The UK’s policy is based on a model such as is used in pandemic simulations. The (simulated) influenza in this model is an upper respiratory tract infection, and is airborne which means you can get it just by breathing the air of someone who is near you. Their simulated disease also has a large population of people who don't show any symptoms and have half the infectivity of those who do have symptoms. These assumptions are not based on real world data for COVID-19 but rather on data for influenza. Influenza and COVID19 are unrelated diseases. Both are respiratory tract infections,but influenza is not a coronavirus.ns is that we are using a simulated flu to guide policy rather than data from the real disease.

skip to: Some of the key differences between the UK policy and the WHO recommendations (and Contents).

The reason the UK has different policies from the WHO recommendations is that we are using a simulated flu to guide policy rather than data from the real disease.

Key differences between UK simulated flu and reality

  1. The virus that causes COVID-19 is NOT airborne [except for some medical procedures] - spread through droplets that fall to ground in seconds ✔
    The simulated virus is airborne and can be transmitted just by breathing X
  2. Most of the transmission in China (perhaps 75 to 85%) happened in households. Most of the rest is through other forms of close or prolonged contact. ✔
    A third of the transmission happens in the community to random strangers X
  3. Nearly all transmission of COVID-19 is from cases that show noticeable symptoms at some point ✔
    A third of the transmission is through asymptomatic cases X

For details see What do the WHO recommend we do? in my longer article and The Imperial college London study in the same article

On point 1, there are many stories claiming that this virus is ariborne. No it's not. Except for some medical procedures such as intubation.

See WHO tweet here. For details see also my The coronavirus COVID-19 is NOT AIRBORNE.

This makes a big difference to the study as it means you can't get it from random strangers in the community by just breathing the air they breathed out. No evidence of this yet. They need to be talking at close quarters or coughing or sneezing, or get it via contact including touching surfaces they coughed or sneezed on and then your eyes nose or mouth.

For points 2 and 3 see the sections below::

COVID-19 is an unusual respiratory disease. It is a lower respiratory tract disease and it is not airborne. The main difference is that SARS-CoV2 (the virus that causes COVID-19) has an affinity for the cells in the lower respiratory tract. It causes little by way of symptoms in the upper respiratory tract such as a runny nose or phlegm. The way it transmits differs too, only through the larger droplets that you produce when you cough, sneeze or talk, not the much finer mist of droplets you exhale when you breathe.

The flu used for modeling for the UK policy is an unconfirmed hypothesis. Unless validated, any such model should be regarded as based on a fictional disease rather than a real one.

As Bill Gates said about one of the Imperial College response team’s models:

The experience in China is the most critical data we have. They did their “shut down” and were able to reduce the number of cases. They are testing widely so they see rebounds immediately and so far there have not been a lot. They avoided widespread infection. The Imperial model does not match this experience. Models are only as good as the assumptions put into them.

Bill Gates addresses coronavirus fears and hopes in AMA

First, for any of you who are scared, and understandably so - the main thing on a personal level is that you can protect yourself. Because this disease is not airborne - you can't catch it just by breathing in the air that someone else breathed out. The droplets that transmit it fall to the ground in seconds and don't travel further than a meter or two. You can’t totally stop yourself getting flu. But you can stop yourself getting this disease.

You must wash your hands thoroughly, and you must get out of the habit of touching your face or not touch your eyes, nose or mouth except with thoroughly washed hands. You must also stand 1 to 2 meters away from anyone coughing, sneezing or talking and not shake hands or get up close while talking.

The 13 international experts who studied China for the e Report of the WHO-China Joint Mission on Coronavirus Disease 2019 toured the worst hot spots for the virus in China for 9 days and spent the last 1.5 days in Wuhan did that and were able to come away again without even needing quarantine and say "I am not a contact for COVID 19, I don't have it, I am very low risk". That's over a month ago. You see Maria van Kerkhove on every WHO press conference - she spent 9 days touring virus hotspots in China and she doesn't have COVID 19.

