COVID-19: who’s going full doomsday prep on this?

Nambra

Postmeridian

One for those who think this is just like the common cold or flu....


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The three phases of Covid-19 – and how we can make it manageable

https://thespinoff.co.nz/society/09-03-2020/the-three-phases-of-covid-19-and-how-we-can-make-it-manageable/
Siouxsie Wiles | Contributing writer

How is the coronavirus likely to play out, how does it end, and does our behaviour make a difference? Here infectious diseases expert Dr Siouxsie Wiles walks us through the epidemic curve, with illustrations by Toby Morris.
The Spinoff’s ongoing expert-led, evidence-based coverage of Covid-19 is funded by Spinoff Members. To support this work, join Spinoff Members here.
In a post last week, I showed you a picture of how the Covid-19 outbreak has played out in China. It was a graph of the number of cases reported each day, something we call an epidemic curve. It looked a bit like this. We can use the epidemic curve as a visual way to think about how Covid-19 could go, both here in Aotearoa New Zealand and globally.

But before we get to that, let me just explain epidemic curves in a little more detail. First, they have three parts: a start (phase one), a middle (phase two), and an end (phase three). Each of these phases is influenced by different things. Such as, how infectious is the virus or bacterium? How is it transmitted? Is it person-to-person, or from eating or drinking? If it’s person-to-person, are people infectious before they have symptoms and don’t know they are unwell? And if people do have symptoms, are they mild enough for people to go about their daily routine? Is everyone susceptible to the infection, or just some people? What resources do we need and have to contain the outbreak? The answers to these questions will influence the shape of the epidemic curve.
Phase one of the Covid-19 epidemic curve – containment
At the moment, Aotearoa and many other countries are in phase one for Covid-19. This is the start of the curve where cases pop up sporadically as people who have contracted the virus in one country travel to other countries.
Think of Covid-19 as several fires blazing away, with embers shooting off in all directions. Our goal is to stop those embers from turning into another blazing fire. It’s beginning to look like anyone who has travelled overseas recently should think of themselves as a potential ember and be on the lookout for symptoms.
Sticking with the fire analogy, it’s not unusual for embers to smoulder a little when they land. That’s why public health officials are actively looking for people who have been in close contact with someone with Covid-19. This is called contact tracing. Anyone at high risk of having contracted the virus is then put into isolation. Here in New Zealand, two of the five people who have tested positive for the virus so far are partners or relatives of those “embers”.
Read more of Dr Siouxsie Wiles’ explainers on the Covid-19 outbreak here.
Our aim is to stay in phase one. The longer we can stay in phase one, the better we can prepare for phase two. If we can stay here for the next one to two years, then hopefully a vaccine will become available and we can avoid phases two and three altogether. One way to do that would be just to ban all international travel. No one in or out. Just to be clear, I don’t think this is the right approach to take. One to two years is a long time.
Alternatively, we could just make everyone who travels here, Kiwis included, go into isolation for two weeks. Again, I’m not sure how well this would work in practice. My advice to everyone, even if you haven’t travelled, is to be on the lookout for any of the symptoms of Covid-19. If you have a fever, or a cough, or shortness of breath, stay away from other people if you can. If you’ve a runny nose or sore throat this could be a really mild form of Covid-19 so I would also isolate yourself.
Phase two – community transmission
The way Covid-19 is playing out globally, we are going to enter phase two at some point. This will happen when people who don’t realise they have contracted Covid-19 go about their daily lives rather than stay isolated. More and more cases will be reported each day as the virus transmits from person to person out in the community and outpaces our ability to keep up with the contact tracing. The quicker and higher the numbers rise, the more likely the outbreak will overwhelm us, making it harder to control.
The data so far suggests all of us are susceptible to the virus. It’s clear from what’s happened overseas that many people with Covid-19 spent many weeks being treated in hospital before they recovered. This isn’t a trivial disease. China built two new hospitals in a matter of weeks to keep up with demand. Do we have the resources to do that if it came to it?
Flattening the curve
Our aim will be to keep phase two of the epidemic curve as flat as possible, keeping the number of cases reported each day as low as we can. If we can achieve that, it’ll mean we’ll be able to treat everyone who needs treating. We can all help with this by washing our hands regularly, avoiding touching our mouth, nose, and eyes, and staying away from other people when we are sick. This also means calling ahead if you feel sick and want to go to the doctor or hospital. The last thing we need is loads of our healthcare workers in isolation because they’ve been exposed to Covid-19. Forty-five staff from North Shore Hospital have been isolated as a precaution because of a probable case.

