everyone is currently “arriving” from a place with a higher rate of transmission (mixing with others outside) to a place with a lower rate (“stay at home”).
It equally makes sense to isolate as many as possible of those actually infected or assumed to be infected who are now being told to self isolate at home in separate accommodation rather than infecting the rest of their household who are also required to isolate in order to avoid spreading that infection to other households.
But there was no discussion of that at all. Nor have I seen any elsewhere.
I am sure the models would confirm that it is a much lower priority than measures that have been taken (belatedly) so far. That lower priority is because even if it could make a 100% difference between infection of 1 person and infection of 4 (which is far more than it could achieve), that is only a “once off” equivalent to one week of the recent rate of doubling. It is not an ongoing reduction in the rate and other measures were more urgent for achieving that.
But those remaining gaps and measures not yet taken to delay and lower the peak hitting the hospitals very soon are precisely what attention should be given to. Not the past or the more distant future.
Where are we now?
Worldwide it is still an impending health catastrophe developing into an ongoing current health catastrophe, especially for poor countries. Australia is several weeks behind Italy which is still in full catastrophe. A major campaign is being waged worldwide by the Wall Street Journal, assisted here by The Australian, for a more “proportionate” and “balanced” approach that trades off the number of avoidable deaths against avoidable damage to the economy. This “pro-death” campaign accelerates both health and economic catastrophe and is assisted by the rigid fixation of the rest of the media on breathless twittering about the past and the almost equally rigid fixation of actual decision makers on the “evidence based” present, both medical and financial.
Emergency Management in a pandemic is not about the past, nor the present but about the immediate future – the “future present” or “present future”. Triage of planning resources in an exponential period means the present has already passed and cannot benefit from planning.
Unlike normal affairs in which events occur at certain rates whose variability and response to interventions is within the understanding and experience of decision makers, an infection that doubles every few days is the future happening right now. The future happens in the present “first gradually, then suddenly”. It is what one has to orient to as happening right now from observation of the “road runner” cartoons running off a cliff with one’s legs rotating rapidly. Collecting evidence about the initial rate of descent and the distance to the cliff edge is a cartoon staple for illustrating a ludicrous lack of orientation even for quadratic descent under gravitational acceleration. The initial exponential period of community transmission happens much more suddenly than falling off a cliff after the earlier seeding happened “gradually” with all attention trained on daily numbers.
Given that the response eventually requires a full shutdown of non-essential activities while maintaining essential activities and intensifying emergency activities, the intertwining of health and economic measures necessarily requires war-time state capitalism rather than “stimulus”. It isn’t possible to make sense of what various governments and others are doing economically in the meantime so I am not attempting to.
What started gradually and was responded to by reassuring messages to the public that everything was under control (together with some measures to bring it under control) rapidly turned into something happening “suddenly” well inside the observation-orientation-decision-action loop of the decision makers responding to it so that they simply cannot prepare for what has already become inevitable. A pandemic is not an intelligent opponent to be taken by surprise. But it moves faster than decision makers can observe and then orientate before reaching a decision to take an action.
https://en.m.wikipedia.org/wiki/OODA_loop
Those of us who do not face the awesome responsibility of firefighting the current situation and being accountable for life and death decisions, can best contribute by doing what they simply do not have time to do. Shut out the noise from both recriminations about the past and emergencies of the present and focus on the immediate future (as opposed to the present which is already passed, or the more distant future a few months away, for which there will be plenty of time to observe before orienting and there is no point in speculating).
While Four Corners twitters about “test, test, test”, the need to enforce quarantine on all returning travellers and to rapidly expand intensive care and other hospital capacity, it is safe to assume the public health authorities are already acting on all those:
- The test kits, masks, alcoholic sanitzers etc that should have been stockpiled long before advance notice was available are now being ramped up as fast as they can.
- Strict enforcement of quarantine at the borders by actually escorting arrivals into secure accommodation that should have been started long ago is now being done.
- The public information campaigns on hygiene and “social distancing” which should have begun much earlier have now got to the point where they do have the full attention of nearly the entire population. The enforcement of prohibiting gatherings of more than two people is sufficient to ensure that.
- Follow ups for organizing delivery services to replace shopping, contact with individuals and households in distress and homeless people etc etc are being rolled out with whatever levels of bumbling are unavoidable. This will be done like grocery and pharmaceutical supply chain issues at achievable linear rates that will not significantly add to the level of the impending health catastrophe.
- But the danger of catastrophe remains because no matter how brilliantly the expansion of hospital facilities for severe cases, Intensive Care Units for the most severe and ventilators for the ICUs are ramped up, they will still be overwhelmed unless other interventions actually reduce the “R” multiple from infections to new infections below 1 very soon.
Enquires into what could have been done better in the past (and accountability) will be important for the long term in which we can expect to be dealing with successive waves each time restrictions are lifted until an effective vaccine is deployed – expected to take 12-18 months.
But right now, the focus must be entirely on the immediate future for the first peak, which is only weeks away. What additional measures that are NOT already being taken can still be taken to push the rate R below 1? Others can and should come up with other such lower priority measures. Here’s my list.
What Must be Done Now
1. Announce that separate accommodation for everybody infected will be made available so that a lower proportion of the rest of their household remaining in enforced self-isolation will actually become infected and thus further reduce the overall transmission rate in addition to the higher priority measures already undertaken.
2. Announce that separate accommodation for everybody particularly vulnerable who is currently living with people less vulnerable will be made available to directly reduce the mortality rate among those vulnerable people.
3. Announce that these and related initiatives for homeless etc will take time to roll out and will initially be available only to those who need it most urgently as coordinated with the “package” for maintaining contact and mental health well-being etc.
4. Announce that preliminary estimates indicate subsantial numbers of premises previously used for other purposes and substantial numbers of people not currently working on other activities will be needed both to deploy and then to staff this emergency accommodation for the large case loads expected and registrations to participate in this new sector of the economy will be opened shortly.
5. Implement the long overdue announcements. But first announce them to pave the way for clamour rather than resentment.
PS
Apologies for both delay and haste. After having had to make a trip to the city to replace my phone after intending to be in isolation I had to make another trip out to replace a computer and then another to replace the new phone. So I haven’t had time to write better and still won’t until after setting up computer. (This is composed on Android Tablet and while still not back on email).
C21st Left 
The video at above link is still correctly Four Corners on my WordPress app:
But it displays as an earlier (and very useful) video on exponentials on another browser!
No idea why.
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Some bizarre cache problem. Both links ok now.