By following the same methods as these experts, you not only protect yourself, you also stop all the transmission chains that could go through you to others. We need to keep dong this until the general community in the UK is free from this virus. But you can do that! It becomes a routine. This should be as automatic as buckling up your seat belt when you get in a car.

Boris Johnson, Matt Hancock, Prince Charles and the others who recently tested positive in the UK, just didn't take this advice seriously. Professor Neil Fergusson also tested positive, as he tweeted on the 19th March, the lead author of the Imperial College study. But follow this advice correctly and you can be safe from it.

I wrote this not to alarm people but to try to put pressure on our government to change, and not a week from now, not even a few days from now but right away.

Even when it gets very serious we can turn it around. The Chinese showed that in Wuhan. Their success there is a message of great promise and hope for the rest of the world.

The UK and other countries have now shown they are prepared to take drastic measures to stop it, as drastic as the measures the Chinese adopted in Hubei province. So we can definitely stop this even at this late stage.

The question is no longer, "Can the UK do actions as drastic as the Chinese?" The question is, "Can the UK do the right actions to stop this disease?"

I am sure the answer is YES. And WE WILL. Once the situation is clear we will rise to this challenge just as our country has done before many times in the past.

But it is an emergency situation. Like an emergency response, rapid action based on proven methods will save many lives.

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.

Please share this widely and especially, let's try to get the attention of decision makers in the UK, also journalists and any experts who may have the ear of politicians.

CONTENTS

skip to: Some of the key differences between the UK policy and the WHO recommendations

SOME OF THE KEY DIFFERENCES BETWEEN THE UK POLICY AND THE WHO RECOMMENDATIONS

skip to: Where does the WHO say this?

This has had a huge effect on our policy

This has had a huge effect on our policy

UK policy compared with WHO recommendations

  1. WHO: COVID19 can be stopped ✔
    UK: COVID19 can’t be stopped but it can be delayed X
  2. WHO: Test every suspected case of COVID19 ✔
    UK: Only test if the patient needs an overnight stay in a hospital. X
  3. WHO: Caring for infected people at home may put others at risk. E.g the patient and carer must both wear medical masks. ✔
    UK: If you are infected with suspected COVID-19 it is likely others in your household are infected already or will get infected - no need for masks X
  4. WHO: Isolate a confirmed case from everyone including their household. Trace anyone a confirmed case was in close contact with and isolate them too for 14 days to see if they get symptoms ✔
    UK: Everyone with CVOID-19 like symptoms should stay at home with their household for 14 days [or 7 days if living alone]. No need to trace contacts X

For the UK guidelines for 2.- requirement of an overnight stay, see the guidelines here

For 3 and 4, see the NHS guidelines here.

If you have symptoms of coronavirus, you'll need to self-isolate for 7 days.

After 7 days:

if you do not have a high temperature, you do not need to self-isolate
if you still have a high temperature, keep self-isolating until your temperature returns to normal

You do not need to self-isolate if you just have a cough after 7 days. A cough can last for several weeks after the infection has gone.

Those guidelines have been in place for a fortnight now. The UK is starting to test health workers with mild symptoms of COVID-19 but so far is only testing those working in critical care. It has tested a few high profile figures with mild symptoms such as various politicians and royalty. But most with mild symptoms are still not being tested.

As of 26th March, according to the BBC, London is reporting that some hospitals have 20 - 50% of the health care professionals absent because of sickness or self isolating. At present our government has no idea how many of these have COVID-19.

For 3. see

For 4 here for instance is Matt Hancock the health secretary who tested positive for Covid 19 - says he will be self isolating until next Thursday.

(click to watch on Youtube)

Boris Johnson also said he will be self isolating for 7 days. They are both people who live alone so the rule about households doesn't apply to them.

Incidentally when they say "fortunately my symptoms so far have been very mild" - this is true for everyone who gets COVID-19. It is always mild for most of the first week and sometimes into the second week. See COVID-19 is stealthy (below).

WHERE DOES THE WHO SAY THIS?

skip to: What do the WHO recommend we do?