Another thing we are all going to need to start doing soon is minimising or avoiding contact with other people. This is called social distancing. If you are greeting people, don’t hug, shake hands, hongi, or kiss. Bump elbows or feet instead. Work from home if you can. Much as it pains me to say it, social distancing also means avoiding public transport (get on your bicycle!). Similarly, it means avoiding gyms, churches, cinemas, concerts, and other events and places where people congregate. At the community level we may need to close schools, universities, museums, and workplaces, limit public transportation, and cancel public events. This is what China did so effectively and what Italy is currently implementing in some regions.
Moving into phase three
We move into phase three when the outbreak is either brought under control or everyone has been infected and there are no more susceptible people left to infect. Vaccination is one way we can stop people being susceptible, or at least enough people that the disease stops spreading from person-to-person – that’s what herd immunity is all about.
Given we are one to two years away from a vaccine, bringing Covid-19 under control is obviously the goal here and what China has achieved. But if there are still susceptible people in a population and we stop taking all the right measures then we will see cases flare up again.

That’s why what happens on the global scale is so important. Any “fires” left blazing threaten us all. At the moment, many of the new cases being reported in China are people who have contracted the virus while travelling outside of China. They are essentially back in phase one but with all the understanding of why it’s so important to stay there. And all the expertise and public knowledge to make it happen.
While the coronavirus responsible for Covid-19 likely started out in bats, so far, it’s not clear how it got from bats to people. SARS jumped from bats to humans via civet cats. With SARS once we managed to stop all human-to-human transmission, the disease then ran its course in those infected, and we haven’t seen SARS since.
Hopefully, if we can stop all human-to-human transmission of Covid-19 that’ll be the end of this coronavirus too. But it’s clear that we’ll all have to play our part to make that a reality.
Read Dr Siouxsie Wiles’ explainers on the Covid-19 outbreak here.
Good read, thanks @johnny. The takeaway for me is "get on your bicycle!"...
 

pink poodle

Our man in Japan
bullets have no effect on zombies, or bogans with dusty martin inspired mullets
You haven't seen zombie land...

I was at the cardiologist with my Mum a week ago and there was a lady coughing into people's faces at the waiting room, just happened to be Chinese too and no one even flinched.
That's very generous of her. See even if we didn't have the corona virus to be scared of, people shouldn't be coughing around like that anyway. Where did we leave our manners?

Now, how different is this thing to the swine bird sars flu chaps of a a little more than a few years ago? I don't recall the panic being this widely spread
 

stirk

Wheel size expert
Now, how different is this thing to the swine bird sars flu chaps of a a little more than a few years ago? I don't recall the panic being this widely spread
I think covid19 is killing more people in shorter time than SARS did hence people are shitting themselves and buying all the dunny roll.
 

Flow-Rider

Wheel size expert
You haven't seen zombie land...
That's very generous of her. See even if we didn't have the corona virus to be scared of, people shouldn't be coughing around like that anyway. Where did we leave our manners?

Now, how different is this thing to the swine bird sars flu chaps of a a little more than a few years ago? I don't recall the panic being this widely spread
I bet it knocks out a few old people.

Well, only 200 dead in 24 hours in Italy so it appears everybody is over reacting
Italy has been pretty much screwed for ages, they barely recovered from the GFC and the health system there is a total joke.
I think covid19 is killing more people in shorter time than SARS did hence people are shitting themselves and buying all the dunny roll.
You can't eat toilet paper or can you ?
 

johnny

I'll tells ya!
Staff member
Coronavirus: Why You Must Act Now
Politicians, Community Leaders and Business Leaders: What Should You Do and When?
Tomas Pueyo
Tomas Pueyo


Mar 10 · 22 min read
Updated on 3/11/2020
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.
As a politician, community leader or business leader, you have the power and the responsibility to prevent this.
You might have fears today: What if I overreact? Will people laugh at me? Will they be angry at me? Will I look stupid? Won’t it be better to wait for others to take steps first? Will I hurt the economy too much?
But in 2–4 weeks, when the entire world is in lockdown, when the few precious days of social distancing you will have enabled will have saved lives, people won’t criticize you anymore: They will thank you for making the right decision.
Ok, let’s do this.
1. How Many Cases of Coronavirus Will There Be in Your Area?
Country Growth


The total number of cases grew exponentially until China contained it. But then, it leaked outside, and now it’s a pandemic that nobody can stop.


