The idea that COVID-19 can’t be stopped and has to go in waves is based on the idea that it transmits like flu.
But COVID-19 is not flu.
COVID-19 can be stopped; it can be contained. Any second wave can be stopped too.
You can totally crush COVID19. China, South Korea have shown how. Spain and Italy are doing it now too. The WHO say this with every press briefing but the media almost never report this. To do this you test, isolate and care for cases, trace contacts and quarantine the contacts.
If you stop 75% of the transmisions you change a transmission that goes
100 cases → 200 cases → 400 cases
to one that goes
100 cases → 50 cases → 25 cases
and it soon stops.
You can't do this with flu. You can't stop much more than half the transmission chains because it is airborne. You can do this with Ebola which can be stopped without a vaccine.
The academics who run the UK response are not ready yet to believe that a respiratory disease can be stopped in the same way as Ebola but the evidence is clear. We don't have time for them to re-evaluate their models and realize they made a mistake.
The main reason we can totally CRUSH this new virus, COVID-19 is because it is a very unusual respiratory virus.
- the virus that causes COVID-19 is not airborne [except for certain medical procedures]
- most cases have symptoms or go on to get symptoms - and any that never develop symptoms can't be very uninfectious - it is not driven by them.
- it is not very infectious but it is infectious for a very long time, from several days before symptoms to several days after the symptoms disappear
The spread of this virus is driven by people that typically either have symptoms or develop symptoms later (presymptomatic), which means we can find them.
That is why contact tracing is so important. If someone gets COVID-19 then they may have infected someone else days earlier. That person then has up to 14 days inclubation and it is only in the last several days of that period that they can infect others. So if you can catch and quarantine those people that they infected even a week or more ago, you can stop a lot of the onward transmission from them too.
We can find those others by going back through their personal history of the people they had close or prolonged contact with over the last several days. We then quarantine their contacts while presymptomatic before they in turn go on to infect others.
.COVID-19 can be stopped completely because it does not transmit like flu.
WHAT ABOUT A SECOND WAVE?
So, what about a second wave? Spanish flu had a more deadly second wave. A flu's second wave is just like the first wave, it can't be stopped, only delayed.
But again, this is not flu. Nobody knows if COVID-19 will have a second wave. COVID-19 is different even from SARS. China, South Korea, Singapore etc have not seen any signs of a second wave yet, but they stay at high alert for one.
Any country that stops its first wave can do the same as them - stay alert for a second wave of COVID-19, and be ready to nip it in the bud before it starts, at the first few cases. They will know what to do and be ready to respond much faster to a second wave, if it happens, because of the tools we have developed to stop the first one. Just keep CRUSHING this virus every time, if it does come back.
This is another article I'm writing to support people we help in the Facebook Doomsday Debunked group, that find us because they get scared, sometimes to the point of feeling suicidal about it, by such stories. If scared of COVID-19 the main message on a personal level is you can protect yourself, following the advice of the WHO, see my:
- How To Protect Yourself From COVID-19 - And Help Stop The Spread - If Everyone Did This The Epidemic Would Soon Stop
Please share this widely with other scared people and especially with scientists, politicians and decision makers in the UK
HOW COVID-19 DIFFERS FROM FLU
COVID-19 is not airborne (apart from some medical procedures such as intubation). It is spread in large droplets that infecting people produce when they cough, sneeze or talk. These fall to surfaces in seconds and can only get into your eyes, nose or mouth if you are very close to the person, or you touch a surface the droplets fell on and then touch your eyes, nose or mouth.
It can’t get into you just through the tiny droplets of moisture in someone else’s breath.
Text: FACT CHECK: COVID-19 is NOT airborne
Overlay: The virus that causes COVID-19 does not transmit like flu
COVID-19 can be CRUSHED not just flattened
Most cases are symptomatic. Through contact tracing then some cases are detected before they have symptoms, but 75% of those go on to develop symptoms. We know that the spread of this disease is driven by those who are symptomatic.
For Maria van Kerkhove's summary, see 12:27 into this press briefing on 1st April:
Maria van Kerkhove [lead of the WHO COVID-19 response team]: With regard to the reporting of cases, our case definitions include laboratory confirmed cases regardless of the development of symptoms because we know there are individuals who are followed up through contact tracing and they are identified very quickly, and some of those individuals who are identified have not yet developed symptoms. So it is important for us to capture those individuals as part of case detection as part of surveillance. Because from data that we've seen from China in particular we know from data that individuals identified as asymptomatic, about 75% of those go on to develop symptoms.
So when we look at our language and we look at what proportion of the reported cases are asymptomatic, it is important to classify those as no symptoms and PCR positive and then do not go on to develop symptoms.
Those individuals who are identified as asymptomatic at time of reporting and go on to develop symptoms, 75% of those, are actually in that presymptomatic phase.And then of course most of those who are identified are symptomatic. And we know that transmission of this disease is driven by people who are symptomatic. But it is important for us to capture that full spectrum of illness and detection of symptoms through surveillance. So our case definition includes laboratory confirmed cases regardless of the development of symptoms.
