Handling the coronavirus crisis

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If the United States had begun imposing social distancing measures one week earlier than it did in March, about 36,000 fewer people would have died in the coronavirus outbreak, according to new estimates from Columbia University disease modelers. And if the country had begun locking down cities and limiting social contact on March 1, two weeks earlier than most people started staying home, the vast majority of the nation’s deaths — about 83 percent — would have been avoided, the researchers estimated. Under that scenario, about 54,000 fewer people would have died by early May.

   

Lockdown Delays Cost at Least 36,000 Lives, Data Show - The New York Times

And not surprisingly...

President Trump on Thursday dismissed as a "political hit job" a Columbia University study that showed thousands of lives lost to the coronavirus could have been saved with earlier social distancing measures. The president defended his actions to combat the pandemic after The New York Times published findings from the university's disease modelers that roughly 36,000 fewer people in the U.S. would have died from COVID-19 if the country imposed restrictions just one week earlier..

Trump calls study on taking earlier action against coronavirus a 'political hit job' | TheHill

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Incredibly, U.S. states are only now rolling out contact tracing programs, many months after places  that have successfully managed the pandemic: Hong Kong (4 deaths, 1056 cases), South Korea (11,065 cases, 263 deaths), Taiwan (440 cases, 7 deaths), Thailand (3031 cases, 56 deaths), Vietnam (320 cases, 0 deaths) – have run test, trace, and isolate programs.

I have written three previous posts (see here, here, and here) on what has made Hong Kong’s approach so successful. For each of these, I’ve been able to draw on the wisdom of my old Oxford friend, Dr. Sarah Borwein, a Canadian who has practiced medicine in Hong Kong for fifteen years, and before that, in Beijing. Densely-populated Hong Kong has 7.5 million residents, and so far, has recorded four deaths, and just over 1000 cases, despite a slow and bungled initial response by chief executive Carrie Lam and by eschewing misplaced reliance on any techno-fix apps that carry significant risks to civil liberties (see here, where I discuss these points in detail; and this FT article discussing the limitations of contact tracing apps, Coronavirus contact tracing apps struggle to make an impact). And I turned to Sarah again to discuss some necessary conditions for successful contact tracing.

Flaws in U.S. Contact Tracing
Despite Cuomo and other US leaders waking up to the merits of a contact tracing strategy, there are at least three flaws inherent this late Damascene conversion.

First, the United States has simply left it too late to join the contact tracing party. Its botched testing strategy means COVID-19 had spread widely, throughout many communities, and public health authorities are blind as to what they were dealing with.

Second, there is too wide a gap between when the contact is identified, and then informed of the possible exposure. During that gap, the victim may be asymptomatic, and spreading the virus. According to Technology Review, in an article with a headline that minces no words  Why contact tracing may be a mess in America

And I find my third point to be incredible. The U.S. contact tracing programs trace, but once identified, they do not automatically test the contact to determine whether s/he has contracted the disease.

U.S. COVID-19 Contact Tracing Programs Designed for Failure, Despite Bloomberg Money; Why Can't the U.S. Copy the Lessons of Hong Kong's Success? | naked capitalism

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Senegal is developing a Covid-19 testing kit that would cost $1 per patient, which it is hoped will, in less than 10 minutes, detect both current or previous infection via antigens in saliva, or antibodies. It’s hard to know exactly how this compares with the price of Britain’s tests, but many of them use polymerase chain reaction, or PCR, to detect the virus, and cost hundreds of dollars. And I can testify that a leaflet that came through my door in London this week offered me a private testing kit for £250.

Senegal is in a good position because its Covid-19 response planning began in earnest in January, as soon as the first international alert on the virus went out. The government closed the borders, initiated a comprehensive plan of contact tracing and, because it is a nation of multiple-occupation households, offered a bed for every single coronavirus patient in either a hospital or a community health facility.

As a result, this nation of 16 million people has had only 30 deaths. Each death has been acknowledged individually by the government, and condolences paid to the family. You can afford to see each death as a person when the numbers are at this level. At every single one of those stages, the UK did the opposite, and is now facing a death toll of more than 35,000.

Ghana, with a population of 30 million, has a similar death toll to Senegal, partly because of an extensive system of contact tracing, utilising a large number of community health workers and volunteers, and other innovative techniques such as “pool testing”, in which multiple blood samples are tested and then followed up as individual tests only if a positive result is found. The advantages in this approach are now being studied by the World Health Organization.

Why are Africa's coronavirus successes being overlooked? | Afua Hirsch | Opinion | The Guardian

• Even some poor African countries doing MUCH better than many rich Western ones
  

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The popularity of New Zealand’s Labour prime minister, Jacinda Ardern, is, presently, stratospheric. With the confidence of popularity, her government is positioned to promote political ideas that were almost beyond imagination only a few months ago. One of them, mooted on Wednesday, is encouraging the country into a four-day working week.