Here is the graphic again

UK policy compared with WHO recommendations

  1. WHO: COVID19 can be stopped ✔
    UK: COVID19 can’t be stopped but it can be delayed X

  2. WHO: Test every suspected case of COVID19 ✔
    UK: Only test if the patient needs an overnight stay in a hospital. X

  3. WHO: Caring for infected people at home may put others at risk. E.g the patient and carer must both wear medical masks. ✔
    UK: If you are infected with suspected COVID-19 it is likely others in your household are infected already or will get infected - no need for masks X
  4. WHO: Isolate a confirmed case from everyone including their household. Trace anyone a confirmed case was in close contact with and isolate them too for 14 days to see if they get symptoms ✔
    UK: Everyone with CVOID-19 like symptoms should stay at home with their household for 14 days [or 7 days if living alone]. No need to trace contacts X

Instead of linking to the detailed technical documents on the WHO website, I will cite the Director General’s speeches where it’s explained simply and plainly. He says these things over and over, but here are some examples:

Several countries have demonstrated that this virus can be suppressed and controlled.

The challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same – it’s whether they will [point 1]
WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020

For points 2,3 and 4 , I will use his “test test test” speech

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

SO WHAT DO THE WHO RECOMMEND WE DO?

skip to: COVID-19 is stealthy

This difference in the models makes a huge difference in the policy needed.

With the fictional flu, physical distancing can slow it down and there is no way to stop it.

With COVID-19 however, most of the spread is in households and close or prolonged contacts.

So what should we do?

Our real priorities for COVID19 according to the WHO

  • Test all suspected cases for COVID19, isolate them while waiting for the test, and quarantine anyone who has it.
  • Trace all contacts of confirmed cases from 2 days before onset of symptoms. Ask all contacts to isolate themselves until 14 days after the contact
  • Test all contacts for COVID19 if they show any symptoms.
  • Quarantine anyone who has it until 14 days after they get better.
  • Physical distancing is a defensive measure. All it can do is to buy us time. We can’t win without going after the virus

This is how Dr Mike Ryan put it in the press conference on Monday 22nd March.

All that we get from movement restrictions and people staying at home and all of these measures; we buy some time, we take the heat out of the epidemic or the pandemic, we buy some time.

… one of the key ways we can move forward is a massive scale-up - in public health capacities to do case finding, isolation, quarantine of contacts and being able to go after the virus rather than the virus coming after us

There is a very, very precious window now in which we can prepare to do that.

WHO - on Netherlands and UK - precious second window of opportunity to chase after the virus with case finding and contact tracing

Also

You can't win a football game only by defending. You have to attack as well.

Asking people to stay at home and other physical distancing measures are an important way of slowing down the spread of the virus and buying time – but they are defensive measures.

To win, we need to attack the virus with aggressive and targeted tactics – testing every suspected case, isolating and caring for every confirmed case, and tracing and quarantining every close contact.

See WHO COVID 19 23rd March: We must attack the virus not just defend against it - you can't win a football game only by defending

They describe the recommended responses in detail here:

The details for contact tracing are here:

But the UK is not listening because of its policy based on a fictional flu.

This might not be the only method. One small provincial Italian town has found another approach. They tested everyone in their small town of Vo Euganeo with 3,300 residents and they isolated everyone with COVID-19 whether symptomatic or asymptomatic (remember COVID-19 patients with mild symptoms may be asymptomatic and still spread the virus for up to two weeks). Within two weeks the number who tested positive was reduced 90% and there were no new cases after that point.

This is an approach that might work especially well in small wealthy countries like Monaco, Iceland or Monaco, or to remove COVID-19 infections from a small area of a larger country. There are machines from Roche Diagnostics that can test 2,500 samples a day. We can rapidly ramp up our testing capacity if that is a priority:

However the UK approach is not evidence based, has not been tested by anyone before, and is not even an attempt to stop this virus.

The hypothesis of a second wave is based on the imperial college model. Any such model is only as good as the assumptions that go into it. The real world has not yet shown any signs of a second wave in China or South Korea and with rapid testing, if there were new cases then they can be found quickly, and the second wave suppressed far faster than the first one.