This is what makes it possible to stop it with contact tracing and isolation.
For details see my
- COVID-19 Does Not Transmit Like Simulated Flu - UK's Policy Fact Checked Against WHO Recommendations And Scientific Evidence
Typically the numbers infected can be reduced by about 90% a fortnight, about the same speed it increased before you start the suppression.
You don't notice the effect of your measures until getting on for two weeks after you start on them. The new infections per day start dropping instantly, but the cases are not diagnosed typically until two weeks later so the new confirmed cases are typically people who were infected two weeks ago. It can be less than that with fast diagnosis and the public educated to get diagnosed as soon as they notice symptoms - but it still is going to be a week or so - the Chinese with Wuhan noticed the effect of the control measures in their data 9 days later.
In this figure, the new infections dropped instantly at the lock down, onset of symptoms dropped a few days later, but this is not known until you do the diagnostic tests which happened on average 9 days later in this instance.
I discuss this graph here (towards the end):
WHAT ABOUT THE LOCKDOWNS?
Lockdowns by themselves are not enough to stop it, only perhaps slow the increase a little. But if you do isolation and tracing as part of a lock down the two combined have a huge effect.
The UK is imitating the lock down in China but they are leaving out the isolation and tracing and until they do that they won't be able to emulate the success of China. So far it is a superficial imitation of just the most visually dramatic thing China and Italy did, and not imitating the core reason for their success.
CORE REASONS FOR CHINA'S SUCCESS - LOTS OF TESTS - BUT ALSO ISOLATING CASES AND TRACING CONTACTS
We need lots of tests too, to find the people to isolate and contact trace but we need to isolate them as well.
The UK probably has 100,000 cases now, all potential seeds of new clusters in our country or in others. We need to isolate them all. Not only that, we have to isolate all their contacts too.
The WHO say it is okay to isolate contacts at home, with the right information about how to avoid infecting others and a very rapid system to get them out of their homes if they become sick.
Isolating sick individuals at home confirmed with COVID-19, as we are advised to do in the UK, is very much a last resort. You need a clinician to advise the family and inspect the premises to make sure they can isolate properly and both carer and the patient wear masks - ideally you don’t do this at all.
This is about contacts of confirmed cases, who are not yet sick, not confirmed cases:
When we come to contacts it very much depends on the context and the intensity of any given moment. In low-incidence areas where there are sporadic cases or clusters, we advise that all contacts should be quarantined.
Ideally that quarantine should occur in a place other than the home and for this reason, one, because if that person gets sick they may already have infected their family.But that's not always possible so at least quarantining contacts at home with good health advice about not transmitting disease if they become sick and with regular monitoring of that individual is an option for countries. It is difficult to do that in the middle of intense transmission where you might have hundreds of thousands of contacts because you're having thousands of cases a day.
It is difficult to deal with that, so home quarantine of contacts is acceptable with appropriate information, education and more importantly a very rapid system of getting those people out of their homes if they become sick
VALUE OF LOCK DOWN AS PART OF A LARGER STRATEGY OF CONTAINMENT
With all the lock downs, we have a precious second window to find the confirmed cases and isolate them and quarantine all their contacts.
As Maria van Kerkhove put it, in the WHO press conference on 30th March:
Maria van Kerkhove: In some senses transmission has been taken off the streets and pushed back into family units. Now we need to go and look in families to find those people who may be sick and remove them and isolate them in a safe and dignified manner so that's what I was saying previously; the transition from movement restrictions and shut-downs and stay-at-home orders can only be made if we have in place the means to be able to detect suspect cases, isolate confirmed cases, track contacts and follow up on the contacts' health at all times and then isolate any of those people who become sick themselves.
That is possible. If we do that then the cases per day will go down rapidly. This is a golden opportunity to do this. We have far fewer contacts during a lock down which makes contact tracing easier.
The isolation has to be for long enough - and isolated from others in the same household, not isolated together with others who don't have it yet.
You can isolate a confirmed case in a household but very much as a last resort. If you do, the WHO advise that both carer and patient should wear masks and they should be advised by a clinician who inspects the premises to check they are suitable and advise them how to do it.
The Director General said this in his famous “test test test” speech, where the UK only reported the need to do lots of tests and left out the part about needing to isolate the confirmed cases
Director General: We have a simple message for all countries: test, test, test.
Test every suspected case. [point 2]
Caring for infected people at home may put others in the same household at risk, so it’s critical that care-givers follow WHO’s guidance on how to provide care as safely as possible.
For example, both the patient and their care-giver should wear a medical mask when they are together in the same room. [point 3]
People infected with COVID-19 can still infect others after they stop feeling sick, so these measures should continue for at least two weeks after symptoms disappear. [point 4]
Visitors should not be allowed until the end of this period.
WHO Director-General's opening remarks at the media briefing on COVID-19 - 16 March 2020
NEED TO DO THE WHOLE PACKAGE - NOT JUST LOCK DOWN AND TESTING
The UK is not doing this. We have to do the whole package not just the lock down and the testing, if we want to succeed in the way other countries have done. Not only China and South Korea - other countries too are succeeding with these measures.