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Report 13 from Imperial College covid-19 response team has latest plausible estimates of efficacy of recent measures taken in Europe as at 2020-03-30:
https://doi.org/10.25561/77731
Report 12 of 26 March confirms radically relevant different demographics:
https://doi.org/10.25561/77735
Report 11 of 24 March. Evidence from China
https://doi.org/10.25561/77646
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Current policy only just got to point of announcing mobilization of private hospitals to join public system and provide some quarantine accommodation:
https://health.govcms.gov.au/ministers/the-hon-greg-hunt-mp/media/australian-government-partnership-with-private-health-sector-secures-30000-hospital-beds-and-105000-nurses-and-staff-to-help-fight-covid-19-pandemic
“In an unprecedented move, private hospitals, including both overnight and day hospitals, will integrate with state and territory health systems in the COVID-19 response.
These facilities will be required to make infrastructure, essential equipment (including ventilators), supplies (including PPE), workforce and additional resources fully available to the state and territory hospital system or the Australian Government.
They will also continue to support the needs of long-stay public hospital National Disability Insurance Scheme participants, and aged care patients and general needs patients.
In conjunction with Commonwealth, State and Territory Health Ministers, private hospitals will support the COVID-19 response through services including but not limited to:
Hospital services for public patients – both positive and negative for COVID‑19.
Category 1 elective surgery.Utilisation of wards and theatres to expand ICU capacity.
Accommodation for quarantine and isolation cases where necessary, and safety procedures and training are in place, including:
Cruise and flight covid-19 passengers.
Quarantine of vulnerable members of the community.
Isolation of infected vulnerable COVID-19 patients.
This is a landmark decision. Our Government is underwriting the future of the private hospital sector to:
Ensure health network capacity during the COVID-19 pandemic.Provide workforce retention that includes medical, nursing, clinical and ancillary staff to preserve the private hospital sector.
Allow activities such as non-urgent elective surgery to resume and accelerate at the appropriate time, once the COVID-19 pandemic recedes.”
Boasting about mobilizing hospitals as “unprecedented” and a “landmark” confirms complete disorientation at least of those compiling media releases.
Hopefully it is just poor wording that suggests they are so disoriented as to be relying on “safety procedures and training” to combining isolation of infected and others in same hospital buildings. Infection controls between wards in same building are vastly more difficult and resource intensive than between separate buildings.
I would assume, despite the wording, that 30,000 beds and staff will be used to add to public hospital capacity in an integrated system and only temporarily be also used to help with 14 days quarantine of current stream of 2000 returning travellers arriving daily. But even mentioning that also suggests the logistics ramp up for accommodating returnees in empty tourist hotels is not fast enough and they are still not thinking about further ramp up for actual isolation of infected cases as they contiinue to rise.
NB Immediate decline in daily increase suggested by first couple of days stats does confirm “social distancing” is working but it is still a DAILY INCREASE. That is a long way off from a daily decrease which will be an actual turning point which then a less long way to go before “under control” (and preparing for the next wave).
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A much more sensible transcript from a new Deputy CMO, Dr Nick Coatesworth (who was working in hospital 2 weeks ago):
https://health.govcms.gov.au/news/deputy-chief-medical-officer-interview-on-channel-9-today-0
Same source, on a different TV channel, trying to cope with a journalist demanding optimism:
https://health.govcms.gov.au/news/deputy-chief-medical-officer-interview-on-channel-7-sunrise-0
Deputy CMO Paul Kelly on making models available in a week or so:
https://health.govcms.gov.au/news/deputy-chief-medical-officers-press-conference-about-covid-19-on-30-march-2020
In general, the media releases from public health authorites are much less pointless and distracting than the resulting actual coverage from journalists in media most people get there info from. Takes much less time to follow them eg here:
https://health.govcms.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-news-and-media
The technical information is much more relevant again and still not being adequately explained for wider general audience (as the people producing that information are flat out). Most useful links are via Imperial College reports which I provided URL for early on. But these are only attempting to communicate to the CMOs etc, not to the general public and quite beyond the comprhension of journalists.
Speculation about cures, vaccines, arrivals of more ventilators etc is completely pointless. Even DCMO Paul Kelly, who is not a particularly good communicator, is utterly clear the focus has to be on reducing transmission rates and not speculations about the future that distract from the urgency of that.
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This report on how Singapore contained it is well worth watching.
Because they were ready (from experience with SARS), they were able to test and isolate.
Isolation of those infected was NOT “stay at home” (and increase the chances of infecting your household).
It was immediate transport from separate testing clinics to quarantine hospitals.
Containing the rate of transmission obviously required actual isolation of people infected, not just enforcement of an order to stay at home.
That STILL is not being done in Australia.
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“Models have supported Australia’s response to COVID-19
They are a vital part of moving from preparedness to targeted response.”
In Cosmos magazine (1 April 2020) Professors Jodie McVernon and James McCaw write:
“Mathematical models of infectious disease are representations of the way infections spread between individuals, in households, and through society. They can be used to anticipate the likely future impacts of a disease, and to consider how well public health interventions, treatments and vaccines might reduce infection transmission, and limit severe outcomes.”
https://cosmosmagazine.com/biology/models-have-supported-australia-s-response-to-covid-19
This paragraph links to:
Click to access PRISM_Modelling-guidelines-web.pdf
That is a “User’s Guide to Infectious Disease Modelling”, a 25 page introductory guide published in 2016 which the two Professors helped to edit and write.
The only reference to “pandemic” is this gem:
“Where good quality
evidence is not available, expert opinion or simple and
general comparisons (cf. Occam’s razor) can still be useful,
particularly in regard to identifying potential policy options
with poor outcomes. For instance, impacts of border
screening on pandemic influenza were quickly identified
as being relatively ineffective despite very little empirical
evidence being available.”
There is of course no reference to “coronavirus” and the focus is to:
“…support decision-making related to immunisation policy
and the control of vaccine preventable diseases.”
I am not qualified to form an opinion but my guess is that a good deal less attention should be paid to experts on the control of vaccine preventable diseases and a good deal more attention should be paid to the warnings from expert teams tracking the current novel coronavirus pandemic (covid-19), which is not expected to become a vaccine preventable disease for 12 to 18 months.
The main world center of expertise, the Imperial College covid-19 response team, abruptly switched strategic advice to the UK government after learning from the negative experience in Italy. The UK government changed tracks very quickly (but far too late) and the US government, like Australia, took longer to accept the new reality.