Also our strategy needs to be co-ordinated with other countries. Yesterday (Friday March 27th) the director general of the WHO talked about how the G20 countries need to unite to help the world fight the virus.

Yesterday, I had the honour of addressing an extraordinary meeting of leaders from the G20 countries.

My message was threefold: we must fight, unite and ignite.

Fight to stop the virus with every resource at our disposal;

Unite to confront the pandemic together. We are one humanity, with one, common enemy. No country can fight alone; we can only fight together.

And ignite the industrial might and innovation of the G20 to produce and distribute the tools needed to save lives.

Others are trying to contain it with contact tracing, but, for instance if a contact from Italy goes to the UK it can no longer be traced any further. This lack of co-ordination weakens our fight against the common enemy.

COVID-19 IS STEALTHY - IT SEEMS INNOCUOUS FOR A WEEK THEN RAPIDLY OVERWHELMS EVEN THE MOST ADVANCED HEALTH CARE

skip to: The Imperial college London study

COVID-19 is also stealthy. It resembles flu for the first week which may be why countries don’t react to it quickly enough. It leads to complacency, a feeling that they are tackling it.

We see that here in the UK. The UK government says that Boris Johnson, Matt Hancock, Prince Charles all have the mild version of the disease.

This disease always starts very mild.

This disease starts in the upper respiratory tract where it gets into your body. The virus causes little by way of symptoms there, just a fever and a persistent dry cough. It stays there for the first week of infection.

This disease turns severe if it develops a major infection in the lower lungs area.

We have known this since the earliest published studies from China in mid January.

Here is a recent re-analysis of the data for the first 191 patients in Wuhan to get it, All those early patients were hospitalized From the start of the illness, it took them 4-9 days to start to feel breathless, 8 to 15 days for intensive care unit admission,12 to 19 days to need a ventilator and for the ones that died, 17 to 25 days to die.

This shows a typical progression of the disease using the median of the data. Half the hospitalized patients had onset times before this point and half after this point. There are two graphs here, for survivors and non survivors:

ARDS=acute respiratory distress syndrome. At this point patients need oxygen
Red in the second diagram means the patient is on a ventilator.
Orange = fever.
Purple = administration of corticosteroids which reduce inflammation and fever.
Pale blue = cough.
Dark blue = Dyspnoea (breathlessness)
Green = intensive care unit admission.

Boris Johnson is at home right now self isolating for 7 days according to NHS advice. A week from now he will come out of this isolation and resume normal activities unless he is one of those to develop early onset of breathlessness.

This will be too soon to know for sure if he will progress to the severe disease, and he will still be infectious.

The mild and the severe version of the disease are caused by the same virus.

It is not that all people with certain health conditions die. 80% even of 90 year olds survive and a fraction of a percent of those under 40 die. When they die it is not necessarily for any obvious reason, that one person died and another got only the mild version. Having respiratory diseases, weakened immune system, or heart conditions increase your risk but don’t mean you necessarily will die.

An analogy may help some of you. It’s a bit like two cars in a race between the antibodies and the virus. Your body is producing antibodies to fight off the virus. The driver of the antibodies car may have a head start with youngsters, but then can spin off the road somewhere and the virus car takes over, just by chance. Vaccines fix the race in favour of the antibodies by stimulating your body to produce antibodies before it has even seen the virus.

In the case of COVID-19 then one significant factor is whether it gets established in the lower part of your lungs early on or not and that could be partly a matter of chance. I explain this just to help give a rough idea of why being young and fit doesn't make you invulnerable and being over 90, and with diabetes, say, isn't a death sentence. Each case is unique.

If he did get the severe version, and of course I very much hope he won’t, then he may get minor breathlessness in the second week. If he feels breathless after he leaves isolation he will need urgent medical care; he should see a doctor if he feels even slightly breathless.

If it takes a turn for the worst, he will soon need oxygen, then a ventilator. If he is one of the 1 in 100 or so at his age that die, then he continues to multi-organ failure and death. All this happens starting about the third week and serious cases can be on a ventilator for up to six weeks according to the WHO. They can still pull through but many die.

