Covid-19 – the China Syndrome

15 Mar

Today’s Guardian quotes Anthony Costello, former director of the World Health Organization:

The key principles from WHO are intensive surveillance. You test the population like crazy, find out where the cases are, immediately quarantine them and do contact tracing and get them out of the community. This deals with family clusters. That’s the key bedrock of getting this under control.

This was how South Korea, China, Japan, Hong Kong and Taiwan had brought their case numbers down. You can really take people out of the population and make sure they are quarantined. That is vital.

A twenty-five strong WHO Joint Mission was sent to China in late February. It was made up of:

25 national and international experts from China, Germany, Japan, Korea, Nigeria, Russia, Singapore and the USA, and headed by Dr Bruce Aylward of WHO and Dr WannianLiang of the People’s Republic of China.

Here are the key findings – full report here – as compiled on Reddit:

  • When a cluster of several infected people occurred in China, it was most often (78-85%) caused by an infection within the family by droplets and other carriers of infection in close contact with an infected person. Transmission by fine aerosols in the air over long distances is not one of the main causes of spread. Most of the 2,055 infected hospital workers were either infected at home or in the early phase of the outbreak in Wuhan when hospital safeguards were not raised yet.

  • 5% of those diagnosed with Covid require artificial respiration. Another 15% need to breathe in highly concentrated oxygen – and not just for a few days. The duration from start of the disease until recovery is 3 to 6 weeks on average for these severe and critical patients (compared to only 2 weeks for the mildly ill). The mass and duration of the treatments overburdened the existing health care system in Wuhan many times over. The province of Hubei, whose capital is Wuhan, had 65,596 infected persons so far. A total of 40,000 employees were sent to Hubei from other provinces to help fight the epidemic. 45 hospitals in Wuhan are caring for Covid patients, 6 of which are for patients in critical condition and 39 are caring for seriously ill patients and for infected people over the age of 65. Two makeshift hospitals with 2,600 beds were built within a short time. 80% of the infected have mild disease, ten temporary hospitals were set up in gymnasiums and exhibition halls for those.

  • China can now produce 1.6 million test kits for the novel coronavirus per week. The test delivers a result on the same day. Across the country, anyone who goes to the doctor with a fever is screened for the virus: In Guangdong province, far from Wuhan, 320,000 people have been tested, and 0.14% of those were positive for the virus.

  • The vast majority of those infected sooner or later develop symptoms. Cases of people in whom the virus has been detected and who do not have symptoms at that time are rare – and most of them fall ill in the next few days.

  • The most common symptoms are fever (88%) and dry cough (68%). Exhaustion (38%), expectoration of mucus when coughing (33%), shortness of breath (18%), sore throat (14%), headaches (14%), muscle aches (14%), chills (11%) are also common. Less frequent are nausea and vomiting (5%), stuffy nose (5%) and diarrhoea (4%). Running nose is not a symptom of Covid.

  • An examination of 44,672 infected people in China showed a fatality rate of 3.4%. Fatality is strongly influenced by age, pre-existing conditions, gender, and especially the response of the health care system. All fatality figures reflect the state of affairs in China up to 17 February, and everything could be quite different in the future elsewhere.

  • Healthcare system: 20% of infected people in China needed hospital treatment for weeks. China has hospital beds to treat 0.4% of the population at the same time – other developed countries have between 0.1% and 1.3% and most of these beds are already occupied with people who have other diseases. The fatality rate was 5.8% in Wuhan but 0.7% in other areas of China, which China explained with the lack of critical care beds in Wuhan. In order to keep the fatality rate low like outside of Wuhan, other countries have to aggressively contain the spread of the virus in order to keep the number of seriously ill Covid patients low and secondly increase the number of critical care beds until there is enough for the seriously ill. China also tested various treatment methods for the unknown disease and the most successful ones were implemented nationwide. Thanks to this response, the fatality rate in China is now lower than a month ago.

  • Pre-existing conditions: The fatality rate for those infected with pre-existing cardiovascular disease in China was 13.2%. It was 9.2% for those infected with high blood sugar levels (uncontrolled diabetes), 8.4% for high blood pressure, 8% for chronic respiratory diseases and 7.6% for cancer. Infected persons without a relevant previous illness died in 1.4% of cases.

  • Gender: Women catch the disease as often as men. But only 2.8% of Chinese women who were infected died from the disease, while 4.7% of the infected men died. The disease appears to be not more severe in pregnant women than in others. In 9 examined births of infected women, the children were born by caesarean section and healthy without being infected themselves. The women were infected in the last trimester of pregnancy. What effect an infection in the first or second trimester has on embryos is currently unclear as these children are still unborn.

