covid-19 Roadmap to Recovery

The “Group of Eight” major research Universities has released a “Roadmap to Recovery” which spells out two alternatives for recovery from covid-19:

Media release: Go8 provides evidence-based “Roadmap to Recovery” report to Federal Government

The first is continued restrictions for longer to “Eliminate”.

The second is for quicker lifting of restrictions for “Controlled Adaptation” accepting some ongoing level of infections while avoiding the health system getting overwhelmed.

The second is current Australian government policy accompanied by a steady drumbeat from business and the media insisting on a rapid return to work. The first is a clearly viable better alternative.

I find the pretence at academic neutrality between the two options quite irritating and the proclamation of “ethical principles” even more so.

But they have struck a blow that will make it much harder for “business” to get its way. The report release is well timed as efforts to reopen schools are being rushed in an effort to pre-empt a policy of Elimination.

The two page “snapshot” version makes it obvious that “Eliminate” is the way to go.

The 28 page summary obscures this with academic waffle.

The 192 page full report will not be read by many.

A major weakness is the parochial focus on Australia. An “Aussies all together” program of national service is proposed “to inclusively engage the young from across the nation in the process of social reconstruction across the country.” (p16)

Any country lucky enough to be able to “Eliminate” has major responsibilities to help the rest of the world. Australia will have particular responsibilities to help PNG and Indonesia as well as joining with New Zealand in support of others in the region. That is far more engaging and inclusive than a vision limited to “across the country”.

Some minor weaknesses:

  1. The section on “Six imperatives in the implementation of Recovery” is confusing as much of it applies mainly to “Controlled Adaptation” rather than to both approaches, but it appears before either approach has been set out. (p17-22)
  2. The next section on ” 1 An Ethical Framework for the Recovery” adds nothing whatever. (p23-25).
  3. After a very brief introduction, the report should have simply started with “2 The Elimination Option” (p26-57) followed by “3 The ‘Controlled Adaptation’ Strategy” (p58-82).

In fact I strongly recommend readers should simply skip everything before page 26. Just read the separate 2 page “snapshot” first rather than getting bored by academic pontification either in the summary or preceding the full report.

  1. Section 2 should start with a clear explanation that “Elimination” does not mean zero cases but rather, as explained by the New Zealand government, “zero tolerance” of cases, with any occasional sporadic outbreaks promptly suppressed. The opposite impression was created on p10.
  2. Key Performance Indicators for contact tracing cite a pre-print by Lokuge et al but do not provide any means for accessing it. The doi URL should have been included:
    https://www.medrxiv.org/content/10.1101/2020.04.19.20071217v1
    This technical paper is very important. It rightly stresses the importance of upstream tracing.

In discussing KPIs for contact tracing, reference should also be made to:

Rapid Audit of Contact Tracing for Covid-19 in New Zealand
Dr Ayesha Verrall
University of Otago
10 April 2020
https://www.health.govt.nz/publication/rapid-audit-contact-tracing-covid-19-new-zealand

  1. Lokuge et al includes a reference to Ferretti et al and to Imperial College Report 9. But it omits the essential confirmation in Imperial College Report 15, that testing cannot replace, but must be combined with, digital tracing , citing Ferretti et al. See links at:

https://github.com/dentarthur/next-waves/blob/master/Schools_and_TTT.md

A full appreciation of that should result in clearly linking public acceptance of digital tracing to a goal of “Elimination”. A government aiming at anything less than Elimination will not be able to get whatever level of public tolerance of dataveillance it needs for “Controlled Adaptation”. As Ferretti et al document, pre-clinical transmission itself has a reproduction number almost high enough for an uncontrolled epidemic without any symptomatic transmission. So success at Elimination requires far more contact tracing than can be achieved without popular enthusiasm. Transmission chains can be detected from primary care surveillance of symptomatic cases but with restrictions on social contact lifted the necessary upstream and downstream contact tracing could not get anywhere close to the results achieved manually under near lockdown conditions.

I included those references together with links on transmission through Schools because the battle over reopening schools will largely determine whether the outcome is Eliminate or not.

  1. Suggestions that Elimination could be achieved in 30 to 60 days “assuming no major institutional or other outbreak events” weakens the argument. Epidemics are inherently stochastic. The argument should simply be that although local outbreak events can be assumed, they can also be locally suppressed. That is New Zealand’s “zero tolerance” as opposed to “Controlled Adaptation”. The uncertainty arising from risk that one might be infected in an outbreak is no different from normal risks of accidents. It is very different from living in a society that has “adapted” to a stream of deaths from “controlled” infection.

I only skimmed the alternative “3 The ‘Controlled Adaptation’ Strategy” (p58-82) as I don’t really take it seriously. Not sure whether it is meant to be taken seriously. Seems obvious that if it was possible to “control” an epidemic with R just under 1 it would make sense to go for Elimination with a lower R. I did not notice any evidence supporting the idea that there is some way “gradually” lifting restrictions could change the reality that lifting them enough to resume normal economic activity would leave R above 1 and an epidemic explosion as already demonstrated around the world.

I don’t have time to read the rest before posting this and am more interested in first carefully studying the very important paper by Lokuge et al.

Overall my impression is that this report is more than enough for Victoria to hold out for Elimination and that is sufficient to put a spanner in the works of any pretence at “Controlled Adaptation”.

So despite both the major and minor weaknesses mentioned above, what I have read of the full report is a very welcome counter blast to the endless droning from the pro-death lobby. It does a job that needed doing.

covid-19 “What are we waiting for?”

“Are we nearly there yet” is a well known phrase from bored children on a long trip.

It is a developing theme in media coverage of the only measures that can save lives in the current pandemic. It keeps bubbling up in stories from the ABC and Nine Entertainment including The Age and The Sydney Morning Herald.

Usually expressed in a whiny questioning tone like bored children, “Are we nearly there yet” is also being pushed by a very serious campaign from the Wall Street Journal and its local expression The Australian.

The masters of the universe are really worried about all this talk of “essential services”. Deep down they know that what they own is essential in any society, but having them as owners is not. Health workers, supermarket stackers, teachers are all suddenly noticed as essential – they have the satisfaction of doing meaningful jobs that are obviously useful to society so it is not necessary to pay them as much as is needed to “compensate” useless parasites for having empty soul destroying lives increasing their own “net worth”.

The owners and their servants are desperately keen for a “proper balance” between saving lives and preserving their asset values. That means no more avoidable deaths than are strictly necessary to to get the economy going again. After all it is hard to make money from dead workers. So they don’t actually want the hospital system to be overwhelmed. But no less avoidable deaths either. If “the economy” demands sacrificial slaughter to be appeased then it shall have it. There must be as many avoidable deaths as the hospital system can handle in order to save their assets.

The priests of ancient cultures preferred slaughter of young virgins. We live in more enlightened times. First the owners of our economy have to mobilize popular opinion. That is hard work on a “pro-death” program.

“Why are we waiting?” is a popular anthem demanding “We want attention” from a crowd forced to wait, often a crowd of school children.

Andrew Bolt is a skilled and intelligent agitator on behalf of the owners of our economy. He makes the pro-death program of the Wall Street Journal far more presentable to a popular audience.

His subeditor picked a nice variation of “Why are we waiting” for his latest piece of bullying petulance.

The entire text is included below, together with review and analysis {enclosed in braces}

WHAT ARE WE WAITING FOR?

Thursday April 16, 2020 page 41

Herald Sun (Melbourne, Victoria, Australia) heraldsun.com.au
http://www.heraldsun.news.com.au/

Publisher: News Limited
Document Type: Bloviation

762 words

ANDREW BOLT: “Australia’s most read columnist”

“What exactly is the sign of success the Government is looking for before these stay-home laws can be eased? We deserve to know.”

THIS is extraordinary. Why won’t the Morrison Government tell us the sign it’s waiting for to release us all from home imprisonment?

Why won’t it level with us?

{The government did level with us when it warned that the restrictions needed to avoid the healthcare system being overwhelmed would need to be “sustainable” for “six months or more”. The 12 to 18 months expected before any vaccine is “six months or more” so technically they were being unusually “level”. Recently the government has started pandering to whiny journalists with ludicrous talk of being “on the cusp” etc. That gives an opening to Andrew Bolt.}

Haven’t we already achieved everything the government – and the state premiers, too – once said was the excuse for imposing on us a virtual police state?

{By “virtual police state” Bolt means businesses being shut down to reduce the number of avoidable deaths from a pandemic with no vaccine and no adequate preparations. He is not stupid. He kows what the stakes are given events in New York where the Wall Street Journal has its home. The answer to his question is that thousands have already died and are still dying in Italy, Spain, the UK and USA and the Australian government has not yet achieved everything it needs to do to avoid that here. He knows that, so he passes it off as a whiny “question” just like the usual crap from other media. But what he really means is a demand that they stop trying to avoid unnecessary deaths as fast as possible.}

Its medical advisers told us a month ago we had to stay shut in our homes because up to 150,000 Australians would die from the coronavirus.

{A month ago was March 16. That’s when the UK government was told by its advisors that current policies would result in a catastrophe similar to Italy. Doing nothing would result in say half a million avoidable deaths in the UK and over 1 million in the USA. The UK along with most European countries quickly followed advice to suddenly slam on the brakes. So did New Zealand. Australia took slightly longer but had the huge advantage of being further behind on the same trajectory.}

But just 63 of us have so far died. Even around the world the death toll is fewer than 130,000.