There is no reference to the important reports from that team, which are accessible here:
https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/
Instead, the second paragraph tells us:
“Models have a particular role to play in planning for the emergence of novel diseases, such as pandemic influenza or COVID-19. By definition, we don’t know when or where they will emerge, how infectious they will be, or how severe. Without such knowledge, we can model different scenarios to think in advance about different disease control strategies that would be effective and proportionate. These models can also be used to estimate requirements for essential resources, like hospital beds and personal protective equipment.”
Actually the reference cited was jointly written by the leader of the Imperial College team and explains:
“…what most often informed policy decisions on a day-to-day basis was arguably
not sophisticated simulation modelling, but rather, real-time statistical analyses based on mechanistic transmission models relying on available epidemiologic and virologic data.
**Lessons learnt** A key lesson was that modelling cannot substitute for data; it can only make use of available data and highlight what additional data might best inform policy.
https://apps.who.int/iris/handle/10665/271098
Surely it would be difficult to miss that point when Australia is trying desperately to nearly quadruple the number of ICU beds and ventilators and staff to avoid a catastrophe like Italy and Spain?
But the Professors continue to the third paragraph:
“The Australian Health Management Plan for Pandemic Influenza (AHMPPI) is a living document developed over many years to guide preparedness activities in Australia. While focused on influenza, its principles are relevant to other respiratory viruses. Response strategies are framed around modelled pandemic influenza scenarios with different clinical impacts. In a real influenza pandemic, early assessment of the virus’s growth rate and severity helps decision makers identify which scenario they’re in, informing targeted response actions.”
Again, I am no expert, but the link refutes the paragraph. The AHMPPI is not a “living document” but a dead parrot firmly nailed to its perch:
“The 2014 AHMPPI was last updated on 21 August 2019 to incorporate minor amendments.”
https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-ahmppi.htm
At that point I gave up on the article.
The “support” for Australia’s response is expressed as follows:
“These measures are essential over a period of many months to ensure that our health system is not overwhelmed and that all Australians can access the care they need, including for COVID-19.”
It is quite plain that essential measures were delayed on the advice of Australian “experts” and that their belated introduction cannot “ensure” that our health system is not overwhelmed precisely because it cannot ensure that all Australians can access the care they need. The planning was spectacularly bad but these Professors are boasting about it.
The only positive point I can see is the article does mention that emergency measures will be required for “many months”. That is better than the ABC’s Dr Norman Swan with 4-6 weeks or Donald Trump’s “15 days”, though still nowhere near the estimates of 12-18 months before a vaccine is available.
As an April Fool’s Day joke the article is in poor taste.
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C21st Left
covid-19 Four Corners looks back – ignores urgent need for Quarantine accommodation
Posted on March 31, 2020 by Arthur
I just watched the latest Four Corners. It did successfully highlight dangers that were obvious a full month ago and calls for actions that were needed earlier than that. But it rigidly avoided looking to the future and discussing the measures that are needed now and are still not being announced and prepared. Instead it repeated most of the actual video footage at least 3 times each. At one point I had to check whether I was watching a repeat loop of the video. They repeated exactly the same thing so many times to emphasize how little they had to contribute to actual thinking. But it is certainly worth watching to understand the state of public consciousness in Australia:
[I think this needs a better lead paragraph than some grizzles about the what was missing from the ‘Four Corners looks back’ program]
As far as I know the only places that may have got their initial outbreaks under temporary control are those that did move infected people to quarantine accommodation until 80% recovered from mild or moderate illness while not passing on infection and the other 20% or so became more severely ill and needed transfer to emergency hospitals. Since many cases are unreported with very mild or no symptoms they still initially lost control but recovered faster. These are Asian economies – China, Taiwan, Singapore, South Korea – with experience from SARS and MERS and very different social conditions to Anglosphere countries – Australia, NZ, Canada, US and the UK
By now other countries on the same trajectory to catastrophe as Italy and Spain should have at least announced an intention to follow the successful examples as rapidly as they can in order to avoid the looming catastrophe already occurring in some countries which did not. Instead Dr Birx, US coronavirus coordinator has announced that the US learned much from China’s experience as well as the UK Imperial College models, but that this Chinese approach of quarantine accommodation for people infected is not being followed. Instead of home self-isolation is more appropriate to American social conditions. The US and UK, like Australia are of course now adopting other, even more urgent, emergency measures for “social distancing” etc.
The conditions are different. Those Asian societies all have more crowded accommodation in which self isolation in homes shared with others not yet known to be infected is less feasible and a culture in which people are more likely to comply quickly with intrusive government health directions.
But those are grounds for careful preparation and rollout, which requires early announcement and offering the option of separate accommodation first on a rationed basis for those most likely to need it (including in the package of measures to maintain contact with households, school children and people especially vulnerable, to support mental health and coping generally). There should be announcements now about how to apply for such accommodation and apologies that it may have to be initially limited.
An obvious consequence of the different culture in countries like Australia is that it is far better to have people clamouring to be accommodated in quarantine than threatening them with compulsory quarantine (even if the latter also becomes necessary later). Therefore early announcements of not having the facilities ready yet are all the more important.
That would set the scene for rapidly ramping up the logistics operation currently dealing with a couple of thousand people returning to Australia each day and moving them to the larger hotels. That stream will dry up fairly soon but the capacity to handle accommodation for 50,000 cases and to increase it at 2000 per day will have been established in about two weeks and should be able to provide an “officer and NCO corps” for a larger mobilization following immediately.
The new stream of much larger numbers of people infected for a couple of weeks may soon completely dwarf incoming travellers in both numbers and significance.
Since so many activities have been shutdown, there is a much larger workforce available and lots of space available to roll-out whatever is needed. But it does take time to ramp up. Instead of just telling people to stay home to “fight the war” they should be told how to “sign up”. If a real mobilization will be ramped up over the next few weeks there should be announcements already and discussion about it even among people as detached from reality as ABC journalists.
On the positive side, at least Four Corners was not still twittering about such totally irrelevant issues as toilet paper panic buying and the relatively minor incompetence in managing supply chains for groceries and pharmaceuticals. The focus now is on the actual impending catastrophe rather than trivia that in any developed country will be quickly resolved and is unlikely to become a central cause of death even in poorer countries. Even if 10% of the population anywhere dies suddenly, essential services can and will be restored and maintained with any problems doing so being insignificant relative to the actual underlying catastrophe.
But Four Corners interviewed nobody about ANY measure that has not ALREADY been announced.