As of today, this is mostly due to Italy, Iran and South Korea:


There are so many cases in South Korea, Italy and China that it’s hard to see the rest of the countries, but let’s zoom in on that corner at the bottom right.


There are dozens of countries with exponential growth rates. As of today, most of them are Western.


If you keep up with that type of growth rate for just a week, this is what you get:


If you want to understand what will happen, or how to prevent it, you need to look at the cases that have already gone through this: China, Eastern countries with SARS experience, and Italy.
China


Source: Tomas Pueyo analysis over chart from the Journal of the American Medical Association, based on raw case data from the Chinese Center for Disease Control and Prevention
This is one of the most important charts.
It shows in orange bars the daily official number of cases in the Hubei province: How many people were diagnosed that day.
The grey bars show the true daily coronavirus cases. The Chinese CDC found these by asking patients during the diagnostic when their symptoms started.
Crucially, these true cases weren’t known at the time. We can only figure them out looking backwards: The authorities don’t know that somebody just started having symptoms. They know when somebody goes to the doctor and gets diagnosed.
What this means is that the orange bars show you what authorities knew, and the grey ones what was really happening.
On January 21st, the number of new diagnosed cases (orange) is exploding: there are around 100 new cases. In reality, there were 1,500 new cases that day, growing exponentially. But the authorities didn’t know that. What they knew was that suddenly there were 100 new cases of this new illness.
Two days later, authorities shut down Wuhan. At that point, the number of diagnosed daily new cases was ~400. Note that number: they made a decision to close the city with just 400 new cases in a day. In reality, there were 2,500 new cases that day, but they didn’t know that.
The day after, another 15 cities in Hubei shut down.
Up until Jan 23rd, when Wuhan closes, you can look at the grey graph: it’s growing exponentially. True cases were exploding. As soon as Wuhan shuts down, cases slow down. On Jan 24th, when another 15 cities shut down, the number of true cases (again, grey) grinds to a halt. Two days later, the maximum number of true cases was reached, and it has gone down ever since.
Note that the orange (official) cases were still growing exponentially: For 12 more days, it looked like this thing was still exploding. But it wasn’t. It’s just that the cases were getting stronger symptoms and going to the doctor more, and the system to identify them was stronger.
This concept of official and true cases is important. Let’s keep it in mind for later.
The rest of regions in China were well coordinated by the central government, so they took immediate and drastic measures. This is the result:


Every flat line is a Chinese region with coronavirus cases. Each one had the potential to become exponential, but thanks to the measures happening just at the end of January, all of them stopped the virus before it could spread.
Meanwhile, South Korea, Italy and Iran had a full month to learn, but didn’t. They started the same exponential growth of Hubei and passed every Chinese region before the end of February.
 

johnny

I'll tells ya!
Staff member
Eastern Countries
South Korea cases have exploded, but have you wondered why Japan, Taiwan, Singapore, Thailand or Hong Kong haven’t?


Taiwan didn’t even make it to this graph because it didn’t have the 50 cases threshold that I used.
All of them were hit by SARS in 2003, and all of them learned from it. They learned how viral and lethal it could be, so they knew to take it seriously. That’s why all of their graphs, despite starting to grow much earlier, still don’t look like exponentials.
So far, we have stories of coronavirus exploding, governments realizing the threat, and containing them. For the rest of countries, however, it’s a completely different story.
Before I jump to them, a note about South Korea: The country is probably an outlier. The coronavirus was contained for the first 30 cases. Patient 31 was a super-spreader who passed it to thousands of other people. Because the virus spreads before people show symptoms, by the time the authorities realized the issue, the virus was out there. They’re now paying the consequences of that one instance. Their containment efforts show, however: Italy has already passed it in numbers of cases, and Iran will pass it tomorrow (3/10/2020).
Washington State
You’ve already seen the growth in Western countries, and how bad forecasts of just one week look like. Now imagine that containment doesn’t happen like in Wuhan or in other Eastern countries, and you get a colossal epidemic.
Let’s look at a few cases, such as Washington State, the San Francisco Bay Area, Paris and Madrid.