{How upsetting. If only the world had done as the Wall Street Journal demanded we could have appeased the economy with far more deaths! “Why are we waiting?” “All we are saying… Is give death a chance”}

The government also told us we had to be banned even from sitting alone on a park bench so that we could “flatten the curve” of infections.

{That is certainly what Italy and France did when they shut the parks. New Yorkers were ordered to “shelter in place” which certainly prohibits going out to sit on a park bench. No such order was made in Australia nor will it be needed unless we get closer to the 1000 deaths per day that New York is experiencing, as Andrew Bolt and the WSJ demand.}

But that curve is now as flat as a pancake. For days we’ve had 50 or fewer new infections. Many more people are getting better than are getting sick.

{“All we are saying… Is get more people sick”}

It also told us it had to ban elective surgery so hospitals wouldn’t run out of intensive care beds to save the masses dying from this virus.

{Andrew Bolt desperately needs a facelift because his portrait is starting to look like Dorian Gray’s}

But those 2200 ICU beds – and the many more emergency beds we’ve now added – have for many days had just 80 or so virus patients in them. Thousands of beds lie empty.

{“Why are we waiting?” “What do we want? Fill those ICU beds! When do we want it? NOW!}

If all this isn’t success, what is?

{Success will be continuing to avoid the 23% per day growth in cases that forced the government to suddenly slam on the brakes less than a month ago when we last had only 50 cases and those cases suddenly started doubling more than twice a week because restrictions had not been imposed and nothing else stops a virus that has no vaccine.}

What exactly is the sign of success the government is looking for before these stay-home laws can be eased?

{Well currently they are pandering to the whining by explaining that during the next four weeks they need to:

  1. Establish adequate testing.
  2. Develop industrial scale levels of surveillance to track each infection and isolate all contacts.
  3. Be able to respond locally to sudden outbreaks like the need to isolate 5000 people in Tasmania on just one day.

But actually I don’t think they are that stupid. They know that a lot longer than 4 weeks will be needed and that “community transmission” is still increasing, not declining, at the current levels of suppression.

My guess is the government think pandering will help keep the public on side better than simply telling the truth. That instinct is natural to politicians. But I don’t think they are looking for a “sign of success” expecting to “ease” anything. I think they are waiting to be told by the Chief Medical Officers when it is necessary to impose further restrictions.}

What is the key metric it’s looking for to ease the restrictions that have cost hundreds of thousands of Australians their jobs and their savings?

{Their usual politicians Key Performance Indicators have been suspended for the duration. Careful measurement of the volume of bellowing from a whole army of Andrew Bolts is unlikely to overide the advice of the CMOs. But they will keep pandering and that will only encourage Andrew Bolt to bellow louder.}

We deserve to know. Yet when I interviewed Health Minister Greg Hunt this week, he repeatedly refused to say what the government was waiting for.

{I don’t watch TV. The Minister ought to have said “Which part of ‘six months or more’ did you not understand?”}

Was it when we had not a single new death? Hunt would not say. Was it when we had no more infections at all? Hunt would not say. Was it when we had inflection rates this manageably low for another week? Two weeks? Hunt would not say.

{No. A week or two weeks is not “six months or more”. A month is more than four times a week and more than six months is more than 26 times a week and more than 13 times two weeks.}

What’s the big secret? Shouldn’t we all know what the government is aiming for, and debate the costs and benefits of that target?

{There is no big secret. In Wuhan the provincial Andrew Bolt’s of the police were able to briefly bully doctors in December last year to keep an imminent global pandemic secret. But everyone knows now and there is nothing Andrew Bolt could say that will change the impact of what people have seen unfolding right next to the Wall Street Journal in New York.}

Clearly, it can’t keep insisting these stay-home bans will last “six months”, given Hunt admits the death toll is much, much lower than it had thought possible.

{I won’t argue about whether Hunt is as weak as piss. But whether he pulls himself together and tells Andrew Bolt where to go or not, any government official in the developed world that ignores what its Public Health Units tell it must be done during an epidemic will be promptly replaced. Andrew Bolt would do well in Belarus, but not here.}

And what was so magical about six months?

It’s just a date plucked from a calendar, and six months of these bans would drive many Australians crazy and many more broke, as well as leave our economy devastated.

{True enough. It is possible that anti-viral drugs will improve the situation in six months, but it won’t be over until a vaccine which is not seriously expected in less than 12 months. Many Australians will be driven crazy, especially fans of Andrew Bolt. Many others will die.}

I don’t mean to criticise the government for what it has done until now. Hunt is right to boast: “The steps we’ve taken have literally saved lives and they’re making a massive difference, as difficult and as tough as they are.” Correct. All praise to Hunt and the rest of the government.

In fact, I supported the bans – and wanted more of them sooner – back when we had no idea how lethal this virus was or how fast it would spread.

Now the argument is a different one: where to go from here? Which bans actually make a difference, and which don’t?

{Yes Andrew Bolt is far more intelligent and skillful than the lunatics who denied that anything needed to be done at all. He knows that he needs to whip up resentment of minor irritations and a mood of “Why are we waiting”. The business readers of the Wall Street Journal can relate to a simple demand that their asset values be preserved. But the Herald-Sun has a working class audience many of whom live from pay check to pay check with no assets to preserve. So Andrew Bolt cannot speak as plainly as His Master’s Voice}

For instance, does Victoria’s ban on even surfing and fishing make any sense? Hunt told me we couldn’t relax because a “second wave of infections” might come, as we’ve just seen in China and Singapore.

{Ooh look, over there… surfing and fishing. There are very good reasons for rushing out dead simple rules to “stay at home” and sort out the details later. There are equally good reasons for Andrew to pretend he is just arguing about which bans actually make a difference when he is in fact demanding that more lives be sacrificed to preserve asset values.}

But what if it doesn’t? We could be waiting months and months for a second wave that may never come, and wait at an horrendous financial and human cost.

{The pretense is so transparent that Andrew Bolt actually forgets himself and becomes comical. Just imagine how awful it would be if a second wave was prepared for and never came! Fear not Andrew Bolt. There is no way to avoid repeated outbreaks when nearly 100% of the population has not been infected yet and is still Susceptible because there is no vaccine. You will get opportunities to present your demands many times over the next year or more. Every time the death rate subsides you can pop up and demand “Give death a chance”.}

Surely it makes sense to fight any second wave if and when it actually comes. We’ll be far better prepared then, and can bring back all the restrictions we like when required.

{Surely. Just like it made sense for New York to not fight the first wave until it hit them and they had a thousand deaths per day.}

Tasmania this week actually set a more realistic and affordable model for fighting a “second wave”.

It had an outbreak of infections – 78 new cases – at two hospitals in Burnie. It blitzed that outbreak at its source, closing the hospitals and putting 5000 people there in quarantine.

{Utterly brilliant! Andrew Bolt knows he has some really, really stupid fans. They will have heard that instead of being “flat as a pancake” at 50 cases per day as Andrew claims, Tasmania had to isolate 5000 people in one day and needed help from the military to do it. So simply tell them that this was a “more realistic and affordable model” and they will just remember that it was part of their hero’s argument for doing nothing instead of thinking it showed that the curve is not “flat as a pancake” like their “dear leader” says.}

This must be our future. Yes, let’s have stricter quarantining of the infectious; better isolation and support of the most vulnerable, who are overwhelmingly aged over 70; and aggressive testing and tracking down of people who might have the bug.

But let the rest of us slowly get back to work to pay the monstrous bill. Just tell us the key to start that great engine.

{Essential services are at work. That unavoidably results in community transmission, even in hospitals as seen in Tasmania. But it is unavoidable no matter how carefully peope leaving their homes to work try to avoid contact. Andrew’s problem is that the longer essential services are the focus the more obvious it becomes that the people he bellows on behalf of are in no way essential.}

What is the government waiting for, and why won’t it say?

{Good question. I think the government is too gutless to simply arrest and quarantine Andrew Bolt as a biosecurity hazard.
But watch out for the CMOs.}

BLOG WITH BOLT blogs.news.com.au/heraldsun/andrewbolt/HERALDSUN.COM.AU

covid-19 Four Corners looks back – ignores urgent need for Quarantine accommodation

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]…

https://www.brisbanetimes.com.au/politics/federal/medi-hotels-instead-of-home-isolation-for-mild-covid-19-patients-20200413-p54jfc.html?ref=rss&utm_medium=rss&utm_source=rss_feed

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://www.theguardian.com/world/datablog/2020/apr/08/is-australia-flattening-the-coronavirus-curve-your-questions-on-testing-and-community-transmission-answered

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.

  1. Incoming travellers enforced quarantine from midnite Saturday 28 March.
  2. 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).

https://www.health.gov.au/news/australian-health-protection-principal-committee-ahppc-coronavirus-covid-19-statements-on-7-april-2020

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”:

https://www.health.gov.au/resources/publications/impact-of-covid-19-in-australia-ensuring-the-health-system-can-respond

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.

http://covidsim.eu/

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).

Covid-19 Two weeks from catastrophe – here – now

Poorest countries likely to be devastated

Even the Wall Street Journal finds it “troubling”:

https://www.wsj.com/articles/coronavirus-is-advancing-on-poor-nations-and-the-prognosis-is-troubling-11585149183?mod=hp_lead_pos10

Ten days till Intensive Care Units full in Australia. Two weeks till more than 20% avoidable death rate in hospitals.

