China today reports no new cases. How did they manage to gain control over the virus to this extent? I came across this interview which explains how it was done. Basically, it involves testing, testing and more testing as we have already heard but crucially, the first test is to take the temperature and any anomaly is immediately isolated. No home quarantine since the first group to get infected is the family. So, anyone with a temperature was obliged to go to a fever clinic where they are tested further. Firstly, with a blood test to see their white cell count, which, if normal means no viral infection and they can go home. Secondly a test for the normal flu (if positive then they can go home) and then through a CT scan to detect any lung damage. If none is found, then again, they can go home. Only if that is positive, are they tested for the Coronavirus and if that is positive, then off they go to a quarantine centre to see how their illness will develop. These are the new hospitals which we saw being built in 8 days in Wuhan.
To support this, every person is required to self-test every day and to report the result and is tested whenever they go out and move around. This is backed up by the district manager who appears to play a crucial role in the process. Responsible for a district of about 1000 people, the district managers are close enough to each of them to know what they are doing. They are informed of the temperature of each person every day and of course know if people are breaking the quarantine in any way. These strict social controls seem to have been the key in China; would this be acceptable in Europe?
The key question is what measures are really necessary to control the spread of the virus? Is a complete confinement necessary? What degree of social distancing is effective? How free will our society be once the cases have stabilised? How many cases per 1000 people per week is an acceptable number? And on a more sinister note, what form of society will emerge from this whole pandemic?
I wrote 1 week ago about the situation and I included some of the curves which I have been tracking each day. There are many others doing the same thing, but I do not see them being talked about very much, even if they are key to understanding the situation – and knowing what to do later. One of the interesting factors is how the situation has evolved in different countries each taking different measures and reflecting underlying societal differences. I talk about China above, but South Korea has managed a measure of control without such drastic measures (through extensive testing and tracing of contacts) and Japan is a complete anomaly which experts are starting to try to understand.
It is important to understand that in this analysis it is not the absolute numbers which are critical as these depend on the test regime in place and many local conditions. But assuming that a country or region follows the same regime from day to day, the rate of change is the critical factor. Last week I posted the charts for Northern Italy and Lombardy. I am following 3 of the provinces which were locked down on 28th February and 2 which were locked down with the rest of Lombardy on 8th March. These are all trending downwards which looks as though the peak of new cases has passed and some control has been achieved.
Note this is a long way from being an acceptable rate. The number of deaths will still rise, lagging the number of new cases by up to 14 days – this is already destined. But if the rate comes down then it shows the measures are working.
No other European country (with the exceptions of Sweden and Denmark) is yet showing such a response and the daily cases continue to grow at rates between 10% and 20%. Germany seems to be one of the better ones whilst Sweden is lower despite not having a confinement strategy. Maybe these will be guides for the future although the Swedish government is coming under criticism for not doing more.
Happy to exchange views with people and I hope that I am not adding to your Coronavirus information overload in writing this short note.
So, as of today, in Belgium, as in France and many other countries in Europe, we are now officially confined to our homes. The temptation to go out has been removed by closing bars, restaurants and most shops. Fortunately, it seems that we are still allowed to go to the park to walk our dog as long as we don’t meet and socialise with any of the other dog walkers doing the same thing. This has to be the right policy at the moment as the first priority must be to bring the epidemic under control. Only then can we start to see what level of social interaction will be possible afterwards. There seems little doubt that we are in this for the long haul.
It is now widely understood that the goal of the measures is to bring the level of infections down to a point where they can be managed by the health services. To understand that we need to look to China and Korea which have managed to achieve control and the rate of infections has slowed to a manageable level. Testing, testing and more testing is their advice, echoed by the WHO.
How long can we expect it to take to bring under control? It seems to have taken about 4 weeks in both China and Korea. In China, a total shut-down in Hubei (around Wuhan) was imposed; measures which would be difficult to impose in Europe. In Korea, the response was less rigid, but the outbreak started in a religious group which allowed better tracing of contacts; contact tracing is one of the key tools to control the spread. In both these countries the rate of new infections has fallen to a very low level. Can this be maintained is the key question?
But how is Europe doing? Italy was the unlucky precursor where an outbreak happened in Lombardy (starting in Codogno in the province of Lodi). On 28th February, a lock-down was imposed around Lodi (then extended to Lombardy (8th March) and then around the whole country (10th March). Other countries have followed.