Ardern’s leadership of New Zealand through the coronavirus crisis has compounded credentials well established by her government’s deft and empathetic handling of the horrific massacre in Christchurch last year. When corona hit, the lockdown of the country was swift, draconian and effective; there have only been 21 deaths from the disease to date in New Zealand, and while the rest of the world grapples with a rising number of daily cases, no new cases have been reported in New Zealand in three days.

A mind-boggling 92% of New Zealanders laud their government’s containment efforts. According to latest polls, Ardern is the most popular party leader there in more than 100 years..

'Snap back'? Jacinda Ardern snaps forward with a four day week: no wonder she's popular | Van Badham | Opinion | The Guardian

• Senegal, Ghana (see previous entry), a host of Asian countries like Taiwan, Vietnam, Hong Kong, and of course New Zealand, but there is also Greece, Iceland, etc. Covid success stories because of rapid and decisive interventions while the much richer and more well endowed countries like the US and a number of West European countries badly faltered..
  

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President Trump said Tuesday the fact that the United States has the most coronavirus cases in the world is a “badge of honor” because it shows how much testing the country is doing. The U.S. of course has a larger population than most countries, with almost 330 million residents. But even on a per-person basis, it ranks near the top in both cases and deaths. It has the 11th most cases per person of any country and ranks 13th in deaths, according to data compiled by The New York Times.

And when it comes to testing on a per-person basis, the U.S. is far from the leader, despite recent improvements. Denmark, for example, conducts about twice as many tests per person as the U.S., according to figures compiled by Our World in Data, yet still has less than half the cases of the U.S. per person. Ashish Jha, director of the Harvard Global Health Institute, said no “serious person” thinks the U.S. has the most cases in the world because of its testing. “It’s just that we had such a massive outbreak and we had six weeks of complete blindness to the pandemic because we had little or no testing,” he said..

Why the US has the most reported coronavirus cases in the world | TheHill

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President Trump on Friday ordered governors to allow houses of worship to open immediately, declaring them “essential” to American life during COVID-19.  “The governors need to do the right thing and allow these very important essential places of faith to open right now, this weekend,” Trump said, during brief remarks at the White House that his press shop had touted as a briefing. Trump took no questions, however, and left immediately after his brief statement. “If they don't do it I will override the governors. America we need more prayer, not less.”

Trump demands governors allow churches to open | TheHill

• Yea, churches, where older people rub shoulder to shoulder singing and spreading the virus, bring them back on..
  
• Trump took no questions, no surprise:
  

Hospitalized COVID-19 patients who were treated with hydroxychloroquine, an anti-malaria drug touted by President Trump, had a much higher risk of death than those who were not, according to a new study of 96,000 patients. The study, published Friday in the medical journal The Lancet, found that patients who were treated with hydroxychloroquine or chloroquine also faced a much higher risk of abnormal heartbeats, called arrhythmias, which could result in cardiac arrest.

Anti-malaria drug touted by Trump has high death risk in COVID-19 patients, new study shows | TheHill

[Admin]

So Trump orders states to open churches..

There’s mounting evidence that airborne transmission indoors is a key — perhaps the main — pathway to SARS-COV-2 transmission. In this post I want to look at why that’s so, give examples, and suggest a simple heuristic to stay safe. Material like this might also be used to inform public policy (here; here) by reducing superspreader events in enclosed spaces like churches (airborne transmission via singing), restaurants (loud talking, especially if room is noisy), bars (ditto), nursing homes (shouting[1]), gyms (grunting), meat-packing plants (shouting), call centers (talking), offices generally (air conditioning), and other hot spots, but working that polucy out is not the object of this post (see here for engineering controls for airborne transmission, and here for covid-proofing public spaces).. A crowded indoor place, then, with poor ventilation, filled with people talking, shouting, or singing for hours on end will be the riskiest scenario.

#COVID19: New Practical Results on Airborne Transmission Indoors | naked capitalism

• Article goes at length to explain the main risk is indoors, especially with vocalization (singing, talking, shouting, etc.) and with longer term and little distance and no masks..
  
• Then churchgoers are typically older, more prone to risk..
  
• And it's no surprise, we know religious gatherings have functioned as superspreader events, like in South Korea, Malaysia, lots of other places.
  
• So this exhortation of churches having to open up is exactly the opposite of what one would advice from a health/risk perspective
  
• It's only out of political expediency the President is exhorting this, he is willing to sacrifice the health and even life of older church visitors in order to boost his reelection chances.
  
• Everything Trump does with respect to the pandemic is out from a political perspective, not a health perspective.
  
• He orders states (even if he can't force that) to open up, to open up churches, etc. while leaving them to their own devices when it comes to testing, PPE, contact tracing, their budgets, etc. refusing to invoke the Defense Production Act and letting states compete against one-another for critical supplies.
  