When a system breaks: a queuing theory model for the number of intensive care beds needed during the COVID-19 pandemic
Hamish DD Meares and Michael P Jones
Med J Aust
Published online: 26 March 2020 (preprint)

https://www.mja.com.au/journal/2020/212/10/when-system-breaks-queuing-theory-model-number-intensive-care-beds-needed

The very simple model fits the data from Italy and the current rates of admission to hospital (increasing 23% per day i.e doubling more than twice per week).

Confirms what I’ve been saying, most deaths from unavailable care. Estimates almost a quarter of hospitalized cases will die from unavailable ICU care, not from covid-19, starting 2 weeks from now

“Now, instead of a steady state, imagine the number of total positive cases in the community increases by 20% every day (23% currently in Australia [7]). On the day you have 100 total positive cases, you will have approximately 120 the next. Those 20 new positive cases will require one new ICU admission and a 10-bed ICU to service that rate of admissions.

That implies that the number of ICU beds needed is approximately 10% the Total Positive Cases or 50% of the number of new positive cases. Australia has around 2200 ICU beds, which implies if public health measures fail to curb the rate of growth, Australia’s ICU capacity will be exceeded at around 22 000 COVID-19 cases sometime around the 5 April, 2020. Other sources [8] have suggested that Australia could cope with up to 44,580 COVID-19 cases, but even if this is true it only grants a 3-day extension to the 8 April, 2020. The practical impact on ICU capacity of this scenario is made clear in Figure 1″ [at end of the pdf version]

“Figure 2. ICU admission rate per 100,000 population in Lombardy initially increases exponentially followed by a steep linear increase”

“In Figure 3 we found the mortality rate among hospitalized averaged 8.8% from Day 1 to Day 14 and was essentially steady (p=0.9), but from Day 15, the mortality rate dramatically rises (p<0.001) with an average mortality of 22.7% from Day 15 onwards.”

“The authors’ conjecture is that initially the 8.8% mortality is predominately from COVID-19 patients in ICU but from around Day 15 onwards, the increased demand for ICU beds outstrips the capacity of the system to supply them, and patients perish not from COVID-19 per se but from lack of access to an ICU bed. This is also illustrated in Figure 3 (available in the PDF version) where the ICU admission rate falls as demand increases, with a corresponding increase in the mortality rate.

“These data imply that the eventual mortality rate of COVID-19 may be much higher than currently estimated because once the system reaches breaking point and there are insufficient ICU Beds, mortality rises dramatically.”

Conclusion

“While the specific form of the proposed model can be debated, it does appear to represent a realistic clinical scenario, is consistent with international data and suggests the conclusion that the impending demand for ICU beds could overwhelm capacity in even the largest Australian hospitals in the near future. Australia must immediately take all available measures to rapidly decrease the rate of new cases and radically increase the number of ICU beds otherwise we may face the same fate as Italy, or worse.”

My conclusion is slightly different. Radically increasing the number of ICU beds will only delay catastrophe a few days although that will certainly be a good thing and even more useful for later waves.

The whole focus right now must be on “all available measures to rapidly decrease the rate of new cases“.

That includes Quarantine accommodation which can be rolled out much faster than ICU beds and without diverting any resources from efforts to increase ICU beds.

Hopefully Victoria’s Chief Medical Officer will again “jump the gun” as he did in stress testing the pharmacy supply chains by advising people to stock up for two months lockdown. He should start the full lockdown today and then insist on prompt Quarantine accommodation for ALL cases, and separately for vulnerable people living in households with others, not just household isolation. If he does, others will follow.

Personal refection on above from MJA Editor:

https://www.mja.com.au/journal/2020/212/10/sars-cov-2-medical-profession-ventilator-beds-and-mortality-predictions

Henry Ergas joins the WSJ campaign for more deaths to save the economy

The Australian has reported the above story:

https://www.theaustralian.com.au/nation/tougher-lockdown-key-to-health-system-coping-research-reveals/news-story/4cf57becfbe8165adeb49ebface1902d

But it is still pushing the WSJ’s “pro-death” campaign.

https://www.theaustralian.com.au/commentary/coronavirus-it-will-be-unhealthy-to-ignore-the-cost-of-all-this/news-story/60f5e2f3c1708aa9036aa1778933f15b

As a biosecurity hazard The Australian should also be shut down – now – and stay shut down until it agrees to stop campaigning for more deaths.

Swan Song

Here’s the ABC’s Dr Norman Swan with basically correct advice on what has to happen immediately for “social distancing” but a ludicrous claim that it will result in getting back to normal in say 4 to 6 weeks:

https://www.abc.net.au/news/2020-03-26/how-australia-could-beat-coronavirus-swan-nbk/12091688

He ends with this verbatim quote:

“How long is it going to last before people say ‘stuff this I’m going out’. And then you get the epidemic coming back. Short, sharp, time-limited, get back to our normal life over a period of time.”

It does need to be sharp and stressing “short and time-limited” may help get people to comply with sharp measures more quickly than they otherwise would. Trump seems to be doing that in the USA with his usual posturing against the medical advice while authorizing rapid sharp shutdowns for an initial 15 days and pretending that will be enough.

But 4 to 6 weeks is almost as ludicrous as Trump’s talk of the US economy roaring back after Easter. I think the difference is simply that Trump knows he has a more credulous and reluctant audience than the ABC and is facing either an election or postponement of elections in November. (Presumably the Electoral College mechanism in the US Constitution could still operate without public polling but the US Northern Command Combatant Commander might be just as plausible as either Trump or Biden to maintain a functional national government in that circumstance).

The period cannot be time-limited in advance. It can only be based on testing and a better understanding of how long it takes between triggers for lifting restrictions to increase the rate “R” to a level above 1 that again threatens hospital capacity and triggers for resuming restrictions to get it back below 1 (with increased capacity including ventilators and anti-viral drugs) to again cope. It won’t be “over” (for this season of this strain) until herd immunity via either a vaccine or most of the population having recovered from infection. This is clearly explained (for a technical audience) in Report 9 from the Imperial College covid-19 response team.

As Dr. Anthony Fauci, the USA’s top expert spokesperson says:

“You don’t make the timeline. The virus makes the timeline”

There may be a way to explain that clearly with texts and visualizations, but I don’t know how, and am convinced it urgently needs “Explorable Explanations” with widgets. I doubt that Dr Norman Swan COULD explain it to his ABC audience even if he DOES get it himself (which I also doubt).

Dr Swan is certainly right that people will be saying ‘stuff this I’m going out’ in a short, time-limited period unless they DO understand.
That short, time-limited period should be used to provide clear “Explorable” Explanations that it will NOT just be a single flattened peak and of many other things concerning how society will cope with the actual expected multiple waves.

The other point he stresses is the need for mass testing. That is certainly true and governments certainly do know it now and will get that happening a lot faster than they can possibly roll out ventilators and ICU beds. They simply don’t have enough test-kits yet, not a lack of understanding that they need them. I assume that capabilities to mass produce test-kits fast enough are being rolled out now without need for social mobilization to force them to do so. Like ventilators and ICU beds, test-kits, masks and alcoholic sanitizers cannot replicate themselves as fast as this pandemic virus. But unlike ICUs, they only need to be ramped up at achievable rates to avoid catastrophe.

More important than the tests to confirm who has it (which can be clinically diagnosed reasonably accurately very shortly after symptoms even without tests) are smaller random sample blood tests to see who has recovered from it without being recorded as a case. That data is essential for setting trigger levels for imposing and lifting restrictions in advance of hospitals becoming overloaded. It is a technical matter that does not need to be urgently understood by the general public and unlike Quarantine accommodation I am confident it is already being worked on as fast as possible.

USA likely to be hardest hit modern industrial country

While Spain is closely following the Italian trajetory to catastrophe and major European countries including the UK not far behind, Australia is still a couple of weeks further behind.

I haven’t been following the US situation but this article from Wednesday (25 March) suggests the US will end up worse off than others:

https://www.theatlantic.com/health/archive/2020/03/how-will-coronavirus-end/608719/

It also has some explanation of the protracted nature and multiple waves of the pandemic crisis and speculation about social changes in the aftermath (plus of course some of the usual incomprehension from Never Trumper’s of why Trump’s popularity has not collapsed – but perhaps less dominated by that than usual for “The Atlantic”).

But if you are missing “the usual” from Never Trumper’s, “The Atlantic” is still a good place to find some:
https://www.theatlantic.com/ideas/archive/2020/03/presidents-character-unequal-task/608743/

BTW I’m not following US politics but headlines show Trump’s approval higher than ever in most of the polls. Interestingly Rasmussen poll which usually shows Trump approval significantly higher than others (because it only counts people likely to vote) is relatively static.