- Spain, Italy, Germany And Iceland On Course To Contain Their Outbreaks Of COVID-19 - With A Change Of Direction UK Can Too
The Chinese isolated most of the mild cases in community centers and gymnasiums, stadiums etc set up to accommodate vast numbers of mild cases to isolate them from society and from their own households and families.
Do this and our numbers will start falling as has been shown in multiple countries now.
It is possible that we get the start of a second wave. This is just a hypothesis and so far there hasn’t been any sign of a second wave in any of the countries that have succeeded in controlling COVID-19. It can happen with some diseases but they don’t know yet if COVID-19 is such a disease.
If we do get a second wave - then we just do the same again but we catch it much faster at an earlier stage.
When we turn the peak and the cases per day start going down the message is to keep up our efforts and push it all the way down to zero. Then keep alert and keep it at zero if it resurges.
This is not possible with flu but COVID-19 is a very unusual respiratory disease, different also from SARS which was airborne, and COVID-19 can be stopped in this way.
From that same press conference:
Mike Ryan: The question is how do you go down and going down isn't just about a lock down and let go. To get down from the numbers, not just stabilize, requires a redoubling of public health efforts to push down. It won't go down by itself. It will bepushed down and that's what we need countries to focus on. What is the strategy now to put in place, the public health measures that will push down the virus after those measures may be released and then how do we take care of people better in a clinical environment to save more lives
Maria van Kerkhove: These physical distancing measures, these stay-at-home measures have bought us a little bit of time, a little window of time and that short window has to be used appropriately so that we get systems in place to look for this virus aggressively through testing, through isolation, through finding contacts, through quarantining those contacts, through caring for further patients because we will still see patients and many patients are going to still require need, to support other countries that are going to go through thus.
So, focusing on what we do now is absolutely critical to make sure we use that time wisely, we use that time effectively so that once we do reach that peak we continue to push and suppress that virus down as quickly as possible but still be ready to find additional cases should they show up. What we've seen in a number of countries in Asia where they brought this virus down, they brought this transmission down; they're now seeing repeat introductions from outside of their countries. They have not let their guard down, they're still aggressively looking for those cases as they come in and suppressing them so that it doesn't start again.
So we need to focus on the now, we need to use our time wisely and that is to aggressively find this virus and care for our patients
The video of that press conference is here.
CRUSHING THE CURVE
Harvey Fineberg puts it like this:
Most of his ideas are similar to the WHO except the antibody passports. These are very speculative as it is not yet known if antibodies do protect you from reinfection. With some viruses such as Dengue they can make the second infection worse. It's not yet known if the antibodies for COVID-19 do protect you from the virus or how long. These "passports" could give people a false sense of security and invincibility.
HOW TO TELL IF THE UK IS STARTING TO DO THE RIGHT THINGS
The UK is starting to talk about the right things. However, we aren't doing it right until you have
- Many more tests, we are talking about 100,000 a day not 10,000 a day. We must find a way to do this. And not by the end of April. We need them right now, as fast as we can. If we can construct a field hospital for 4000 patients in two weeks, surely one way or another we can find a way to get testing capabilities for 100,000 people in less than a month.
[Then we have to use this opportunity to stop the disease]
- Isolating people away from their households if they have the disease - not isolating a household together, at least, not without a clinician inspecting the house to see if it is possible.
- Clean up all our hospitals and care homes. We shouldn't be treating people in premises that may have COVID19 and with doctors and nurses who may have it.
- Quarantine all the contacts of people with the disease.
- Adequate isolation period -through to death for those that die and to two weeks after recovery or two negative tests 24 hours apart.
There are probably other things we need to do. Basically we need to get advice from the WHO rather than from mathematical modelers and also look at what other countries have done that has actually worked.
None of this is meant as any criticism of the mathematical modelers. They were all surely well motivated and doing their best to help. It is natural for modelers to believe in their models, in all subjects. It is just the connection of the model to policy that's the problem not the modeling as such or their conviction in their own models.
In the normal course of science, you have others with other models and it's a dialog between each other and with the scientific evidence which plays out over months to years. Some months, or years down the line they would publish a revised or second paper taking account of the issues found with their first paper. The main issue here is that in the emergency situation, that natural dialog was bypassed and the papers of one group of modelers used directly to drive policy. We may need some kind of watch dog / evidence checking to make sure it doesn’t happen again - if it is confirmed that this approach lead to many people losing their lives, as seems likely.
For details see my
- Good News From Italy: COVID 19 Outbreak Halted In Italian Town Of Vo Euganeo At Record Speed - 90 To 0 New Cases In Two Weeks
- WHO COVID19 Mar 20 - Message Of Courage And Hope In Difficult Times - First Pandemic In History With Power To Change Way It Goes
- Yes Your Country Can Stop COVID-19 - Singapore Shows How
This will be over and will be just a memory, some time in 2021, sooner if we act to suppress it now.