• Taking credits when things go right, pointing the blame on states when things go wrong
  

[Admin]

In addition to the previous entry..

A single church service in Frankfurt, Germany, held in early May appears to have led to at least 107 reported cases of coronavirus in the area, according to a report from the Wall Street Journal. The outbreak highlights the risks that accompany easing lockdowns even in countries that have managed to control the spread of the virus relatively well. And it also serves as a reminder of the acute threat posed by “superspreader” events involving crowds, a pressing concern in the US as President Donald Trump encourages churches nationwide to reopen their doors to worshippers..

The main way people are getting sick with SARS-CoV-2 is from respiratory droplets spreading between people in close quarters. The risk of catching the coronavirus, simply put, “is breathing in everybody’s breath,” says Charles Haas, an environmental engineer at Drexel University. Droplets fly from people’s mouths and noses when they breathe, talk, or sneeze. Other people can breathe them in. That’s the main risk, and that’s why face masks are an essential precaution (they help stop the droplets from spewing far from a person’s mouth or nose).
...
A crowded indoor place, then, with poor ventilation, filled with people talking, shouting, or singing for hours on end will be the riskiest scenario. A sparsely populated indoor space with open windows is less risky (but not completely safe). Running quickly past another jogger outside is on the other end of the spectrum; minimal risk.

One German church service resulted in more than 100 coronavirus infections - Vox

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In mid-March, Brazil took what seemed to be a forceful early strike against the coronavirus pandemic. The Health Ministry mandated that cruises be canceled. It advised local authorities to scrap large-scale events. And it urged travelers arriving from abroad to go into isolation for a week. Although Brazil had yet to report a single death from COVID-19, public health officials appeared to be getting out in front of the virus. They acted on March 13, just two days after the World Health Organization called the disease a pandemic. Less than 24 hours later, the ministry watered down its own advice, citing “criticism and suggestions” it had received from local communities. In fact, four people familiar with the incident told Reuters, the change came after intervention from the chief of staff’s office for Brazil’s President Jair Bolsonaro. “That correction was due to pressure,” said Julio Croda, an epidemiologist who was then the head of the Health Ministry’s department of immunization and transmissible diseases.

The intervention by the chief of staff’s office has not been previously reported. The about-face, given scant attention at the time, marked a turning point in the federal government’s handling of the crisis, according to the four people. Behind the scenes, they said, power was shifting from the Health Ministry, the traditional leader on public health matters, to the office of the president’s chief of staff, known as Casa Civil, led by Walter Souza Braga Netto, an Army general. Brazil has lost two health ministers in the past six weeks - one was fired, the other resigned - after they disagreed publicly with Bolsonaro over how best to combat the virus. The interim leader now in charge of the Health Ministry is another Armygeneral.

More importantly, the revisions underlined the hardening of Bolsonaro’s view that keeping Brazil’s economy running was paramount, the people said. Bolsonaro, a far-right former Army captain, has never wavered on that stance formulated during a crucial few days in mid-March, despite domestic and international criticism of his handling of the crisis, and a snowballing death toll. Brazil now has the world’s second-worst outbreak behind the United States, with more than 374,000 confirmed cases. More than 23,000 Brazilians have died from COVID-19. “So what?” Bolsonaro said recently when asked by reporters about Brazil’s mounting fatalities. “What do you want me to do?”

Special Report: Bolsonaro brought in his generals to fight coronavirus. Brazil is losing the battle - Reuters

• We know from a host of countries that if they had persisted with that early intervention, the infection and dead toll could have been a fraction of what it is today.. 
  
• We also know from Brazil's own experience with earlier pandemics:
  

Some experts said Brazil’s stumbles are all the more shocking because of its previous success containing malaria, Zika and HIV. “One thing that has been a shining light in Brazil has been their public health system,” said Albert Ko, a professor at the Yale School of Public Health who has decades of experience in Brazil. “To see that all disintegrate so quickly, it’s just been very sad.”

Special Report: Bolsonaro brought in his generals to fight coronavirus. Brazil is losing the battle - Reuters

• And then there is this:
  

Winter added: “It’s a terrible irony that the US has banned travel from the country that most closely imitated its approach to Covid-19. “People try to make this about diplomacy but ultimately it is just a very, very sad indictment of the Covid policies really in both countries – because Bolsonaro has clearly been imitating both the actions and the rhetoric of the Untied States.”

Jair Bolsonaro under pressure after Trump bans flights from Brazil | World news | The Guardian

[Admin]

President Donald Trump has repeatedly lied about the coronavirus pandemic and the country’s preparation for this once-in-a-generation crisis. Here, a collection of the biggest lies he’s told as the nation endures a public-health and economic calamity. This post will be updated as needed.

All of Trump’s Lies About the Coronavirus - The Atlantic

• Very useful overview of Trump's biggest lies with respect to the coronavirus pandemic