For deeper insight into why “Never Trumpers” lost the Republican Party, here’s one whining about his life being in danger as a doctor. The incompetent shortage of Personal Protective Equipment for health workers is very real and serious. But most of them are angry that they risk having to stop working for a few weeks when they get infected, thus further overloading their colleagues and reducing the health system’s capacity to save lives. They aren’t as intensely focussed on themseves as either Trump or this writer for “The Atlantic”:

https://www.theatlantic.com/ideas/archive/2020/03/were-failing-doctors/608662/

On the plus side, at least The Atlantic is strongly opposing the campaign to sacrifice a million or more lives for “the economy” being waged by the Wall Street Journal with a lot of traction on the right (and supported by the NYT’s Thomas Friedman):

https://www.theatlantic.com/ideas/archive/2020/03/national-shutdown-least-bad-option/608683/

I’m only attempting to follow the epidemiology of pandemic disease covid-19, not the virology of the virus responsible, SARS-CoV-2. But for those interested, The Atlantic does have an interesting article on that:

https://www.theatlantic.com/science/archive/2020/03/biography-new-coronavirus/608338/

Also interesting for those trying to follow aspects other than the epidemiology is an account of the dramatic Danish economic response, supported by all parties there:
https://www.theatlantic.com/ideas/archive/2020/03/denmark-freezing-its-economy-should-us/608533/

“Life in a time of Corona”

Here’s a relaxing video from an ABC Foreign Correspondent stuck at home.

https://www.abc.net.au/news/2020-03-24/life-in-the-time-of-corona/12086808 25 minutes Tuesday 24 March.

“Necessity is the mother of invention” so ABC Foreign Correspondent Emma Albericci stuck at home had the bright idea of interviewing her Italian relatives under lockdown. Starts with usual ABC ominous sound track with pictues of deserted Milan, but then shows Italians in near total lockdown coping well now that they know what they have to do and why they have to do it. Less reassuring but appropriately informative on what happened to Italian hospital system because they did not act fast enough to do what they now ARE doing. This is helpful for other countries to do it now instead of “proportionally” and worry less about reactions.

Visualization and Explanation

Quite a good item from the ABC on the actual data for cases, with a reasonably clear message (unlike their previous efforts with “9 charts” and then “13 charts” that were pointless). Worth reading, although I don’t agree with the explanations of differences between countries.

https://www.abc.net.au/news/2020-03-26/coronavirus-covid19-global-spread-data-explained/12089028

What the visualizations actually show is that most countries being tracked are closely bunched together along much the same trajectory of “community transmission” with a common doubling period of known cases of between 2 and 3 days. The outliers are China where containment was sucessful except in Hubei and four other Asian economies (Japan, Singapore, South Korea, Taiwan) that had experience from SARS and MERS. I won’t go into a detailed critique as the central message is good.

But a glance at the numbers makes it glaringly obvious the crisis is nowhere near ending in ANY of these countries. The numbers already infected might be say 10 times larger than the case numbers so far but there is no reason to expect that nearly all of them have recovered and now have at least short term immunity. Even if the numbers infected were 100 times the cases, that would still leave the overwhelming majority susceptible. eg South Korea currently appears to have covid-19 “under control” with total flattening out at around 10,000 cases. Even 100 times that is only 1 million which would still leave 98% of the population susceptible. It isn’t worth arguing about whether the actual numbers infected are closer to 5 or 10 times rather than 100 times as there is no practical difference between 98% susceptible and 100%. That is simply not mentioned.

Nor in my view is there much practical difference depending on what percentage of people infected remain as carriers when restrictions get lifted despite appearing to have either fully recovered or never had symptoms. There will still be a battle using tracking and isolation of cases in small outbreaks with the ongoing potential for eventual “community transmission” and no reason not to expect further peaks after getting the initial outbreak “under control”.

The end of the crisis comes only with a vaccine for herd immunity (followed by regular updated vaccines for new strains of a likely new endemic disease). That is still expected to be 12 to 18 months away.

Tensegrity

On an entirely different note, which somehow feels related to me:

https://tinyurl.com/sthh2fz

That’s all from me on reviewing the media. I’m going back to the technical literature now.

covid-19 The “Republic of Letters” Strikes Back

Things in Australia are now moving almost as rapidly towards a less insane policy as in the UK. It is already too late to avoid catastrophe in the UK but Australia has more time in which to at least reduce the scale by a larger factor than the UK can hope to achieve.

Basically scientists have been unleashing a flood of papers that make it pretty clear governments will be held criminally liable for negligence, with proof beyond reasonable doubt. They are more polite about it, but they are “expert witnesses” spelling out the case for prosecution.

The UK Center for Mathematical Modeling of Infectious Diseases has published some prototype “Explorable Explanations” with widgets eg so that anybody can get a “feel” for the UK running out of hospital critical care beds by the end of this month (with the numbers needed doubling every 1-2 days).

https://cmmid.github.io/topics/covid19/

These are still server based Dashboards probably prepared from Jupyter R notebooks using “Shiny”. But they seem to have the server bandwidth to sustain the traffic so far. It won’t be long before easier to understand “Explorables” are available for routine inclusion in any blog post using only browser resources without server support. The difference in impact is roughy comparable to the printing press vs copying out manuscripts by hand. But the prototypes had to come first.

The “Group of Eight” Universities have come out with a group of experts from all relevant fields insisting that the government must “go hard and go now”. Oddly the only google link for that is here:

At the end there is a link to the UK Government’s Scientific Advisory Group for Emergencies – SAGE:

https://www.gov.uk/government/groups/scientific-advisory-group-for-emergencies-sage-coronavirus-covid-19-response

That page is now being updated “on a regular basis with the latest available evidence provided to SAGE.” Note the word “to”, not from. The flood of research is now spilling out of academia onto official government web sites.

There is even a fine grained Agent Based Model for Australia now available via a link from this summary:

https://www.sydney.edu.au/news-opinion/news/2020/03/25/greater-social-distancing-could-curb-covid-19-in-13-weeks.html

I am still studying it, but it does argue that 80% compliance with “social distancing” measure would be needed to get the outbreak under control in 4 months. It does not spell out that 80% compliance is rather implausible without Quarantine accommodation.

Nor does it emphasize that “under control” merely means ending the first outbreak so that it isn’t just doubling every couple of days and there is time to cope. Controls will need to continue on and off until either an effective vaccine has been deployed or most of the population has been infected at a rate the hospitals plus any anti-viral drugs developed can cope with.

I still haven’t seen anybody else advocating a crash program for Quarantine accommodation to isolate infected and vulnerable people from the households they are in. But there is now lots of thinking about how to organize school children during a long shut down.

As explained in my last post in this series that Quarantine accommodation can be arranged much actual new buildings. But it still takes time and needs lots of help from tradies. So it is particularly stupid that the construction industry as being treated as though it was an “essential service” when it obviously isn’t constructing anything essential – like Quarantine accommodation. Most of the construction workers still getting infected on the job will recover in time to help with fitting up Quarantine accommodation for the next few waves if not for the first one. But it suggests there is still no intention to rapidly move into using the establishments and workforce now shutdown to actually do anything to reduce infection rates apart from staying at home.

Still, the complacency is ending. That had to happen for action to begin.

Covid-19 – The Impending Catastrophe and How to Combat It

Introduction

The title of this post in the covid-19 series here is from a pamphlet by Lenin at the end of October 1917. Lenin begins with the words “Famine is Approaching”:

https://www.marxists.org/archive/lenin/works/1917/ichtci/index.htm

We are not in that situation nor anything like it. But there is an impending catastrophe which has been thoroughly documented by the “Imperial College Covid-19 response team” in a series of technical reports:

https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news–wuhan-coronavirus/#

The current absurd floundering will not result in famine. But it could result in more avoidable deaths from Covid-19 than the total deaths from the “Spanish Flu” which killed more people than the “Geat War” that immediately preceded it – the “War to End All Wars”.

This is very likely in countries ruled by Kleptocracies like many in Africa. But already the failure to prepare is killing large numbers in Italy, with Spain and France close behind and London less than three weeks behind Italy on the same trajectory. Lots of people will also die unnecessarily in countries that are modern industrial democracies with blithering idiots in charge of pretending the owners care about the people.

The potential catastrophe we face is much smaller than the consequences of famine. A Case Fatality Rate of 6% or so instead of less than 1% that could have been achieved if quarantine arrangements were prepared to spread out the peak case load. Say half a million avoidable deaths in the UK, 2 or 3 million in the USA, less than a hundred thousand or so in Australia. Nowhere near as bad as famine…

Most of the deaths will be the result of hospital Intensive Care Units so overwhelmed they cannot provide life saving treatment for the most severe case numbers beyond available capacity.

Figure 3 of this recent authoritative announcement has a clearly labelled graph on “flattening the curve”:

Figure 3 Flattening the Curve – Avoidable DEATHS not prevented

https://www.health.gov.au/news/australian-health-protection-principal-committee-ahppc-coronavirus-covid-19-statement-on-17-march-2020

Instead of just the usual horizontal line showing “Health System Capacity” lower than an early high peak and just above a slower spread out peak it adds a label for the very large shaded region above that line for the high peak and the smaller region still above that line, for spreading out.

The label is “Unmet Need”.

That is clear enough. A sharper version, more easily understood and acted on would be:

“Avoidable DEATHS not prevented”.

But even the milder version is omitted from more recent authoritative announcements.

Australia is on roughly the same trajectory as London, Italy and the United States. “Community Transmission” is already well under way in NSW and Queensland and has just got started in Victoria. It makes sense for the other States and Territories to close their borders to buy some more time just as it made sense internationally.

But it won’t be enough.

Update: If this sounds alarmist check out today’s Australian on what others far more qualified to express an opinion are saying:

https://www.theaustralian.com.au/science/coronavirus-tougher-measures-a-matter-of-life-or-death/news-story/fdde8510d7ebbc5b8e041f668dd6405d

Infectious disease modellers say the current round of restrictions would quarter the number of likely infections at the peak of the epidemic, but even with those social distancing measures in place, unless further measures were taken, Australia could still hit a peak of 125,000 infections a day — a level that would overwhelm the nation’s intensive care units.