It was a “no-brainer” to point out that strict quarantine for 14 days should be enforced for anyone arriving from places with higher levels of community transmission and any contacts with people already infected. That has just been done. Most transmissions are still being seeded from international arrivals and tracking and isolation is still effective for more than half of all known cases. So it makes sense to do that before other things.
Likewise it makes total sense for those arrivals and other contacts who appear likely to be already infected to be isolated separately from others who are only being isolated as a precaution (whether those assumed to be infected are confirmed by test or not).
It does not require much in the way of brains to understand that with community transmission already under way in the largest three States everyone is currently “arriving” from a place with a higher rate of transmission (mixing with others outside) to a place with a lower rate (“stay at home”).
[56 word sentence:] It equally makes sense to isolate as many as possible of those actually infected or assumed to be infected who are now being told to self isolate at home in separate accommodation rather than infecting the rest of their household who are also required to isolate in order to avoid spreading that infection to other households.
But there was no discussion of that at all. Nor have I seen any elsewhere.
I am sure the models would confirm that it is a much lower priority than measures that have been taken (belatedly) so far. That lower priority is because even if it could make a 100% difference between infection of 1 person and infection of 4 (which is far more than it could achieve), that is only a “once off” equivalent to one week of the recent rate of doubling. It is not an ongoing reduction in the rate and other measures were more urgent for achieving that.
But those remaining gaps and measures not yet taken to delay and lower the peak hitting the hospitals very soon are precisely what attention should be given to. Not the past or the more distant future.
Where are we now?
[This is a better lead paragraph than starting as a recommendation as to how to ‘fill the gaps’ left in a Four Corners program:] Worldwide it [Covid 19] is still an impending health catastrophe developing into an ongoing current health catastrophe, especially for poor countries. Australia is several weeks behind Italy which is still in full catastrophe. A major campaign is being waged worldwide by the Wall Street Journal, assisted here by The Australian, for a more “proportionate” and “balanced” approach that trades off the number of avoidable deaths against avoidable damage to the economy. This “pro-death” campaign accelerates both health and economic catastrophe and is assisted by the rigid fixation of the rest of the media on breathless twittering about the past and the almost equally rigid fixation of actual decision makers on the “evidence based” present, both medical and financial.
Emergency Management in a pandemic is not about the past, nor the present but about the immediate future – the “future present” or “present future”. Triage of planning resources in an exponential period means the present has already passed and cannot benefit from planning.
Unlike normal affairs in which events occur at certain rates whose variability and response to interventions is within the understanding and experience of decision makers, an infection that doubles every few days is the future happening right now. The future happens in the present “first gradually, then suddenly”. It is what one has to orient to as happening right now from observation of the “road runner” cartoons running off a cliff with one’s legs rotating rapidly. Collecting evidence about the initial rate of descent and the distance to the cliff edge is a cartoon staple for illustrating a ludicrous lack of orientation even for quadratic descent under gravitational acceleration. The initial exponential period of community transmission happens much more suddenly than falling off a cliff after the earlier seeding happened “gradually” with all attention trained on daily numbers.
Given that the response eventually requires a full shutdown of non-essential activities while maintaining essential activities and intensifying emergency activities, the intertwining of health and economic measures necessarily requires war-time state capitalism rather than “stimulus”. It isn’t possible to make sense of what various governments and others are doing economically in the meantime so I am not attempting to.
What started gradually and was responded to by reassuring messages to the public that everything was under control (together with some measures to bring it under control) rapidly turned into something happening “suddenly” well inside the observation-orientation-decision-action loop of the decision makers responding to it so that they simply cannot prepare for what has already become inevitable. A pandemic is not an intelligent opponent to be taken by surprise. But it moves faster than decision makers can observe and then orientate before reaching a decision to take an action.
https://en.m.wikipedia.org/wiki/OODA_loop
Those of us who do not face the awesome responsibility of firefighting the current situation and being accountable for life and death decisions, can best contribute by doing what they simply do not have time to do. Shut out the noise from both recriminations about the past and emergencies of the present and focus on the immediate future (as opposed to the present which is already passed, or the more distant future a few months away, for which there will be plenty of time to observe before orienting and there is no point in speculating).
While Four Corners twitters about “test, test, test”, the need to enforce quarantine on all returning travellers and to rapidly expand intensive care and other hospital capacity, it is safe to assume the public health authorities are already acting on all those:
• The test kits, masks, alcoholic sanitzers etc that should have been stockpiled long before advance notice was available are now being ramped up as fast as they can.
• Strict enforcement of quarantine at the borders by actually escorting arrivals into secure accommodation that should have been started long ago is now being done.
• The public information campaigns on hygiene and “social distancing” which should have begun much earlier have now got to the point where they do have the full attention of nearly the entire population. The enforcement of prohibiting gatherings of more than two people is sufficient to ensure that.
• Follow ups for organizing delivery services to replace shopping, contact with individuals and households in distress and homeless people etc etc are being rolled out with whatever levels of bumbling are unavoidable. This will be done like grocery and pharmaceutical supply chain issues at achievable linear rates that will not significantly add to the level of the impending health catastrophe.
• But the danger of catastrophe remains because no matter how brilliantly the expansion of hospital facilities for severe cases, Intensive Care Units for the most severe and ventilators for the ICUs are ramped up, they will still be overwhelmed unless other interventions actually reduce the “R” multiple from infections to new infections below 1 very soon.
Enquires into what could have been done better in the past (and accountability) will be important for the long term in which we can expect to be dealing with successive waves each time restrictions are lifted until an effective vaccine is deployed – expected to take 12-18 months.
But right now, the focus must be entirely on the immediate future for the first peak, which is only weeks away. What additional measures that are NOT already being taken can still be taken to push the rate R below 1? Others can and should come up with other such lower priority measures. Here’s my list.
What Must be Done Now
1. Announce that separate accommodation for everybody infected will be made available so that a [much] lower proportion of the rest of their household remaining in enforced self-isolation will actually become infected and thus further reduce the overall transmission rate in addition to the higher priority measures already undertaken.
2. Announce that separate accommodation [will be made available] for everybody [those who are] particularly vulnerable [and] who is [are] currently living with people less vulnerable will be made available [in order] to directly reduce the mortality rate among those vulnerable people.
3. Announce that these and related initiatives for [the] homeless etc will take time to roll out and will initially be available only to those who need it most urgently as [and] coordinated with the “package” for maintaining contact and mental health well-being etc.