He will remain infectious all the way through to death if he dies - patients who die of COVID-19 are still shedding virus.

THE IMPERIAL COLLEGE LONDON STUDY

skip to: Example of Singapore shows genuine random community spread is rare

The Imperial College COVID-19 response team who advise the government say in the paper itself that their model was designed to model influenza originally. It is largely unchanged with minor modifications.

We modified an individual-based simulation model developed to support pandemic influenza planning to explore scenarios for COVID-19 in GB. The basic structure of the model remains as previously published. In brief,individuals reside in areas defined by high-resolution population density data. Contacts with other individuals in the population are made within the household, at school, in the workplace and in the wider community.

Paper Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand

Popular exposition here: 3 charts that helped change coronavirus policy in the UK and US

Much of my information about COVID-19 for this section comes from this report:

This is cite number 16 of the Imperial college paper. However, unlike most scientific papers, there are no inline citations. I don’t see anything in the paper that matches what the WHO-China report says about COVID-19.

In the Imperial College London model:

  • One third of transmission occurs in schools and workplaces.
  • One third of transmission occurs randomly in the community (depending on distance between people in the community)
  • One third occurs in the household

Here is where they say this:

We modified an individual-based simulation model developed to support pandemic influenza planning to explore scenarios for COVID-19 in GB

With the parameterization above, approximately one third of transmission occurs in the household, one third in schools and workplaces and the remaining third in the community. These contact patterns reproduce those reported in social mixing surveys

...

Transmission events occur through contacts made between susceptible and infectious individuals in either the household, workplace, school or randomly in the community, with the latter depending on spatial distance between contacts.

Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand

According to the big WHO-China joint report however

  • 78%-85% of transmission in Guandong and Sichuan province was within families (secondary attack rate 3-10%) - and this is typical of China.

In China, human-to-human transmission of the COVID-19 virus is largely occurring in families. … Among 344 clusters involving 1308 cases (out of a total 1836 cases reported) in Guangdong Province and Sichuan Province, most clusters (78%-85%) have occurred in families … preliminary studies ongoing in Guangdong estimate the secondary attack rate in households ranges from 3-10%. Report of the WHO-China Joint Mission

  • There is excellent data from Singapore, Hong Kong and China which shows that for their clusters at least, transmission randomly in the community doesn’t seem to be a significant factor.
  • There is transmission in workplaces but it usually involves close or very prolonged contact - you aren’t going to get it from sharing a lift with someone
  • Infections in schools were not a factor in Wuhan as the schools were closed for the Chinese New Year holiday, and the school holiday was extended during the lockdown.

    However they found no example of a child infecting an adult.

"The Joint Mission learned that infected children have largely been identified through contact tracing in households of adults.Of note,people interviewed by the Joint Mission Team could not recall episodes in which transmission occurred from a child to an adult." Report of the WHO-China Joint Mission
[the WHO continue to say they don’t know the answer when asked in recent press briefings]

  • COVID-19 is spread in hospitals, prisons care homes and since the report also in some religious gatherings (South Korea and Iran)
    - this is not modeled by them.

"There have been reports of COVID-19 transmission in prisons (Hubei, Shandong, and Zhejiang, China), hospitals (as above) and in a long-term living facility. The close proximity and contact among people in these settings and the potential for environmental contamination are important factors, which could amplify transmission."

Report of the WHO-China Joint Mission

This assumption of random transmission in the community might be one of the main reason for the difference in approach of the UK Government and the World Health Organization.

EXAMPLE OF SINGAPORE SHOWS THAT GENUINE RANDOM COMMUNITY TRANSMISSION IS RARE

skip to: Asymptomatic spread

This is about the assumption:

randomly in the community, with the latter depending on spatial distance between contacts.

There may be some genuine community transmission of COVID-19 between random people who are unconnected, not airborne but through them coughing on each other. However there is so little of this that nearly all the cases in Singapore are connected through traceable links to previous cases, or come from outside of Singapore:

With influenza this random transmission is often through short distance airborne transmission. This is possible for influenza viruses particularly in crowded enclosed spaces.