Cases of COVID-19 are currently doubling every four days in Australia and heading towards a trajectory of a three-day doubling. If the epidemic were allowed to continue in this manner, University of Melbourne epidemiologist Tony Blakely said infections could climb to as many as 500,000 a day within weeks.

Under that scenario, the reproductive number of the virus is 2.5 — meaning every person infected with the virus would pass it to 2½ others. Social distancing measures are likely to reduce the reproductive number, known as R0.

Professor Blakely has modelled the impact of social distancing measures and predicts the moves to close pubs, clubs, restaurants and sporting facilities could reduce the R0 to 1.2 by the end of May. That would see the epidemic peak at about 125,000 infections a day in late May, with 60 per cent of the population infected.

Based on modelling completed by epidemiologists from Imperial College London, and adapting their model to Australia, Professor Blakely predicts that by the epidemic’s end, 165,000 ­people, or 0.84 per cent of cases, would require intensive care, ­assuming 60 per cent of people of all ages were infected.

Medium Term

Below on “How to Combat It” is mainly about short term measures. Days and weeks of “Impending Catastrophe”.

Fortunately longer term measures are already under way as explained at the end

Scientists and “nerds” are already pushing aside the barriers to effective cooperation from “Intellectual Property” far more rapidly than the rest of society is moving to push aside other forms of private property in the means of production.

The Enlightenment “Republic of Letters” is emerging again in a modern form with rapid mobilization forcing changes in public health policy as documented in earlier articles of this series:

https://c21stleft.com/2020/03/16/covid-19-over-70s-must-self-isolate-for-4-months-scientists-demand-immediate-social-distancing/

https://c21stleft.com/2020/03/13/covid-19-dont-panic-do-self-isolate/

For those who think they already understand and could not even bother to read the links in those posts there are already some excellent animated videos to explain the basics eg:

Why the actual numbers are much larger and growing faster than the statistics catching up:

Estimating actual COVID 19 cases (novel corona virus infections) in an area based on deaths

Some visualizations that are steps towards “Explorable Explanations” with sliders and other widgets to get a “feel” for what is happening and what can be changed can be found here:

https://observablehq.com/collection/@observablehq/coronavirus

Inceasing Healthcare Capacity

It also makes sense to immediately commandeer hotels as well as private hospitals for conversion into Emergency Hospitals and use entirely separate hospital buildings for covid-19 rather than attempting infection control within the same hospital buildings as wards for other patients. No doubt that will all be done along with many other things to raise capacity.

For those interested in the measures for rapidly expanding healthcare capacity a thorough current account of covid-19 for Emergency Medecine Critical Care professionals is here:

https://emcrit.org/ibcc/covid19/ (about 50pp as of 2 March)

Only the first section is likely to be of wider interest to other health workers. I think that first section is adequately summarized for a wider general audience in the public information campaigns now based on accurate advice from Centers for Disease Control etc. Note that the discussion of precautions against possible airborne transmission in above link is only relevant for those actually treating infectious patients.

No doubt surgeons no longer doing elective surgery will be taught how to do intubation procedures to provide ventilation for the vastly increased numbers of severe cases with viral pneumonia including many with further complications such as bacterial pneumonia, even though most of the teaching will be on the job assisting. Inferior split ventilators will be used and supplies will be ramped up.

Supply Chains

Naturally the main focus of the media has been on shopping. The newspapers are printed on the back of ads for shopping and the broadcast news is squeezed between ads for shopping both online and on air.

My view is that the shopping shambles is not of major signifcance and will be sorted out without major impact. Even if 80% of the workforce have mild to moderate illness lasting 2 to 3 weeks over the same relatively short period and there is disruption generally, essential services can be maintained. Most workers are employed to not do anything useful, let alone essential. Workers from large sectors shutting down now can be fairly rapidly mobilised as (unskilled and bewildered) assistants in essential areas while training on the job.

That is what I expect to happen when the blithering idiots in charge notice that funding businesses to continue trading while insolvent does not actually achieve much in the long term for a shutdown that reduces their turnover to near zero. Even the sheer idiocy of disrupting all credit arrangements by not enforcing payment terms so that deliveries will only be for cash will not be catastrophic in itself although the financial system may be fragile enough to come up with a related catastrophe.

Some fumbling and blunders are inevitable. The supply chains for groceries and pharmaceuticals will recover from panic buying without those stuff ups in emergency management causing many unnecessary deaths. The shortage of face masks and alcoholic sanitizers was avoidable but not necessarily catastrophic.

Impending Catastrophe

So what is the “Impending Catastrophe” if the Medium term is looking good, healthcare capacity can be rapidly expanded and supply chain hiccups are not especially catastrophic? Simply this.

There is no reasonable prospect of increasing the capacity of Intensive Care Units rapidly enough for a pandemic that will accelerate to double the case load every 2-3 days. A week after hospitals reach full capacity they will be dealing with a case load more than four times capacity. A fortnight later, more than 16 times. This is happening now in Italy. London is about 3 weeks behind Italy and Australia and the USA not much further behind, all on much the same trajectory that leads to catastrophe.

What cannot be fixed quickly enough for the first peak is the supply of mechanical ventilators etc for Intensive Care Units. Vastly accelerated scale up still cannot possibly keep pace as countries are now entering the period of doubled demand every 2-3 days:

Clin Infect Dis. 2015 May 1; 60(Suppl 1): S52–S57.
Published online 2015 Apr 10. doi: 10.1093/cid/civ089
Estimates of the Demand for Mechanical Ventilation in the United States During an Influenza Pandemic
Martin I. Meltzer,1 Anita Patel,2 Adebola Ajao,3 Scott V. Nystrom,4 and Lisa M. Koonin5
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603361/

The impending catastrophe is lack of preparations for serious quarantine.

Given a shortage of Intensive Care Units and no vaccine, such measures are the ONLY way to prevent or reduce catastrophe.

Quarantine

The measures for people outside the health system to focus on are for “flattening the curve”. Spreading out the infection directly reduces the death rate by directly reducing the number of people with severe cases who cannot be treated when they all arrive at hospital Intensive Care Units at once and equipment is available for only a fraction of those who need it.

That is not something achieved by telling people to stay at home doing nothing. It requires actually building and organizing things.

We need to actively build and organize QUARANTINE facilities. This is not just passive “social distancing”.

The whole point of the “containment” phase of tracking new arrivals for a short period of “self-isolation” and closely tracking the contacts of anybody infected was only to buy time before “Community Transmission” began. Containment merely keeps the numbers of new infections “contained” at a smaller rate to delay the “local transmission” that will inevitably eventually grow at a much larger exponential rate until “herd immunity” is achieved with effective vaccination (expected 12-18 months away). Some cases were bound to get through and eventually result in enough people infected from unknown local contacts that the origin of most new infections is “the community” rather than some tracked or untracked individual cases seeded from outside. Then the pace accelerates from doubling each week to doubling each 2-3 days as in Italy and others that are near the first peak.

The World Health Organization, WHO, has recommended “test, test, test” because the surprise at the Italian hospital system being overwhelmed showed the pandemic was being fought blindfolded. Containment through border control and isolation cannot work when you do not know who to isolate from whom. It was known since late January that most people infected had only mild symtoms or none (with estimates of 86% of cases not reported in the statistics that media have been relentlessly staring at).

Even with an adequate supply of test kits there has to be somewhere to put people who test positive for the couple of weeks or so until most of them recover. Instead they are being told to stay at home and infect the rest of their household who are now (belatedly) being told to also stay at home. That will reduce the acceleration more than if they were told to just keep going out. But three very urgent measures were obviously necessary then.

Their necessity should have been announced loud and clear while rolling out implementation as fast as possible after announcement. So far not even the necessity has been announced. Here is my view of the three most urgent measures that are critically urgent now:

How to Combat It

1. Quarantine Hospitals for the mildly and moderately ill

Also separate facilities for unconfirmed suspected likely cases (eg travellers from areas with more community transmission to those with less).

I don’t know what the correct term is for what I have called “Quarantine Hospital”. People who don’t live by themselves should obviously not be told to just stay at home and infect their household while they wait to see if they are actually infected or while recovering. Nor should they occupy full hospital beds needed for people more severely ill.

The rest of their household can be told to just stay home for a couple of weeks to see if they are already infected or not, but anyone infected should be immediately separated from people who are not known to have been infected. That is blindingly obvious whether they need additonal medical treatment or not and whether any treatment they need is available or not. Any country not doing this is not seriously trying to flatten the curve.

“Quarantine Hospital” sounds better than “Quarantine barracks” but just somewhere to stay and be fed with some nursing staff is all it takes to seriously spread out a peak. It will require an enormous effort but it can be done using space that must be shut down anyway, emergency furnishings and staff from businesses that must be shut down anyway.

Commandeering hotels etc is for full emergency hospitals, not for the larger numbers of beds needed in Quarantine Field Hospitals. Lots of office space unused with people working from home and entertainment venues shut down must be converted to emergency accommodation. The kitchen facilities are available from the cafes and restaurants being shut down. The beds and bedding are available from households in proportion to the numbers moved out of households that will need those beds, and the staff are available from the huge numbers of small businesses trading while insolvent as well as from those already laid off. So far as I can see that has not even been planned, let alone started.