I have been keeping watch on the rise of the epidemic and in particular watching the rate of cases in key regions; Lodi, Lombardy and Italy. They may be interesting for others. I am writing on the 17th March, so figures are from yesterday and it is looking as though the number of cases is starting to fall. Fingers crossed that this really is the case. The new cases in Lodi have been around 40 per day compared to 140 3 days ago and around 80 before that. For Lombardy, the rate has fallen for 2 days in a row and the most recent figure for the whole of Italy is lower than the peak.
I am just making very simple analyses but using original data. Several sites are really helpful to keep track:
Wikipedia: https://en.wikipedia.org/wiki/2019%E2%80%9320_coronavirus_pandemic
An analysis by a data scientist, Mark Handley at UCL London. http://nrg.cs.ucl.ac.uk/mjh/covid19/
The second is particularly insightful as it is trying to rebase all the countries curves allowing for the differing conditions at the outset. The general rate of increase has been 35% (doubling of cases every 2.5 days) but this is falling to 22% and lower where measures have been taken (Italy overall is standing at around 11%). There is also evidence to suggest that the rate is different between warm and colder countries. But none of these have been showing the Lodi numbers which in theory should give the earliest counter-indication (these are sourced from the Italian Ministry website:
http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1.
The Italian numbers are published each day at 6pm and, below, I give the current propagation rates for the key provinces in Lombardy. Lodi has fallen below 5% whilst Bergamo is falling rapidly and the overall trend is down as it should be. What is an acceptable level of increase? As a maximum it should be less than the recovery rate which I shall start to look at.
This is only the start, but it is essential to bring this thing under control or risk many more deaths than need be the case. We need to keep a watch on China and Korea to see if they can avoid a 2nd wave, and on Italy to see how fast a measure of control can be achieved under western conditions. After that, we may need to see regular bouts of social distancing until 60 or 70% of the population has been infected or a vaccine has been developed. Let us hope that the 2nd comes first.
Warning: I have no competence in epidemiology or in medicine in any way. I am simply reading, playing with some numbers and drawing what are possibly flawed conclusions. I am happy to receive comments and to exchange further on the subject for anyone interested.
As I reported in my last blogpost, EARSC staff are all still working; all from home and not all full time as arrangements are made with partners and especially with children. For the moment at least we can carry on almost as usual and facing many challenges to organise remote events. I am sure it is the same for our members. We should be happy to hear from you and we’ll continue to report here.
Good luck to everyone. We are all in this together.
You have probably seen that the Belgian Federal government decided last night to take some stringent measures to prevent the development of the CoVid-19 virus in Belgium. These included the closure of all schools, cafe's and restaurants and the limited opening of shops up until 3rd April.
The EC has also now decided that all staff should work from home and there will be no visitors.
As far as EARSC is concerned we in the secretariat are all affected by these measures in different ways and each member of the secretariat is adapting their way of working according to their specific situation. Those with children are most impacted.
However, for the moment at least, EARSC will continue to work normally - albeit with significant teleworking. We are working on projects and services where we can work remotely and continue to make progress - and are doing so. Some of our activities are directly concerned; most specifically for PARSEC where a Bootcamp was to have been organised at the end of March. With the agreement of the EC (as it is a contractual requirement) this was changed last week to being a virtual bootcamp and our team are exploring how best to manage this very great challenge to organise a virtual matchmaking type event. It is going to be very interesting to see how this works.
Another large project for us at the moment is preparing our annual conference ExpandEO. For the moment we are committed to going ahead towards the end of June, but no-one can say what the situation will then be and we shall certainly inform you of any change to this.
For other projects, we are working on certain deliverables and awaiting further legal information regarding the contractual obligations. We already know that incurred costs will be covered in the event of cancellation but for new events we are still uncertain.
Please contact us with questions if you wish and we shall keep you informed as usual through our monthly report, through our blog, through social media channels (@EARSC) and through any news on our website (www.earsc.org/) and our portal (earsc-portal.eu).
The situation will be reviewed on a daily basis and we shall inform you of any changes which may affect the service which we provide you with.
On behalf of all the EARSC team, I wish you strength to carry through this exceptional crisis and hope that you all emerge the other side with as little damage as possible.