4. Announce that preliminary estimates indicate substantial numbers of premises previously used for other purposes and substantial numbers of people not currently working on other activities will be needed both to deploy and then to staff this emergency accommodation for the large case loads expected[,] and registrations to participate in this new sector of the economy will be opened shortly.
5. Implement the long overdue announcements. But first announce them to pave the way for clamour rather than resentment.
—
PS having posted this, I find the whole process to be intractable and arcane. I would rather print it out and hand it to you.
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Thanks. Just saw this after getting back inside. Arcane process will become tractable. Will not be handing printouts to each other for many months.
Did not know it was here as did not get call from you. Will call after reading. PS Part of arcane process is tick box to be notified of comments by email.
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Have read it now. Will try to rewrite tomorrow, hopefully after other feedback. Will phone now.
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The first publicly available serious model from USA following basic approach of Imperial College model is is here:
https://www.medrxiv.org/content/10.1101/2020.03.27.20043752v1
Expects between 80,000 and 160,000 deaths over next 4 months.
I would not know but my impression is huge underestimate.
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Where do we have these facilities to accommodate the already infected,and most vulnerable? The massive sell offs of the big institutions and their expansive grounds to private developers in the 80’s & 90’s robbed us of what could have been valauble resources.
Even in terms of welfare housing and similar accommodation options, the sell off of stock, added to the lack of new units being built limits the options there.
Australia could have, but didn’t move quicker. What matters now is what we are doing currently. In the health field i recall a time when we had surplus budgets, allowing money be available for situations like this. In our corporatised workplaces we’re used to working with limited budgets. How this does restricts what we can now do poses a challenge.
It’s going to be a time of rapid learning for those us working in health.
Glen!
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Hi Glen!
Are you working in health? I have been catching up by study since Feb.
No point looking back. Recriminations and accountability later.
All governments of all persuasions can and will commandeer required resources.
Focus on what’s required. They know that even at maximal ramp rate they cannot do much more than quadruple ICU capacity with ventilators before first peak hits and lots will die from triage rather than from covid-19 as result. Further increase will help with later waves since vast majority of population will not acquire even temporary immunity from first wave and vaccine more like 12-18 months away, not 6 months. They are NOW correctly focussed on reducing transmission rate since community transmission well under way in NSW, VIC and QLD (others still correctly focus on border control and tracking).
Rough figures 80% mild and moderate cases. Current policy enforce isolation at home. With stage 3 restrictions already being strengthened the next priority should be lower priority measures that have some additional, though smaller effect on transmission rate.
They NOW know that quarantine accommodation rather than self isolation was essential for ALL incoming travellers and are NOW ramping that up at 2000 per day for 14 day stays so rolling out about 30,000 places from empty toutist accommodation. At same time other readily available accommodation will be repurposed for a similar multiple of at least 4 to 8 times hospital capacity for “severe” cases (say 20% severe of which 5% ICU).
I am saying they need to announce NOW start of planning to continue the roll out of 2000 per day well beyond the totals for incoming travellers with aim of ramping up to OFFER places for 2-3 weeks accommodation of anyone asked to self-isolate due likely infection so that the rest of their household told to self-isolate as a precaution is less certain to also be infected and a small one-off reduction in transmission rate can be achieved instead of current policy of maximizing likelyhood of their household also being fully infected. Plus much harder offers of long term (6-12 months) accommodation of vulnerables who are living with others less vulnerable to directly reduce mortality (which has much less effect than ANY measure to reduce peak overload of ICU beds by reducing transmission rate).
Please help by thinking of who to get through to and how to write it so it has some chance of reaching them and being acted on.
First please read the whole of this post and all comments VERY carefully.
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A small step in the right direction:
https://www.abc.net.au/news/2020-04-05/coronavirus-victoria-offers-free-hotel-rooms-for-health-workers/12122262
Emphasis is on not adding burden to health workers likely to have high rates of infection by forcing them to infect their households. Quite right that these should have highest priority in being offered separate quarantine accomodation while infectious, followed by other essential workers. But still no announcement of any plan to roll out the massive numbers that will be needed – roughly 5 times the peak numbers in expanded hospitals for the severely ill since only of infectious cases 20% expected to be severely ill (of which one quarter ie about 5% of hospitalizations needing ICUs with most of those needing ventilators). Peak would be prolonged by having 80% of the infectious people infecting their households. Does not need to be only hotel rooms but does need plans for emergency accommodation announced now.
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A useful place to start for grasping why the issues I am raising have NOT been already considered is here:
Assessment of two COVID-19 models to guide
community intervention policies
in Anchorage and Alaska
Data current as of 25 March 2020
Click to access 2020-03-25-COVID19-models-review-FINAL-3-30-20.pdf
It has a reasonably competent summary of both the most authoritative conclusions of experts tracking the pandemic (Imperial College covid-19 response team report 9) and simpler models for US States from a US team: covidactnow.org
The Alaska report correctly concludes, consistent with both models, that Alaska should immediately adopt all the measures proposed by both reports and already implemented in Australia.
No wonder the public health authorities in Australia are patting themselves on the back.
But closer inspection easily demonstrates the abysmal levels of ignorance involved.
At p14 the report starts a reasonably clear summary of the two available strategies:
“Definitions of the two fundamental strategies as possible options:
1) Mitigation, which focuses on slowing but not necessarily stopping epidemic spread –
reducing peak healthcare demand while protecting those most at risk of severe disease
from infection. (R>1), goal is to reduce mortality while herd immunity grows.
2) Suppression, which aims to reverse epidemic growth, reducing case numbers to low
levels and maintaining that situation indefinitely. (R<1), goal reduce/stop transmission,
keep cases low."
Inserted at that point is:
"[Reviewers note: There is a continuum between the mitigation and the suppression
strategies, not necessarily an ‘either/or’ approach]"
Of course there is no such "continuum". The exact point the reviewers "note" as a continuum is perhaps the best known discontinuity deeply embedded in popular culture.
This "either/or" complete opposite of a continuum occurring exactly at the point R = 1 is called "critical mass" or these days "going viral", because the same discontinuity is widely understood as applying to nuclear explosions, popular culture "memes" and viral pandemics.
It is not some difficult concept that only experts in epidemiology are familiar with.
With a reproduction rate R 1 it is “uncontrolled” and there is an explosion.
Ignorance of this is BREATHTAKING.
The instinct for a well balanced, proportionate reasonable, evidence based decisions that react to opposing extremes of “either/or” by choosing a golden harmonious mean emerges spontaneously when the insect brain of panic stricken bureaucrats takes over from their reptilian brains and rather minimal higher mammalian cortexes and paralyses even their fight or flight impulses.