2. Quarantine Accommodation for the vulnerable

Older people and people with various severe health probems are especially vulnerable to being part of the less than 1% who might die before a vaccine is available or part of the additional 5% or so that are killed by government incompetence as a result of intensive care not being available for them when the hospitals are overwhelmed. No doubt local communities will get organized to help those who need help while staying isolated in their own homes but there are others staying in households with less vulnerable people equally susceptible to infection.

“Tough” restrictions on visits to aged care institutions are obviously ludicrous. These can only be intended as justification for very soon saying people had an opportunity to make their last visits immediately before an essential full shutdown until proper procedures for safe visits fully separated by glass barriers etc can be organized.

But vulnerable people currently living in households with others must also be offered accommodation separated from the rest of the susceptible population until the peak has passed and sufficient intensive care facilities are available. That will be hard for many. Many may refuse and many may die. But doing nothing to make viable separate accommodation available is criminal. That seems to be the current “plan”.

Neighborhood support groups are starting to be formed spontaneously through social media:

https://www.abc.net.au/news/science/2020-03-17/coronavirus-online-support-groups/12060530

It is important to keep them entirely separate (although overlapping with) closed small “affinity” groups of households with children discussed in item 3 below.

3. Quarantine Separation of children

Obviously schools will have to be shut at some point except for children of households working in healthcare and other essential activities. Meanwhile schools are vitally important community organizing centers for households with children.

The shutdown won’t just be for a couple of weeks. It will end up lasting for many months.

while still open, and even after closing, schools should be organizing children into small groups, much smaller than class sizes, that will be allowed to interact with each other within school and after the shutdown and prohibited from doing so between groups.

This obviously needs to be coordinated with parents because all the households with children in whatever group any child continues to interact with will tend to get infected together. It will be especially difficult for households with children in different age groups and different schools but every household with children must be assigned to a particular group of households it is permitted (not required) to socially interact with. The kids are not going to just stay at home with their parents for six months, let alone eighteen months! Humans evolved in Hominid bands of a couple of dozen, not as isolated nuclear families.

Hopefully if we move really fast the necessary interaction can be online in Virtual Reality but we don’t know how well that will work, for how long or how quickly. It still ought to be based on non-overlapping groups that should be organized now by schools.

These separate child based groups are likely to continue to mix with and infect each other and must accept that their own group of households will or may end up having the larger risk of earlier infection corresponding to an enlarged single household. They must be confined to small numbers of households who trust each other to maintain isolation from the rest of the world to the same extent as the individual households.

Households with older and more vulnerable people are a major complication as self-isolation within a household is unlikely to be effective for long.

Six months is a rather optimistic estimate of how long this crisis will last. It could “conceivably” be as short as 6 months if all goes perfectly but that is not the period to plan for now. Avoiding overwhelmed hospitals requires dragging things out longer, until an effective vaccine gives “herd” immunity or effective anti-viral drugs reduce the death rate. Even if it could theoretically be even shorter than six months most serious estimates are for 12-18 months of on and off waves.

The current authoritative recommendations are that it is still too early for school closing in Australia:
https://www.health.gov.au/news/australian-health-protection-principal-committee-ahppc-coronavirus-covid-19-statement-on-22-march-2020

But that is based on lack of positive evidence that the time is right. See below on tests.

Evidence

Evidence in support of much of the three proposals above can be found from the experience of South Korea so far:

https://www.wsj.com/articles/how-south-korea-solved-its-acute-hospital-bed-shortage-11584874801?mod=hp_listb_pos1

But even Italy where the hospital overload is currently greatest has only had 0.1% of the population as “cases”.

South Korea has a very long way to go before herd immunity and there is nothing in the lower numbers of new cases after the first peak or the success in dealing with that first peak to suggest that there won’t be many further peaks:

https://www.worldometers.info/coronavirus/country/south-korea/

Likewise for Singapore, another success being hailed as though it were not just success with the first peak.

I don’t know whether anybody has solid evidence of whether and how it may be possible to stop transmission between househods via their children during an extended shutdown. As far as I can make out there is just empty hoping that for some unexplained reason it won’t happen. This mainly takes the form of highlighting the distraction that children have much less severe symptoms (which actually enhances their role as disease vectors).

Current Plans

Compared to Australia and the USA the UK is a model of serious but still unsuccessful efforts to explain public health policy to the public via journalists in a joint effort by the PM, the Chief Science Officer and the Chief Medical Oficer.

It is worth spending the time on these two long videos less than 5 days apart to understand how rapidly the situation is changing and how uncomprehending the journalists covering the “issue” are.

Coronavirus: Boris Johnson holds press conference after Cobra meeting
308,797 views – Streamed live on Mar 12, 2020 – starts at 23’30” of 1:10’57”

Coronavirus: Boris Johnson sets out “drastic action” BBC
292,849 views – Streamed live (Mar 16, 2020)

The pandemic model that now forms the basis for planning in the UK expects multiple waves of infection each time “social distancing” is relaxed after successfully suppressing the peak rates to reduce case loads to hospital capacities. This is in Report 9 from the Imperial College team:

https://time.com/5804555/coronavirus-lockdown-uk/

A shorter Australian attempt at explaining the model to a journalist is this video from the ABC’s Dr Norman Swan on 17 March. (I watched it after having written the rest of this article). In many ways it is better than the UK and Australian official explanations but he still ends up distracted by issues of case tracking from the “Containment” phase rather than the current accelerating exponential growth on entering the “Community Transmission” phase. He simply does not get the fact that spreading out the peak necessarily reduces total deaths from unavailable intensive health care units and instead claims that a spread out peak could still have the same total deaths.

“Explorable Explanations” with widgets for people to actually manipulate the paramaters of the models themselves are really essential instead of literally hand-waving – with or without a background graph:

If any of these people trying to explain had access to such Explorables they would be using them on TV. Instead they are waving their hands.

The primary mechanism for transmission during a long shutdown might well be the overlap between different groups of children from different groups of households interacting to transmit the virus between their otherwise separated groups of households. It will certainly occur with younger children still at school.

Similar transmission will occur from the essential workforce in different workplaces also transmitting between different households, but stringent “social distancing” controls at work can reduce that far more effectively than among younger school children. Likewise smaller households without children will get infected more slowly than extended groups of households whose children infect each other.

Tests

School closure timing and arrangements is the hardest issue to grapple with and the least data is available as to transmission rates through these channels. Currently there have been no adequate systematic random samples of the population generally as test kits are only available for more urgent needs such as border control during the containment period and testing health workers.

In particular there is no blood testing yet to measure the immune system responses of people who have already had the virus without symptoms. Such testing is hoped for soon and could be a game changer for enabling decisions on the optimal timing for imposing and lifting isolation restrictions before and after hospitals are overloaded. It could also shed a lot more light on the transmission between children and between adults and children. At present decisions on how to time for less overloading of peak capacity in successive waves are being taken blindfolded.

The separation of groups of children and their households necessarily involves the widest participation in community decision making and implementation and the most discussion to come up with ideas right now. Explorable explanations with widgets are needed urgently for this.

All UK schools closed last week, very shortly after official announcements that the best “science” showed that overall effects of closing schools could be negative because of:

  1. Large effect on essential workforce diverted back into parenting and child-minding, especially from already overloaded health system. (Private schools closed earlier but essential workforce is generally lower paid with a high proportion depending on schools for childcare while working in health system).
  2. Likelihood that traditional reliance on grandparents to assist will result in more rapid infection of the most vulnerable.
  3. Unlikelihood that school students will remain socially distanced from each other while away from school, short, medium and long term.

https://www.theaustralian.com.au/world/coronavirus-boris-johnson-shuts-down-schools/news-story/b836ff32ea9571630404e563fbaf5bc0

Previous announcements were correct. So is the new decision.

What follows from the correctness of the two opposite decisions of our dearly beloved leaders both 5 days earlier and 5 days later is that urgent mitigation measures can and should be taken for all 3 issues. Others can contribute more to discussion of those measures so I won’t attempt it in this article.

All I can say on it is that school closures will happen soon whether desirable or not.

Here is some confusing advice from USA of the same sort that will dominate discussion here:

https://www.usatoday.com/story/opinion/2020/03/16/schools-closed-but-children-can-still-spread-coronavirus-column/5054108002/

In addition to the advice only now being widely disseminated by authoritative public health information campaigns, households with both children and older and more vulnerable people should carefully consider stronger advice from people who have been campaigning for full social isolation to be implemented sooner.

https://www.endcoronavirus.org/

They also have an interesting critique of the mainstream epidemiological models:
https://static1.squarespace.com/static/5b68a4e4a2772c2a206180a1/t/5e70eb32b16229792eb14836/1584458547530/ReviewOfFergusson.pdf

They cannot be considered “authoritative” but I will be carefully studying the technical background necessary to be able to understand both.

Epidemiology for the Uninitiated

Lots of people, like me, will need to acquire some basic epidemiological concepts to understand what the models are about. Studying this is very good practice for understanding the economics of the capitalist business cycle. (The Explorable Explanations will be more accessible for most people both for pandemics and for the business cycle).