Washington State is the US’s Wuhan.The number of cases there is growing exponentially. It’s currently at 140.
But something interesting happened early on. The death rate was through the roof. At some point, the state had 3 cases and one death.
We know from other places that the death rate of the coronavirus is anything between 0.5% and 5% (more on that later). How could the death rate be 33%?
It turned out that the virus had been spreading undetected for weeks. It’s not like there were only 3 cases. It’s that authorities only knew about 3, and one of them was dead because the more serious the condition, the more likely somebody is to be tested.
This is a bit like the orange and grey bars in China: Here they only knew about the orange bars (official cases) and they looked good: just 3. But in reality, there were hundreds, maybe thousands of true cases.
This is an issue: You only know the official cases, not the true ones. But you need to know the true ones. How can you estimate the true ones? It turns out, there’s a couple of ways. And I have a model for both, so you can play with the numbers too (direct link to copy the model).
First, through deaths. If you have deaths in your region, you can use that to guess the number of true current cases. We know approximately how long it takes for that person to go from catching the virus to dying on average (17.3 days). That means the person who died on 2/29 in Washington State probably got infected around 2/12.
Then, you know the mortality rate. For this scenario, I’m using 1% (we’ll discuss later the details). That means that, around 2/12, there were already around ~100 cases in the area (of which only one ended up in death 17.3 days later).
Now, use the average doubling time for the coronavirus (time it takes to double cases, on average). It’s 6.2. That means that, in the 17 days it took this person to die, the cases had to multiply by ~8 (=2^(17/6)). That means that, if you are not diagnosing all cases, one death today means 800 true cases today.
Washington state has today 22 deaths. With that quick calculation, you get ~16,000 true coronavirus cases today. As many as the official cases in Italy and Iran combined.
If we look into the detail, we realize that 19 of these deaths were from one cluster, which might not have spread the virus widely. So if we consider those 19 deaths as one, the total deaths in the state is four. Updating the model with that number, we still get ~3,000 cases today.
This approach from Trevor Bedford looks at the viruses themselves and their mutations to assess the current case count.

The conclusion is that there are likely ~1,100 cases in Washington state right now.
None of these approaches are perfect, but they all point to the same message: We don’t know the number of true cases, but it’s much higher than the official one. It’s not in the hundreds. It’s in the thousands, maybe more.
San Francisco Bay Area
Until 3/8, the Bay Area didn’t have any death. That made it hard to know how many true cases there were. Officially, there were 86 cases. But the US is vastly undertesting because it doesn’t have enough kits. The country decided to create their own test kit, which turned out not to work.
These were the number of tests carried out in different countries by March 3rd:


Sources for each number here
Turkey, with no cases of coronavirus, had 10 times the testing per inhabitant than the US. The situation is not much better today, with ~8,000 tests performed in the US, which means ~4,000 people have been tested.


Here, you can just use a share of official cases to true cases. How to decide which one? For the Bay Area, they were testing everybody who had traveled or was in contact with a traveler, which means that they knew most of the travel-related cases, but none of the community spread cases. By having a sense of community spread vs. travel spread, you can know how many true cases there are.
I looked at that ratio for South Korea, which has great data. By the time they had 86 cases, the % of them from community spread was 86% (86 and 86% are a coincidence).
With that number, you can calculate the number of true cases. If the Bay Area has 86 cases today, it is likely that the true number is ~600.
France and Paris
France claims 1,400 cases today and 30 deaths. Using the two methods above, you can have a range of cases: between 24,000 and 140,000.
The true number of coronavirus cases in France today is likely to be between 24,000 and 140,000.
Let me repeat that: the number of true cases in France is likely to be between one and two orders or magnitude higher than it is officially reported.
Don’t believe me? Let’s look at the Wuhan graph again.


Source: Tomas Pueyo analysis over chart and data from the Journal of the American Medical Association
If you stack up the orange bars until 1/22, you get 444 cases. Now add up all the grey bars. They add up to ~12,000 cases. So when Wuhan thought it had 444 cases, it had 27 times more. If France thinks it has 1,400 cases, it might well have tens of thousands
The same math applies to Paris. With ~30 cases inside the city, the true number of cases is likely to be in the hundreds, maybe thousands. With 300 cases in the Ile-de-France region, the total cases in the region might already exceed tens of thousands.
Spain and Madrid
Spain has very similar numbers as France (1,200 cases vs. 1,400, and both have 30 deaths). That means the same rules are valid: Spain has probably upwards of 20k true cases already.
In the Comunidad de Madrid region, with 600 official cases and 17 deaths, the true number of cases is likely between 10,000 and 60,000.
If you read these data and tell yourself: “Impossible, this can’t be true”, just think this: With this number of cases, Wuhan was already in lockdown.
With the number of cases in countries like the US, Spain, France, Iran, Germany, Japan or Switzerland, Wuhan was already in lockdown.
And if you’re telling yourself: “Well, Hubei is just one region”, let me remind you that it has nearly 60 million people, bigger than Spain and about the size of France.
 
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