  • Age: The younger you are, the less likely you are to be infected and the less likely to fall seriously ill if you do get infected

  • The new virus is genetically 96% identical to a known coronavirus in bats and 86-92% identical to a coronavirus in pangolin. Therefore, the transmission of a mutated virus from animals to humans is the most likely cause of the appearance of the new virus.

  • Since the end of January, the number of new coronavirus diagnoses in China has been steadily declining (shown here as a graph) with now only 329 new diagnoses within the last day – one month ago it was around 3,000 a day. “This decline in COVID-19 cases across China is real,” the report says. The authors conclude this from their own experience on site, declining hospital visits in the affected regions, the increasing number of unoccupied hospital beds, and the problems of Chinese scientists to recruit enough newly infected for the clinical studies of the numerous drug trials. Here is the relevant part of the press conference about the decline assessment.

  • One of the important reasons for containing the outbreak is that China is interviewing all infected people nationwide about their contact persons and then tests those. There are 1,800 teams in Wuhan to do this, each with at least 5 people. But the effort outside of Wuhan is also big. In Shenzhen, for example, the infected named 2,842 contact persons, all of whom were found, testing is now completed for 2,240, and 2.8% of those had contracted the virus. In Sichuan province, 25,493 contact persons were named, 25,347 (99%) were found, 23,178 have already been examined and 0.9% of them were infected. In the province of Guangdong, 9,939 contacts were named, all found, 7,765 are already examined and 4.8% of them were infected. That means: If you have direct personal contact with an infected person, the probability of infection is between 1% and 5%.

A few direct quotes from the report:

China’s bold approach to contain the rapid spread of this new respiratory pathogen has changed the course of a rapidly escalating and deadly epidemic. In the face of a previously unknown virus, China has rolled out perhaps the most ambitious, agile and aggressive disease containment effort in history. China’s uncompromising and rigorous use of non-pharmaceutical measures to contain transmission of the COVID-19 virus in multiple settings provides vital lessons for the global response. This rather unique and unprecedented public health response in China reversed the escalating cases in both Hubei, where there has been widespread community transmission, and in the importation provinces, where family clusters appear to have driven the outbreak.

Much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China. These are the only measures that are currently proven to interrupt or minimize transmission chains in humans. Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts, and an exceptionally high degree of population understanding and acceptance of these measures.

COVID-19 is spreading with astonishing speed; COVID-19 outbreaks in any setting have very serious consequences; and there is now strong evidence that non-pharmaceutical interventions can reduce and even interrupt transmission. Concerningly, global and national preparedness planning is often ambivalent about such interventions. However, to reduce COVID-19 illness and death, near-term readiness planning must embrace the large-scale implementation of high-quality, non-pharmaceutical public health measures. These measures must fully incorporate immediate case detection and isolation, rigorous close contact tracing and monitoring/quarantine, and direct population/community engagement.

 

8 Replies to “Covid-19 – the China Syndrome

    • Just read it Dave. A masterclass in epidemiology, I recommend all read and share widely.

      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.

      • The zerohedge reposting of the Tomas Pueyo article is misleading since it gives the impression that it is admonishing the readers to get up off their arses and DO SOMETHING. It misses out the vital subtitle of the original article: “Politicians, Community Leaders and Business Leaders: What Should You Do and When?” It is vital to note this since it is obvious from the article that, if you are a “regular Joe”, then there is, if you’ll pardon the expression, simply sweet fuck all that you can do.

        Consequently all that stuff about healthcare workers collapsing in overcrowded hospitals etc. is a vision of the inevitable. And this ferociously nihilistic vision doesn’t seem that different from the relentless doom mongering in the main stream press. All of which makes me wonder if this apparent relishing over this disease as the end for capitalism is self-deceivingly naïve. The virus could be a marvellous opportunity for capitalism to impose martial law, finally trash the public services, mask the impending crisis that was going to happen anyway behind a non-economic “cause” etc.

          • One of the key problems with the ‘counter narrative’ is that the politicians, at least in the UK and US, have had to be dragged kicking and screaming to take any kind of measures.

            If they are and/or have been salivating at the thought and choking at the bit of imposing martial law, introduce fascism by the back door etc their attitude and behaviour has been well short of enthusiastic by a country mile.

            In addition to the dilitory attitude which saw UK and US ports of entry with not even basic common sense levels of containment protocols from the time it was required – mid February at least – we have to consider the actual real world action arising, for example, from the UK Government press Conference yesterday and rhe measures they are introducing compared to those being asked for by the epidemiologists like Pueyo based on the hard facts and data.

            Far from the straw man groupthink narrative, projected onto others by such as offguardian, of Draconian impositions Johnson is still stalling by making the closure of pubs, restaurants etc VOLUNTARY rather than MANDATORY.

            The substantive measures and the attitude and approach which underpin them are all based on voluntary cooperation of the populace rather than coercion.