I will be starting here:

https://www.nature.com/articles/nrmicro1845

Book chapters: https://www.bmj.com/about-bmj/resources-readers/publications/epidemiology-uninitiated

Another critique of earlier UK (and current Australian) policy is here:
https://unherd.com/2020/03/the-scientific-case-against-herd-immunity/

If the serious critics are right there won’t be another peak in China and Italy after full social isolation measures are enforced. If the mainstream epidemiological view is correct (as opposed to the government waffle about 6 months) there will be successive waves over 18 months or so until a vaccine is effective, possibly ameliorated by anti-viral drugs. This is because “social distancing” restrictions end up becoming intolerable and therefore ineffective and get relaxed because they cannot be maintained for long when new cases decline to near zero after dealing with each peak in the overloading of ICUs and consequent deaths from unavailable medical treatment. Transmission can be expected to resume gradually and then again suddenly as long as there are large reservoirs of people still susceptible. There will still be large reservoirs susceptible to infection after the first peak overloading the hospitals is shutdown by emergency isolation measures just as there was for the first peak.

The business press is already editorializing about not “over reacting” and the importance of quickly getting people back to work for them. Their views will eventually prevail while the owners are still in charge. Here’s a couple of the Wall Street Journal’s editorials urging that more people be killed quickly to save money:

https://www.wsj.com/articles/rethinking-the-coronavirus-shutdown-11584659154

https://www.wsj.com/articles/the-extreme-state-lockdowns-11584745130

They can rely on help from lots of people who think correct ideas fall from the sky or are inherent in their minds as “just common sense” and are simply not interested in studying the knowledge acquired from social practice and from it alone. The three kinds of social practice include class struggle, the struggle for production and scientific experiment. This is not a good time to be glued to the business channels and ignoring the political class struggle and the struggle for production being waged by workers in the relevant sciences.

Simply assuming the first peak will be the last is as helpful as the Wall Street Journal’s editorials.

The kind of mathematical modeling that is done to help inform public health policy for dealing with this pandemic is closely related to the sort that is needed for understanding the capitalist cycle and the transition from capitalism. So studying the pandemic is not a diversion from other priorities.

Long Term – the “Republic of Letters”

https://en.wikipedia.org/wiki/Republic_of_Letters

The modern form of the “Republic of Letters” is very much based on the communist mode of production and distribution already widespread in the Open Culture (eg Wikipedia) and Open Science offspring of the Free and Open Source Software movement. Such intellectual activity was not enough to produce the Enlightenment, let alone the bourgeois democratic revolution against Feudalism. Nevertheless it was a very important precursor.

Wikipedia has an impressive portal showing the current extent of collaborative effort:

https://en.wikipedia.org/wiki/Portal:Coronavirus_disease_2019

The “pirate” backbone for disseminating scientific and other knowledge from “Library Genesis” and “Sci-Hub” is being hardened against attack and is openly confronting the crisis:

https://www.vice.com/en_us/article/pa7jxb/archivists-are-trying-to-make-sure-a-pirate-bay-of-science-never-goes-down

The main scientific publishers have accepted demands to make all covid-19 research immediately open access (they were being bypassed anyway by pre-prints on community archive sites and by Sci-Hub).

Activists have organized collections of relevant non-current background material. Major Big Tech companies have co-opted the US government to neatly classify what is “Open Access” and what needs to be extracted from behind paywalls and disseminated by activists:

https://www.whitehouse.gov/briefings-statements/call-action-tech-community-new-machine-readable-covid-19-dataset/

https://pages.semanticscholar.org/coronavirus-research

COVID-19 Open Research Dataset (CORD-19). 2020. Version 2020-03-13. Retrieved from https://pages.semanticscholar.org/coronavirus-research. Accessed YYYY-MM-DD. doi:10.5281/zenodo.3715506

Game players with fast Graphics on home PCs are being enlisted for anti-viral drug research:

https://www.vice.com/en_us/article/884djz/scientists-need-your-help-to-find-treatments-for-coronavirus

https://foldingathome.org:

They have vastly more potential computing power than Big Government and Big Data combined:

https://www.wsj.com/articles/in-bid-for-coronavirus-vaccine-u-s-eases-access-to-supercomputers-11584915152?mod=hp_minor_pos4

The 34,000 GPUs mentioned in that article are a drop in the ocean compared to what mobilizing the gamer PCs can deliver.

So anti-viral drugs and vaccines will arrive a lot quicker than usual, as will saner public health policy.

Even before governments started using their powers to commandeer manufacturing resources for ventilators and other hospital supplies, people started organizing to just do it:

https://www.vice.com/en_us/article/5dm4mb/people-are-trying-to-make-diy-ventilators-to-meet-coronavirus-demand see CPAP/

As already mentioned, the Emergency Medecine Critical Care professionals took care well in advance to prepare training materials for their reinforcements before they are overwhelmed:

https://en.wikipedia.org/wiki/EMCrit

A semi-random example of the sort of highly skilled know-how that will need to be increased with extreme acceleration is:

Its interesting that a couple of possibly relevant books listed there have later editions at Library Genesis than the editions mentioned:

Tobin, Principles and Practice of Mechanical Ventilation, 3edn (1500pp)
http://gen.lib.rus.ec/book/index.php?md5=F1730DC52D2BF1A73E857691AF3858FF

The Walls Manual of Emergency Airway Management, 5edn
http://gen.lib.rus.ec/book/index.php?md5=BFA1F68808415E2FA52607AA3F17.

Unfortunately Library Genesis does not have the only book in that list with the word “Intubation” in the title, nor any others in english that look relevant:

The Airway Cam Guide to Intubation and Practical Emergency Airway Management 1st Edition, Richard M. Levitan

Presumably anything relevant wih a doi can be obtained via Sci-Hub or this can rapidly and easily be arranged by the relevant professionals if necessary. Activists are working now to make the relevant materials freely available for people who will find themselves on the front lines along with other health workers quite soon.

Anyway, people are moving way faster than governments.

A new world is being born from the ashes of the old.

Bulk Edit

Arthur

Arthur2 minutes agoUser InfoIn reply to:[…] https://c21stleft.com/2020/03/13/covid-19-dont-panic-do-self-isolate/ […]

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.

[Tried to add this update as a comment but will have to figure that out later]

Surveillance Society

This is currently my only means of communication. After concluding that my phone could have been stolen (incomprehensibly while I was sleeping and with no other sign of intrusion) I took a half empty tram to the city and bought a $89 Telstra Slim Plus as the quickest way to keep in touch, try to find it if has mysteriously hidden itself and turned off regular alarm times and as spare phone for emergencies so I won’t have to deal with Telecos while sick even if it does turn up.

Convinced that Telstra would have a nightmarish registration system online I proceeded to the nearby Telstra shop cnr Bourke and Swanston with my phone and driver’s licence to have it activated while I wait and asked for the form. Told there was no problem but also no form and a “consultant” would assist. Some time later while reading the papers, at 13:39 I was told (without asking) “won’t be long now”. At 14:07 a “consultant” quickly and efficiently established that I simply wanted the phone activated without going online and went off with the phone and driver’s licence.

At 14:23 she returned and told me the phone was “activated” presenting me with the used SIM card container showing the mobile number and a message on the screen inviting me to send a text message. I returned to base to attempt catching my previous phone in hiding by tempting it to make a noise anywhere near me when I call or text it from the new phone. But first I entered a couple of phone numbers in the contact book to get back in touch. On calling each of them I got the message “this number cannot be reached at present from this service” or something equally uninformative.

So at 16:47 I gave up and texted “Hi” to my new number and duly received the message at the only number that CAN be reached with my “activated” phone. So I then had to go through exactly the procedure the “consultant” had spent 15″ pretending to do. But first I had to go online by turning on mobile data and clicking the link for “Activation”. That ensures that purchaser’s of new Telstra phones will set “mobile data” on so they can be billed for more than just making calls. Then I entered a 13 digit SIM card number from the cardboard container after carefully analysing the two different 13 digit barcodes and correctly identifying that the one with ON at the end must be the right one since the N is just to maximize confusion and is not a digit.

The purpose of this is presumably in the hope that I would have thrown away the cardboard SIM card number as completely useless since the SIM was already in the phone and registered to Telstra.

So much for Telstra. Now comes the government surveillance. I knew what to expect and had therefore taken my driver’s licence on the tram trip. Naturally everybody is required to continuously notify the three closest teleco antennas of where they are at all times when their phone battery has not been removed from the phone and this needs to be linked with other surveillance IDs such as driving licence. So I entered the name, address and date of birth shown on my driving licence.

This was completely unacceptable. I was further required to choose between “Mr”, “Miss”, “Mrs” or “Ms”, none of which is on my driver’s licence, compelled to retype the address omitting the “c/o” in front and compelled to provide an email address. Then had to choose between “Prepaid Max” and “Long Life”. There is a 47 page booklet “Telstra Pre-paid Welcome Guide” which I may consult later.

I knew I would have to provide a working email address since the online form would send a verification message and would not activate the phone without me answering it. This is a standard convenient way of handling the common problem of people needing to reset passwords etc after forgetting them and is particularly convenienent for correlating online activity with movement and phone calls as well as for Teleco spam. So I gave them my working gmail address and was told I would get a confirmation email in 4 hours. GOTCHA!

So a completely pointless 4 hour delay was imposed in which I could not search for my missing phone or make other calls. It isn’t even like the banks adding days of delay between accepting cash and adding it to an account because they keep the interest on the “float”. Nor does it serve any government surveillance purpose I can think of quickly (though perhaps others have given it more thought). Seems to just be Telecos being as irritating as possible. Perhaps as further punishment for using a pre-paid account instead of getting a “Customer ID” and linking in all financial transactions for surveillance.