They just cower, quivering and do not even consider what ELSE they could do but only how to continue to look “balanced” on that barbed wire fence as they stare at the expert reports on those options that they already took too long to do and have already resulted in catastrophe.
What MUST be done is whatever it takes to get R < 1 and keep it there until a vaccine.
That includes prompt Quarantine accommodation initially offered as fast as it can be made available and later required for anyone infectious.
That worked in Wuhan when the authorities were finally forced to act AFTER the catastrophe there, and the only other places that even look like they might be able to get past the first peak without a lot of avoidable deaths are those that promptly did the same (eg Singapore and South Korea).
Its already too late in the US and UK as it is in Italy and Spain and was in Wuhan. The less developed world never had a chance to avoid catastrophe.
Alaska is one State that had a bit of extra time just as Australia does. As of that report 10 days ago they did not grasp the opportunity and it looks like NSW, Victoria and QLD won't either. Perhaps the rest might.
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Einige anmerkungen zu Coronavirus, von einem arbeiter der denkt. I’ve always liked Brecht.
We seem to achieving some progress here in Victoria, Australia, re the controlling the spread of the disease. However it’s a long way from where we need to get it, for any talk of easing restrictions. I listen to Gideon Rozner from the Institute of Public Affairs calling for an easing of restrictions due to the suffering of businesses. He cited some public health names,i’m not aware of, as being in agreement with easing restrictions. Rozner’s primary, nay, sole focus was on some mystical return to ‘business as usual’, taking precedence over a health crisis, public health being considered secondary.
I’m not sure what suffering the Harvey Norman business has endured. Last week Gerry Harvey was talking about how the Coronavirus had seen a 9% increase in their sales. Freezer sales up 300%, air purifiers up 100%. Not bad business if you’ve got it.
Of course Alexander Downer needed to have an input saying, ‘we either save avoidable deaths and destroy society, or accept avoidable deaths and save society’. Public health doesn’t seem a big favourite of his.
Then there’s the National Rugby League talking about resuming their industry in late May. Initially they spoke about how they’d recently been in touch with people in the NSW, Queensland and Federal Governments about this, though none of those governments were were aware of having these conversations. It appears there was initial dialogue re this circa a month ago, though no more until yesterday, contrary to the public statements the National Rugby League made.
As the great Stalin said, ‘ everybody has the right to be stupid, but some people abuse the privilege’. The National Rugby League through its poor governance liquidated a $54.6 million sustainability fund back in 2017. Now they are in a parlous financial state. Unlike the Australian Football League they do not have any assets , also were refused a line of credit from the banks quite recently. If their clubs, if the National Rugby League, survive, the Coronavirus crisis, it will be very fortunate.
We are a long way from getting out of this health crisis. It’s not a time for ‘business as usual,’ we need to maintain restrictions and further if we need to, to protect us all. In our work in community health we know we’ve got a long way to go. Yes there’s areas we can improve on, but our practice in many ways is taking us into uncharted territory.
How society looks as we come out of this is an unknown, but there is certainly ‘great chaos under heaven.’
Glen!
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Glen! I tried to leave msg for you at number provided by TomG. Please call Tom to get my number and call me.
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I actually don’t have a number for Thomas. Happy to chat in more detail, but i’m not one to display my number on a website.
Glen!
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Thanks. Just saw this. Same for me. Will call TomG again now. Can suggest a way to sync appearance and disappearance of a phone number at an obscure location via msgs here at mutually convenient window. Meanwhile see github link at top of post under “Update 3” and sign on to github and say hi via an “Issue” there.
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Arthur i’ve had problems with Github. I tried to use it yesterday, then again today, but it appears my user name already existed. I subsequently tried a different name/password , though it again alleged it already exists !
I’m back @ work tomorrow. I’ll get myself up to scratch with where my service is, also services we’re working closely with. I’ll contact you re any updates.
Glen!
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Github has several million users so user names often clash. You can read anything there without an account. When you are ready to write click “Issues” and you will need an account. Any choice of user name plus actual working email will work (they don’t spam your email but it IS necessary for it to be working.
PS See update 4 at top of this post (long)
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Hi Barry! I am guessing you are back since Glen’s comment was “approved” before I saw it. Best wishes!!!
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Good news. See update 5 at top of article.
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Actually the good news is update 6 at top of article.
Update 5 is about number crunching to confirm current stats show more measures still needed.
I think an announcement of plans to make available first before any talk of compulsion would have been far better. But this did follow within a week of the APHCC statement last Tuesday which was only a few weeks after the need was blindingly obvious and pointed out here.
Further agenda, but more relaxed is extending rollout of accommodation to “contacts” required to isolate just in case (eg the households from which infected patients will be taken to “medi-hotels” who might have been already exposed by the patient removed even though they will now not be subjected to further exposure by government negligence.
That involves far larger numbers (but less reduction in transmission).
Then vulnerable people in households with others less restricted. Harder still as 18 months is 36 times longer than 2 weeks. Less impact on death rate than reducing transmission generally but can directly reduce death rate too.
Workforce for largest possible rollout provides basis for workforce needed to cope with responsibilities for future regional aid eg to help Indonesia recover from total disaster.
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Arthur i’m not sure if you’re familiar with the following.
Click to access Direction%20-%20Care%20Facilities%20%28signed%29.pdf
Click to access Direction%20-%20Care%20Facilities%20%28signed%29.pdf
https://www.vic.gov.au/maram-practice-guides-and-resources#maram-practice-notes-updates-during-covid19-response
https://fac.dhhs.vic.gov.au/news/released-covid-19-plan-victorian-community-services-sector
I’ve been in touch with a number of relevant services/workers, this morning. Many have not got any written information/guidelines re administering/supporting/resourcing those in isolation. This is the best i’ve got so far.
Other services have not got back to me; yet. Like a lot of what’s happening, so much is in flux,moving quickly. I’ll inform of you of updates as we receive them.
Happy to talk on phone to fill voids in this.
Glen!
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Thanks! Will download now. Am assuming you keep sensible hours so won’t call tonite.
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Got all links. Vast amounts of MARAM! First and second links identical in case you meant to include a different one for total of 4 as only 3. Calling now as before 9pm
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I’m still trying to obtain information re self isolation & the homeless.
Talking to colleagues doing that work; it’s still a bit ad hoc, learning as they go.
