COVID-19 goes global. What works against it?

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by Fabius Maximus

Summary: As COVID-19 breaks containment to spread across the world, WHO repeats their warnings and reminds us of the methods China has successfully used. Also, how prepared is America? Will the virus or the tide of misinformation do more damage? Since the news media has little interest in these matters, instead drowning people in factoids and rumors, let’s find the answers for ourselves.

By Tenebroso. AdobeStock-322429658.

Remarks by Tedros Adhanom, Director-General of WHO

At the media briefing on COVID-19, 27 February 2020.

Let me start, as usual, with the latest numbers. {See today’s situation report.} As of 6am Geneva time this morning, China has reported a total of 78,630 cases of COVID-19 to WHO, including 2747 deaths.

Editor’s note: As usual, most of the new confirmed cases in China are in Hubei Province: 409 of the total 439. That’s a 1% daily growth rate, which won’t generate devastating deaths in a population of 59 million (ditto for the 66k total cases and 3k deaths so far). For comparison, there were 3,156 new cases reported on February 5. 

About those 39 new cases in the rest of China – in a population of 1.4 billion. For comparison, there were 737 new cases reported on February 5. As the multi-national survey team reported yesterday, China’s quarantines are working (so far, at least): the epidemic in China peaked between the 23rd of January and the 2nd of February, and has been declining steadily since then.

So far, COVID-19 has killed an estimated 3k people in China. The Spanish flu killed roughly 3% of the world’s population (perhaps as many as 5%). COVID-19 would have to kill 42 million (up to 70 million) people in China to equal that effect. I doubt many people, other than historians and doctors, will remember the Spanish Flu a hundred years from now. How quickly will COVID-19 be forgotten?

But as you know, it’s what is happening in the rest of the world that is now our greatest concern. Outside China, there are now 3474 cases in 44 countries and 54 deaths.

We are at a decisive point. For the past two days, the number of new cases reported in the rest of the world has exceeded the number of new cases in China. And in the past 24 hours, seven countries have reported cases for the first time: Brazil, Georgia, Greece, North Macedonia, Norway, Pakistan, and Romania.

My message to each of these countries is: this is your window of opportunity. If you act aggressively now, you can contain this virus. You can prevent people from getting sick. You can save lives. So my advice to these countries is to move swiftly. The epidemics in the Islamic Republic of Iran, Italy and the Republic of Korea demonstrate what this virus is capable of. But this virus is not influenza. With the right measures, it can be contained.

That is one of the key messages from China. The evidence we have is that there does not appear to be widespread community transmission. In Guangdong, scientists tested more than 320,000 samples from the community and only 0.14% were positive for COVID-19. That suggests that containment is possible.

For more about this, see yesterday’s findings of the multi-national survey team. Will the rest of the world listen?

Indeed, there are many countries that have done exactly that. There are several countries that have not reported a case for more than two weeks: Belgium, Cambodia, India, Nepal, Philippines, the Russian Federation, Sri Lanka, and Viet Nam. Each of these countries is different. And each shows that aggressive, early measures can prevent transmission before the virus gets a foothold.

Of course, that doesn’t mean those countries won’t have more cases. In fact, as of Tuesday, both Finland and Sweden had reported no cases for more than two weeks, but unfortunately both had new cases yesterday. That’s why we advocate a comprehensive approach. Every country must be ready for its first case, its first cluster, the first evidence of community transmission and for dealing with sustained community transmission. And it must be preparing for all of those scenarios at the same time. No country should assume it won’t get cases. That could be a fatal mistake, quite literally.

This virus does not respect borders. It does not distinguish between races or ethnicities. It has no regard for a country’s GDP or level of development. The point is not only to prevent cases arriving on your shores. The point is what you do when you have cases.

But we are not hopeless. We are not defenseless. There are things every country and every person can do. Every country needs to be ready to detect cases early, to isolate patients, trace contacts, provide quality clinical care, prevent hospital outbreaks, and prevent community transmission. There are some vital questions that every country must be asking itself today.

  • Are we ready for the first case? What will we do when it arrives?
  • Do we have an isolation unit ready to go? Do we have enough medical oxygen, ventilators, and other vital equipment?
  • How will we know if there are cases in other areas of the country?
  • Is there a reporting system that health facilities are all using, and a way to raise an alert if there is a concern?
  • Do our health workers have the training and equipment they need to stay safe?
  • Do our health workers know how to take samples correctly from patients?
  • Do we have the right measures at airports and border crossings to test people who are sick?
  • Do our labs have the right chemicals that allow them to test samples?
  • Are we ready to treat patients with severe or critical disease?
  • Do our hospitals and clinics have the right procedures to prevent and control infections?
  • Do our people have the right information? Do they know what the disease looks like?
  • It’s not usually a runny nose. In 90% of cases it’s a fever and in 70% of cases a dry cough.
  • Are we ready to fight rumours and misinformation with clear and simple messages that people can understand?
  • Are we able to have our people on our side to fight this outbreak?