SARS was airborne and there was clear evidence from many cases.

But COVID-19 can't do that. The WHO have found no clear evidence for COVID19 - occasional reports that suggest it is get retracted as flaws are found in them. By now with SARS we would have had numerous clear evidence based studies proving it to be airborne as that became clear early on.

. This is where Dr Maria von Kerkhove who heads the WHO COVID-19 response team says that Covid-19 is not airborne and the latest advice of the WHO as of the science brief on 29th March continues to be that airborne precautions are only needed for certain medical procedures

See:

The random community spread figure, therefore, should be close to 0%. It is exactly 0% if that element is meant to model airborne spread.

You don't have to break every transmission chain to end an epidemic, just enough to reduce the numbers enough so that fewer are infected with each step of the transmission.

The difference between a third of it being community transmission, and close to 0% may seem minor, but if you are using contact tracing to stop an epidemic, this difference may be highly significant for projections and recommendations.

ASYMPTOMATIC SPREAD

skip to: Period of infectiousness

In the Imperial College model also

  • One third of cases are sufficiently asymptomatic that they will not know to self-isolate (if required to by policy)

Here is where they say these things:

We assume that symptomatic individuals are 50% more infectious than asymptomatic individual

We therefore assume that two-thirds of cases are sufficiently symptomatic to self-isolate (if required by policy) within 1 day of symptom onset, and a mean delay from onset of symptoms to hospitalisation of 5 days.

In the WHO - China report however,

  • Asymptomatic spreading was rare and was not a major driver of the spread

Asymptomatic infection has been reported, but the majority of the relatively rare cases who are asymptomatic on the date of identification/report went on to develop disease. The proportion of truly asymptomatic infections is unclear but appears to be relatively rare and does not appear to be a major driver of transmission

If a third of the cases were asymptomatic with 50% of the infectivity of the symptomatic cases, this would surely have been noticed in Singapore and elsewhere.

About the only way to model this data with large numbers of asymptomatic cases would be if they have close to 0% of the infectivity of the symptomatic cases. Such cases only be detected later with serological surveys since they don't infect anyone else and so won't show up again as seeds for new clusters even with community wide monitoring such as we have in Singapore.

To take an example, it is possible that large numbers of school children are infected, but the symptoms are so mild they don't infect anyone else, even other school children. This would lead to a larger iceberg of asymptomatic cases but would be of no consequence as regards strategies for controlling the pandemic. .

PERIOD OF INFECTIOUSNESS

skip to: COVID-19 transmission data from South Korea

They have various other parameters that again don't seem to match known figures for COVID-19 but instead are based on previous experience with influenza.

  • Incubation period 5.1 days
  • Symptomatic cases are infectious from 12 hours before onset of symptoms to 7 days after onset of symptoms.
  • Asymptomatic cases are infectious from 4.6 days after infection

According to the WHO

  • Cases are infectious from 1–2 days before symptoms start through to 14 days after patients recover.

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. Visitors should not be allowed until the end of this period. There are more details in WHO's guidance.

WHO Emergencies Press Conference on coronavirus disease outbreak - 20 March 2020.

COVID-19 TRANSMISSION DATA FROM SOUTH KOREA

skip to: Recommendations based on this fictional flu hypothesis

There are two forms of transmission that seem to be driving the spread. There is prolonged contact and there is brief but close contact. In both cases the main thing is the people concerned know each other, so you can do the contact tracing.

For example in South Korea with nearly 9000 cases in their bulletin as of 22nd March they say that epidemiological links have been found for 80.9% of the cases. That leaves 19.1% of the cases either under investigation or sporadic cases. Some of the ones where no contacts have been traced may turn out to just be untraced contacts of the new cases.

Individual provinces have values there varying up to 93.3% with epidemiological links for Chungnam - that's 112 out of 120 cases there that have epidemiological links South Korea is now down to 64 new cases, and 14 of those 64 are imported cases so only 50 new domestic cases on 22nd March.