Here’s a press release they sent me that might provide some more detail .
https://www.premier.vic.gov.au/safe-places-for-the-homeless-to-recover-and-isolate/
I’ll inform of useful news as i learn.
Glen!
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Thanks! Essentially 2 of the 4 conditions mentioned apply to everybody infected, not just homeless based on APCC clinical criteria for “Home Isolation”. See updates at the top of this post for link to that and today’s news re actually starting on accommodation.
“Those eligible for the service are people experiencing homelessness who:
1. have undergone testing for coronavirus and are awaiting results
2. have undergone testing for coronavirus and returned a positive result
3. are required to self-isolate and do not have suitable housing to do so
4. are being discharged from hospital and require accommodation to recover from coronavirus”
Items 1 and 3 are not covered by APHCC which only deals with actual infeced. No brainer for homeless.
Will require MUCH more accommodation to include all contacts required to self-isolate than just those confirmed as infected.
Would like to chat tomorrow re levels of staff support needed for general public in “medi-hotels” because infected (in which case they can use common facilities since they are already infected anyway) or as precaution because of contact with infected (in which case they also need to be isolated from each other).
Also staffing need for non-ambulance transport of infected people at start and end of quarantine and possibility of putting people with mild symptoms in holiday houses further away from ICU hospitals initially and moving them closer in second week or when actually moderately ill (with transport for that).
Also whether similar staffing to hospitals needed for removing infected rubbish or can they just be given special garbage bags?
Lots of those sorts of issues worth considering from below as the people planning won’t have relevant actual experience.
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Just a coincidence? https://www.forbes.com/sites/avivahwittenbergcox/2020/04/13/what-do-countries-with-the-best-coronavirus-reponses-have-in-common-women-leaders/?fbclid=IwAR2nJ0Qq8qJCCwT-RuqxYgS0o6naKJ4E67P8RV9Y6Dzoy4FbDYwxR8WxPTo#1aa72913dec4
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Arthur i’m at work sorting through ‘things’. I’m awaiting some more specifics re the ‘safe place’ for homeless: hopefully the detail arrives in the next few hours.
I aim to ring you later in the morning.
Glen!
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Quite a deal of talking with colleagues,managers, also workers from other services, trying to get an ‘idea’ of what people are expecting from here. Still awaiting some specifc details that i’m meant to be notified of.
Obviously the Federal Department of Health, also DHHS here in Victoria are looking at various contingencies though we’re not getting an overly clear idea on the ground. No surprise there.
We’re of the understanding The ICU capacity in Victoria is being quadrupled. Across Australia, it will be more than doubled.
Depending how well Australia emerges from ‘the peak’, when we encounter it, we will likely end up supporting PNG and the Pacific. I’ve not heard mention bringing people from PNG, or elsewhere in the Pacific here. You’d surmise the best way to support them is providing expertise and equipment. How much of the latter?
Re Indonesia, and if their health service gets swamped,i’m not able to surmise how best Australia can assist them. The smaller nations in the Pacific, Australia should hopefully have the capacity to assist in addressing the problem.
Let’s also see how Aoteaora comes out of this, and what they can provide. Of course a huge caveat is the time lines we’re talking about as each country’s actions have been taken at differing times and at differing levels of the spread of Covid 19.
Glen!
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My guess is that unlike Italy, Spain, UK, USA Australian ICU capacity won’t be overwhelmed (even UK may not be) and Australia will be in a position to help regionally. New Zealand likely to do much better than Australia but smaller country and takes lead mainly in Pacific Islands whereas Australia will need to help both PNG and Indonesia. Indonesian health service certain to be swamped so anything we can do would be useful there. Workforce supporting large scale accommodation for infected here could add to capacity to assist there while “stay home to fight the virus” does not help much (except for those who do online courses instead of watching TV).
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I have finished making comments on your Covid article. I tried to get into github (from home now) and it prompts me with my email address and password. But it leaves my username blank, and my guesses were wrong.
At present careful tracking of each case to determine [both] the date of infection and the individual contact that caused [the] infection is still feasible in Australia.
As at Saturday 2020-04-11 results are:
6,292 cases tracked of which the proportions acquired from different categories is approx:
• 65% overseas from a known contact (previously including tourists, students etc new additions mainly returning Australian residents).
• 24% local transmission from a known contact (mainly from known overseas acquired cases but also from other known locally acquired)
[You explain only 89%. I’m guessing here that after this comment on the above two categories, the remaining 11% is explained.] Both the above categories are controlled by tracking and isolating contacts of the previous source of transmission as well as contacts of the particular case. Only a small proportion of contacts of known cases are not successfully isolated. These [(]together with the unknown numbers of people infected who never become known as cases because they have no symptoms that result in being classified as a case[)] result in the additional categories below.
• 9% “community transmission” from an unknown local contact whose other contacts cannot be tracked and isolated. Only the subsequent contacts can be tracked and isolated so the rate of transmission is inherently much higher than from the fully tracked categories above. But the numbers are initially small.
• 2% “under investigation” as at 3pm on each date of reporting. Eventually each of these cases becomes one of the other three categories above. Those that do not become “overseas” or “local” end up classified as “community” when the attempt to track the original contact that resulted infection fails to identify anyone in particular whose contacts could then be tracked and isolated.
[I find this whole attempt to explain the problem as you see it to be extremely cumbersome. Most of your explanations on the phone to me (in which you convey a passionate concern) made more sense than what you have written here.
In both cases, however, I feel overloaded with facts and possibilities – it is more than I can take in.
This account needs structure – starting with something like the three key issues – your three main concerns. I gather it has do with wrong or ignorant projections as to the spread and potentially unanticipated increases in Covid-19 – whether by media pundits, politicians or experts.
I understand that those, the biggest three issues, might change every day. But I think those three, even if you rewrite them every day, will continue your fundamental critique of what is presented to us every day in the media.
I also suggest that you could recommend the two or three most important strategies or actions that need to be followed to get the best result possible.] The new additions from overseas have been dramatically curtailed to an actual decline of less than 1 [one] new infection per each arrival [(who have been] isolated under guard in a hotel room for 14 days[)]. Otherwise there would not have been a sharp decline in total new infections each day.
Existing tracked local transmission and untracked “community transmission” has been substantially reduced because of greater “social distancing”. But that substantial reduction is not likely to result in less than 1 [one] new infection from each existing infection. If it did [there was less than one new infection from each existing infection] then the overall result would be a continuing decline, not a “balance”.