            And there is a logic to this. I don’t like it but the world does not revolve around my likes and dislikes (not being a post modernist mardy arse). The logic is that of follow the money.

            You see, if the Government forced by decree already existing powers introduced in legislation some of which can be traced back to the 1980’s and even further those small businesses affected by the introduction of martial law fascism etc would be able to go to the insurance companies to claim off the insurance.

            The scale involved would at the very least severely damage and likelyy sink the insurance industry as a whole.

            And we could play the darts game from the film Roxanne and fill reams of space with example after example of the dilitory action of Western Governments which is the exact opposite of this ‘counter narrative’.’

            From the US Government insistence on using its own testing kits which did not work rather than those of the derided and vilified ‘experts (I ‘m still trying to work out which member of the current self indulgent echo chamber that offguardian has become who is the real Michael Gove) wasting 12 weeks; through to the total absence of testing and containment protocols detailed here:

            https://m.facebook.com/story.php?story_fbid=10158245654913669&id=615628668

            Then we have the premature pricking of the financial bubble.

            Every action going as far back as you like by those charged with wanting to use this for whatever purpose has been based on trying to manage the bubble. Keeping it going; trying to create the conditions for reinflating it etc. Because as we have all experienced, the world is overrun by managers who don’t have the imagination never mind the gumption to be so ‘radical.’

            Even banks like J.P Morgan are having heir stocks crash. Though no doubt there is some parang finance house buying up the stock at knockdown prices to recycle it back through the same channels with the bonus of a bail out on top from Main Street.

            Where there’s money always a fiddle for some individual shark. With the emphasis on individual rather than collective.

            The point being we live in hierarchies and when it comes to a choice of being in control or being right ( and in this case being right means maximising profit) it’s a no brainer. Control wins every time.

            No one wants the total absence of control from the current and unfolding financial anarchy. Going on the mattress is bad for business. Ask Don Corleone.

            And that’s a shame. Because the ‘counter narrative’ is missing all the relevant points and issues about how we are really being screwed over by incompetance and malevolence from a totally different direction.

            See here for example:

            https://m.facebook.com/839868742757504/posts/2826134040797621/

            The facts and reality on the ground point more to an attitude and action designed to maximise the reduction of the “economically inactive” by taking advantage of the situation. Further undermining a fragile system to the detriment of the poor and the weak in society.

            Unfortunately, the “counter narrative” lost up its own self satisfied backside (‘we are the only alternative media site telling you the truth because all the others have gone native and are crying uncle’) is singularly failing to not only cover these angles – one wonders why? – it is also failing to heed it’s own advice by applying a healthy dose of scepticism to its own echo chamber groupthink narrative.

            Picking and choosing which statistics are valid and which are not. Coming up with straw man semantics to those which don’t fit it’s narrative whilst quoting as gospal, with no equally sceptical analysis, statistics which support that simplistic narrative.

            People are flexible. They hedge their bets when they see the way the wind is blowing. Like the people’s in the global south who embraced the Christian God whilst continuing to worship their traditional ones at the same time people will take the necessary precautions just in case.

            But don’t fret. If ever the dire warnings of the self-identified “counter narrative” start to show you are not unarmed. You have a psychological weapon when confronted by the fascist agents of the State in the street trying to stop you going about your business:

            “This is a Covid-19 cough.

            The most powerful chest cough in the world.

            It can blow your nose clean off.

            Now in all this excitement I can’t rember whether I let off five coughs or six.

            The question you have to ask is ‘do I feel lucky?’

            Well do you, Punk?”

            Stay chill.

    • Perhaps some people think that a gun is a useful tool for defending yourself against a virus!
      The American experience is that the more people who have guns leads to more people being shot and wounded or even killed. My house went into lock down today, except for the visit to our solicitor to arrange our wills, which will mean another visit to sign the will. We kept it simple and short, tried not to touch anything such as chairs or door handles, and sanitised our hands as soon as we left.

      • And other people might think they need something(in a dark humour type context) to actively protect themselves from incompetent criminally negligent in over their heads people at the helm whose cavalier and sanguine (read couldn’t give a shit) attitudes (“take it on the chin”; “herd immunity”; “culling good for the economy” etc) and behaviour (no containment protocols in place at ports of entry; dilitory attitude towards testing, identifying contacts, breaking the containment chain etc).

        If you need anything fetching up to the land of the Thurgo’s from the shops you have my email address. I’m doing now’t else whilst I’m waiting for my suggestions for a local volunteer system to work its way through the local LP bureaucracy.

        Meanwhile can you help me out Matthew.

        I’m looking for a partner to don a couple of hazard suits with to to burst into a supermarket shouting “WHICH WAY DID HE GO?”

        Hope that’s cheered you up. There’s plenty more where that came from.

        Stay chill.

        Dave Hansell.

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