Ed’s note – the strong and rapid response by the public health agencies of China and other nations has prevented widespread infections for 8 weeks. Soon we will see how well the world has used that time, including learning from China what works.

These are the questions that every health minister must be ready to answer now. These are the questions that will be the difference between 1 case and 100 cases in the coming days and weeks. If the answer to any of these questions is no, your country has a gap that this virus will exploit. Even developed countries could be surprised.

Our message continues to be that this virus has pandemic potential and WHO is providing the tools to help every country to prepare accordingly.

  • We’ve shipped testing kits to 57 countries and personal protective equipment to 85 countries who need it.
  • We have trained more than 80,000 health workers through our online courses, in multiple languages.
  • We’ve issued operational guidelines, with concrete actions countries can take in eight key areas to prevent, detect and manage cases.
  • The guidelines also include key performance indicators, and the estimated resources needed to prepare for and respond to a cluster of up to 100 cases. This is not enough, so we will do more.
  • WHO stands ready to support every country to develop its national plan.

Once again, this is not a time for fear. This is a time for taking action now to prevent infections and save lives now. Fear and panic do not help. People can have concerns and rightly so. People can be worried and rightly so. The most important thing is to calm down and do the right things to fight this very dangerous virus.


About quarantines

Technically, China has implemented cordon sanitaires around (see Wikipedia), not a quarantine (Wikipedia). The former limits the movement of everybody in a region; they are powerful but expensive. The latter applies to people infected or who might be infected (eg, individuals, a household, or a ship); they are cheap and easy.

See the massive research effort

‘A completely new culture of doing research.’ Coronavirus outbreak changes how scientists communicate” in Science; see this excerpt.

“A torrent of data is being released daily by preprint servers that didn’t even exist a decade ago, then dissected on platforms such as Slack and Twitter, and in the media, before formal peer review begins. Journal staffers are working overtime to get manuscripts reviewed, edited, and published at record speeds. The venerable New England Journal of Medicine (NEJM) posted one COVID-19 paper within 48 hours of submission. Viral genomes posted on a platform named GISAID, more than 200 so far, are analyzed instantaneously by a phalanx of evolutionary biologists who share their phylogenetic trees in preprints and on social media.

“‘This is a very different experience from any outbreak that I’ve been a part of,’ says epidemiologist Marc Lipsitch of the Harvard T.H. Chan School of Public Health. The intense communication has catalyzed an unusual level of collaboration among scientists that, combined with scientific advances, has enabled research to move faster than during any previous outbreak. ‘An unprecedented amount of knowledge has been generated in 6 weeks,’ says Jeremy Farrar, head of the Wellcome Trust.”

How well prepared is the USA?

Between past epidemic threats (esp. swine flu in 2009 and ebola in 2015) and fears of bioterrorism – plus the 8 weeks of warnings – America’s health care systems appear well-prepared for #COVID19. See this ABC News story, the CDC’s preparations, As of yesterday, there were 14 confirmed cases in the US.

The first line of defense consists of screening and quarantine procedures. Even in small Iowa cities, warnings are everywhere – public health agencies and hospitals announce that they are vigilant and prepared, and masks have sold out.

Hospitals are the next line. Hospital beds can be quickly expanded, but intensive care units are the bottleneck – for the estimated 6% of cases that are severe. The US has roughly 80 thousand ICU beds., an unusually large number per capita (Belgium and Germany have even more ICU beds per capita than does the US). This number can expand in an emergency, but with difficulty.

What if a US city or region is overwhelmed with a demand for medical services during an emergency, such as a natural disaster or epidemic? Other hospitals in the region and nation can help. Medical professionals can work longer hours, and be reassigned from other services. Retired professionals can return to service; professionals can go where most needed.

What about equipment and supplies? Hospitals have reserves. Vendors can provide supplies from their warehouses. And if that’s not enough, there is the Strategic National Stockpile run by the Federal Dept of Health and Human Services. It costing $600 million per year to maintain – and is well worth the money. This stockpile is designed to supplement state and local inventories.

“With approximately 200 federal and contract employees, the Strategic National Stockpile is organized to support any public health threat. Stockpile staff represent a variety of specialties, and all work together to ensure the right resources are ready and can get to the right place at the right time.”

The inventory consists of twelve Push Packages, stored at secret facilities around the nation. Each occupies 124 cargo containers, weigh 94,424 pounds, and require 5,000 square feet of floor space for proper staging and management. A package fills a wide-body aircraft or seven tractor-trailers. It can be deployed to arrive in any city in the continental US in 12 hours. Here is a WaPo article about the program. See a detailed description here.

The SNS has been supplemented by a second tier of medical products that are under the control and management of selected, pre-qualified vendors. The Vendor Managed Inventory (VMI) is designed to arrive 24-36 hours after SNS deployment.

For another line of defense, the US Army has Combat Support Hospitals, the successor to the Mobile Army Surgical Hospitals used in Korea and Vietnam. There are 8 active-duty units and 14 reserve units (plus 3 overseas). A fully manned CSH has over 600 people when fully staffed, with 248 beds. The US Navy also has two hospital ships (hereand here).




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