When you see a pendulum travelling [what appears to be roughly] horizontally at the bottom of its swing, expect it to [it will] start rising unless further measures are taken to restrain it [true – but the corona virus is not a pendulum. It is called a ‘curve’, but I don’t think it could ever be (although some, the confused, might think it is) an upside down pendulum. All we can say is that epidemics, pandemics, rise in populations, and at some point in time, decline. I find the analogy to be too mechanical (too predictable), and so irrelevant, if not misleading].
I expect those further measures [such as…] to be taken. That [do you mean “further measures”?] could result in a “reasonable worst case” of the peak being delayed and limited so that it is within the capability of the hospital system to not be overwhelmed [Such delays and limits would keep the peak “within the capability of the hospital system]. Maintaining restrictions at the level required to prevent that growing [further growth] could result in a prolonged peak with far more cases than now under far more restrictions than now. [I have no idea how the last sentence relates to the previous sentence. Do you mean current restrictions could result in “a prolonged peak with far more cases than now”? ]
That is called “flattening the curve”. It is a “reasonable worst case”. [I’m lost. Can you write a sentence that sums up what you argue is the meaning of “flattening the curve”? And then what is meant by the “reasonable worst case”?]
That is what the public should be preparing for [some repetition is necessary here – say, if you can, in less than 12 words, “what the public should be preparing for”]. In particular it [It] will need a large roll out of short term quarantine isolation accommodation for both new cases and their contacts to help avoid the transmission rate rising to overwhelm[ing] the hospitals. [This, after about 1500 words, is the first clear recommendation as to what needs to be done.]
Further reductions in the death rate will also require long term quarantine isolation accommodation for vulnerable people living together with essential workers etc.
[My summary of the last two fractious paragraphs:
This is crude – you can do it better…
To avoid an overwhelming rise in the transmission rate, “a large roll out of short term quarantine isolation accommodation for both new cases and their contacts” will be needed.]
To avoid an increase in the death rate, “long term quarantine isolation accommodation for vulnerable people living together with essential workers etc.” will be needed.]
Update 3: Wednesday 2020-Apr-08 11 am
Very important guidance on Home Isolation from AHPCC. Study this carefully . Clear [Who is your audience? I take the view that it is the public. And that the public is made up of billion Peter Greens.] [The following is an extensive account of the] medical criteria that will necessarily require extensive rollout of accommodation (but not their function to organize that).
[I have broken off my comments, and my reading, for now.]
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Peter your username at github is PetervGreen and start page is:
https://github.com/PetervGreen
Thanks for the notes above. It confirms my view that I simply cannot explain the concepts.
Recent apparant peak was just under 500 new cases per day. Government is correctly preparing for a future peak much higher than 500. We are currently in a trough and media is asking “are we there yet” for removing restrictions as it looks as though there will be no higher peak. Government is not attempting to explain that there will be a higher peak or why, but merely saying too early to be confident that we are nearly there (with mixed message that we might be “on the cusp” of being there ie past the peak. I am taking a break before trying again to explain why we are not past the peak and why the peak will be much bigger than past. But still hoping that you could grasp the concept from questions/discussions on phone and write a much better explanation to an audience of Peter Greens.
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“Flattening the curve” is a “reasonable worst case” because it will be achieved at the peak and could remain at a high flat level for an extended period while still having achieved its purpose of preventing collapse of the hospital system. Advocates of lifting restrictions to save economy such as Wall Street Journal and The Australian (now also creeping in to Herald-Sun) could succeed in maintaining it nice and flat at a sustainable peak while more and more get infected as they resume work.
Actual policy in Australia is “Suppression” which means going beyond flat curve to reduce peak substantially and keep it controlled at a much lower level by maintaining a higher level of restrictions.
New Zealand policy is “Elimination” which means flat curve at zero. In practice with occasional small clusters each of which is successfully eliminated by tracking and isolation while most of the economy resumes since there is again no ongoing transmission. If successful, borders remain tightly closed but covid-19 is not a background reality affecting other aspects of normal life.
Actual outcome in Italy, Spain, UK and USA has been catastrophic levels of unnecessary deaths due to failing to “flatten” the curve.
That was entirely possible in Australia until they actually did go to Stage 3 very late. Seems unlikely outcome now though still possible.
Likely outcome in Australia is a first peak successfully “Suppressed”. Much higher than the 500 daily cases maximum we reached earlier but still well below losing controlled.
“Reasonable worst case” is higher still and prolonged plateau at peak capacity of the hospital system but not above it so deaths are from covid-19 rather than from unavailable ICUs as in Italy etc.
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As we talk about the merits of “Elimination”, V “Suppression”, you’d surmise it’s still so very early to contemplate this process.
https://www.abc.net.au/news/2020-04-16/nz-australia-border-could-reopen-jacinda-ardern-scott-morrison/12153752
Obviously there’s a fair way to go, as we still haven’t totally eradicated community transmission. I notice singapore is included in this equation. Clearly i need to read more about it,because there’d been a new wave of transmissions,though more detail is required re the source(s).
Out in community health not much ‘new’ of note to report. Our focus remains on screening, social distancing.
Glen!
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I think the ABC link gives a misleading impression. NZ locked down MUCH tighter as well as faster than Australia so they did not need to enforce quarantine for 14 days as suddenly as Australia did but have done so now (home isolation there was much tighter than here).
https://www.immigration.govt.nz/about-us/covid-19/coronavirus-update-inz-response
In practice both ANZ aiming for “suppression” although NZ, like WA, could theoretically achieve “elimination” and is attempting that.
I think it is only the media that is bleating about “are we nearly there yet?”. CMOs know damn well “community transmission” is still growing, as well as not “totally eliminated”.
Key Fact: Even in countries with catastrophic levels of infection overwhelming hospitals the large majority of the population has not been infected and therefore has no immunity and are just as Susceptible as immediately before the outbreak. It would be utterly absurd not to expect further waves.
Taking a break from research, so I’ll write a new post about Andrew Bolt’s bleating that does not require hard work.
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NZ only 2% of cases are “community transmission” cf Australia closer to 10%
https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-current-situation/covid-19-current-cases
That makes it far less plausible for Australia to aim for “Elimination”. Norman Swan of ABC was/is running a campaign for 4-6 weeks short sharp effort at elimination but not based on any actual analysis. I think CMOs are more likely to be correct in expecting that current levels need to be sustained for more than six months (with much tighter restrictions only immediately before the peak for a few weeks until immediately after the peak). I don’t believe we are anywhere near the peak yet. Neither do they – hence massive expansion of hospital ICUs etc.
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