Anyway, off I went to the park to finish reading the papers, honestly thinking that I would just be able to click on the email link without further hassles. OF COURSE NOT.

Google told me “Account Action Is Required” and then at 19:56 “Your password was changed 14 hours ago”. Same on both Tablet and Laptop. So either Google changed it or my phone WAS stolen. No problem, Google had kept insisting that I provide them with a phone number for verifying changed passwords, which is convenient both for solving that problem of verification when unable to access email and for ensuring that email addresses and phone numbers are tied together in both directions for surveillance. So I did.

AND NOW I AM REALLY STUCK. Since Google can only reset the password when verified from my old phone and the thief has the phone, Telstra won’t activate the new phone. I assume I will now have to call Telstra at some functioning number hidden towards the end of the 47 page booklet and then sort things out with Google later. First a good nights sleep.

Meanwhile, in case my access to this WordPress blog disappears I could start using another WordPress blog on the same account at:

https://thecapitalistcycle.wordpress.com/ or else:

https://github.com/capitalistcycle/tech/issues which is now owned by Microsoft and also tied to my gmail account.

Naturally this is while dealing with covid-19 situation.

My phone has gone into hiding

Could anyone that sees this and has my phone number, please start repeatedly sending (tiny) text messages alternated with phone calls until it rings out to answering machine, while I hunt for it.

It is currently Friday 2020-03-20 at 12:30 pm and I am in the room where I expect to hear a very short whoosh from msg arrival (or less likely a nice long ring tone which it randomly chooses not to do).

First, please post a comment here so I know you are doing that and post another when you stop. (I will see these by email and delete or update this embarassing post when phone found or I give up and go out).

My phone was last seen in the company of another phone I carry only for listening to text to speech books. I am certain they have not escaped from the building and are hiding somewhere inside but I expected to hear a 12 noon alarm from the TTS phone in the room where I expect them to be hiding and I expected to hear it if it was in any other room. So I am very much hoping for a noise from the working phone. I remain certain they are somewhere in the building, for good reasons. Thanks.

covid-19 Over 70s must self isolate for 4 months. Scientists demand immediate “social distancing”

 

He said older people would be “shielded for their own protection” and that the plan would be announced, with further details, when the time was right.

 

Don’t wait for the government to get around to this “big ask” in a few weeks. The danger of infection is doubling every few days and the number of Intensive Care Units cannot do so.

Here’s the introduction to the first of two references attached to a statement signed by over 400 scientists demanding immediate “social distancing”.

 
https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

With everything that’s happening about the Coronavirus, it might be very hard to make a decision of what to do today. Should you wait for more information? Do something today? What?

Here’s what I’m going to cover in this article, with lots of charts, data and models with plenty of sources:

  • How many cases of coronavirus will there be in your area?
  • What will happen when these cases materialize?
  • What should you do?
  • When?

When you’re done reading the article, this is what you’ll take away:

The coronavirus is coming to you.
It’s coming at an exponential speed: gradually, and then suddenly.
It’s a matter of days. Maybe a week or two.
When it does, your healthcare system will be overwhelmed.
Your fellow citizens will be treated in the hallways.
Exhausted healthcare workers will break down. Some will die.
They will have to decide which patient gets the oxygen and which one dies.
The only way to prevent this is social distancing today. Not tomorrow. Today.
That means keeping as many people home as possible, starting now.

 

The second link is a:

Warning from Italy

Covid_19: Open letter from Italy to the international scientific community

As you surely know, Italy is suffering a dramatic spreading of the coronavirus.

In just 3 weeks from the beginning of the outbreak, the virus has reached more than 10.000 infected people.

From our data, about 10% of patients require ICU (Intensive Care Unit) or sub ICU assistance and about 5% of patients die.

We are now in the tragic situation that the most efficient health system of the richest area of the country (Lombardy) is almost at its full capacity and will soon be difficult to assist more people with Covid-19.

This is the reason why an almost complete lockdown of the country has been ordered: to slow down and hopefully stop the contagion as soon as possible.

The virus is spreading at maximum speed, doubling the number of infected people in just 2,4 days[1].

As it emerges without a doubt from the data available, all the European countries are in fact experiencing the same rate of contagion speed and that they are just a few days behind on where it is Italy now [2].

The beginning of the outbreak had the exact same number of infections in China, Italy, and other countries. The difference is that China strongly and quickly locked down Wuhan and all of the Hubei region 8 days before Italy [3].

Just 8 days of delay for the Italy lockdown will result in an enormous increase in the number of total deaths in Italy with respect to China.

This exact same initial dynamic in the number of new cases can also be observed in every country outbreak.

It’s hard for non-specialists to intuitively grasp the way an exponential rate increase can get out of control.

So it’s very difficult to realize the tragic consequences that an exponential growth can have in a contagion like this one.

As a scientist, you surely do understand it. You do also understand that, as long as the rate of increase is exponential, no linear solution to contrast it will work (I.e. increasing x times the number of ICU machines, etc.)

Similarly, just imposing a limitation on people from staying together in large groups is not a sufficient solution.

This is an appeal to you, as a member of the scientific community, to urge your government to act now for actively stopping the virus!

In most EU countries you have enough time to make a lockdown similar to China or South Korea to quickly slow down and stop the contagion with much less effort and cost of what is now needed in Italy.

If Italy had strongly acted just 10 days ago, and that is more or less where you are now, there would have been much fewer deaths and economic tumble.

South Korea and China should be taken as the example to follow to stop this epidemic.

There is no other way.

So please, make your best effort to urge your government to act now! Time is our common enemy as the virus is very fast and really lethal.

Every minute is exceptionally important as it means saving lives. Don’t waste it!

Take care.

 

Here’s the statement from scientists:

 

Click to access UK_scientists_statement_on_coronavirus_measures.pdf

Linked from BBC report:

 

Here’s a sympathetic account of the UK government’s case for delay:

I’m not competent to comment on the optimal time for “social distancing”.

The scientists statement is clearly initiated from mathematicians expert at modelling. But the expertise required for these decisions is in epidemiology.

However it seems bloody obvious that whenever the peak should be, or will be, older people (and others with severe health problems) need to avoid infection until AFTER the peak, when there are again intensive care units available. That may be a lot longer than 4 months and many may not be able to do it. But the “time is right” to be told now.

 

covid-19 update Sunday 2020-03-15

Please note the article to pass on is the earliest of the three in this series all tagged covid-19. It highlights the collapse of intensive care in Italy that makes it essential to mobilize for social distancing immediately without waiting for government advice. The links provide authoritative information:

“covid-19 – Don’t Panic – Do Self Isolate”

https://c21stleft.com/2020/03/13/covid-19-dont-panic-do-self-isolate/

Since that article a national information campaign HAS now begun in Australia:

https://www.health.gov.au/news/launch-of-the-coronavirus-covid-19-campaign

Meanwhile:

Spain goes on lockdown; Italy tops 20,000 cases

Spain’s government today announced a lockdown for the whole country, which begins on Mar 16, affecting 46 million, El Pais reported today. The order, slated to last 15 days, allows people to leave their homes to buy food and medicine, to work, and to care for minors, the elderly, and other vulnerable people.

Behind Italy, which is also on lockdown, Spain has the second most cases in Europe and now has 6,391 cases and 195 deaths, according to RTVE, the country’s public broadcasting network. The country’s main hot spots are Madrid, Catalonia, the Basque country, and Andalusia.

Meanwhile, France, stopping short of a lockdown, announced sweeping new measures today, temporarily shuttering all public places except for food stores, pharmacies, and gas stations, and urging people to stay indoors as much as possible, France 24 reported. The country has now reported nearly 4,500 cases, 91 of them fatal.

Elsewhere, Italy’s health ministry today reported 3,497 more cases and 175 more deaths, raising its respective totals to 21,157 cases, 1,441 of them fatal. Germany now has 3,795 cases and 8 deaths, according to the latest numbers from the Robert Koch Institute.

In the United Kingdom, a group of 229 scientists wrote a letter to the government, urging it to take tougher measures to control the spread of the virus, the BBC reported, noting that UK officials were hesitant to take strong steps too early over worries about public frustrations. The scientists are pressing for more social distancing measures, but some government health officials have said the existing approach factors in some herd immunity benefits. Reuters reported today that the government will ban mass gatherings next week.

The second article in this series at c21st left “Interesting Advice” was just speculative and confuses incubation period with infectious period. Unfortunately people may not notice the main article as later articles are displayed first. Be sure to send direct link as above, not just a link to this blog.

BTW some support for my speculation can be found in this paper, which estimates that 48% or more of the infectious period is before symptoms occurred. However it is just a preliminary unreviewed technical report based on studies at two locations and I am not competent to judge its accuracy or to make speculative remarks based on it.

The proportion of pre-symptomatic transmission was 48% (95%CI 32-67%) for Singapore and 62% (95%CI 50-76%) for Tianjin, China. Estimates of the reproduction number based on the generation interval distribution were slightly higher than those based on the serial interval distribution. Conclusions: Estimating generation and serial interval distributions from outbreak data requires careful investigation of the underlying transmission network. Detailed contact tracing information is essential for correctly estimating these quantities.

https://www.medrxiv.org/content/10.1101/2020.03.05.20031815v1