I don't see how their theory can even begin to model what is happening in South Korea. You can't do it by supposing a vast iceberg of undetected infectious asymptomatic cases because they would infect someone with the more serious disease and these would show up as large numbers of people with no epidemiological links because they got it from someone who was asymptomatic. Also anyone who suspects they might have COVID-19 can go into their local screening center in South Korea and get tested.

Any person who suspect[s] onset of COVID-19 symptoms are advised to call the KCDC call center (1339) or local call centers (area code + 120), ask a local public health center, or visit a screening facility, before visiting a regular healthcare provider directly. All persons who visit a screening center should arrive wearing a mask and in their own car if possible, and disclose their international travel history to the healthcare professionals.

The updates on COVID-19 in Korea as of 23 March (KCDC)

All this would be impossible with flu.

All these differences are why quarantine doesn't work by itself in their model, using their fictional disease - while in South Korea, Singapore, China etc, they are containing it with mainly quarantine and contact tracing.

They don’t model contact tracing and isolation of contacts, or isolation of individuals within a household, just quarantine of entire households which is not a strategy used by China because it would increase the household transmission rate.

Instead the objective was to isolate individual patients from other members of the household who don’t have COVID-19. Sometimes this was done at home but often they made make-shift new wards in stadiums and similar places for the mild cases as a way to isolate them.

Again this is not an intervention they modeled.

The contact tracing is part of the solution to end this. The WHO recommends that everyone does contact tracing. If they want to investigate this in a model they should model contact tracing and see how effective it is. The countries that do comprehensive contact tracing have had most success in stopping the spread.

RECOMENDATIONS BASED ON THIS FICTIONAL FLU HYPOTHESIS

skip to: Some of the main issues with the UK approach

All of this has a major effect on their recommendations.

In their model the physical separation is just to slow down the spread. In the WHO recommendations, it is to break the chains of contact. The recommendations that our government is using come from the Imperial College paper:

With the second intervention where all household members stay at home for 14 days - notice that they comment in the recommendation itself that household contacts double.

In the guidance from the UK government they write:

it is likely that people living within a household will infect each other or be infected already. Staying at home for 14 days will greatly reduce the overall amount of infection the household could pass on to others in the community

Stay at home: guidance for households with possible coronavirus (COVID-19) infection

However though this is true for ‘flu, it is not true for COVID-19.

Household transmission studies are currently underway, but preliminary studies ongoing in Guangdong estimate the secondary attack rate in households ranges from 3-10%.

Between 1% and 5% of contacts were subsequently laboratory confirmed cases of COVID-19, depending on location .

Report of the WHO-China Joint Mission

So, between 3 and 10% of members in the same household get it, and between 1 and 5% of other close contacts.

Telling members of the same household to stay together indoors in a closed environment for 14 days seems likely to increase that secondary attack rate in households, though how far it would go above 10%, I doubt if anyone could model based on the data so far.

This is one of the main items of concern here I think - they may find that their policy is actually increasing the spread of COVID-19 because of their assumption that people in the same household have already infected each other.

This disease already doubles in numbers every 3–4 days and we don’t want to increase that.

Then look at the social distancing of the 70+ year olds. It increases household contacts by 25%. The other factor of contacts in the work place reduced by 75% is not going to do much. The reduction of the other contacts by 75% can help if they avoid things like family gatherings, religious events, visitors to old people’s homes etc.

But an increase in household contacts by 25% again increases the risk that the 70+ year olds get it from family members.

Also, the worst thing here is that their policies are likely to increase the spread to hospitals, because they are not identifying people as having COVID-19 if they get only the mild version.

The UK does have the ability to follow the WHO recommendation because it is what it did until they decided to change to this "delay" phase

SOME OF THE MAIN ISSUES WITH THE UK APPROACH

skip to: Letter to PM

  1. The WHO approach has been proven to work by cutting just about all the transmission chains. The UK government approach is not attempting to contain and stop the disease. Instead of attempting to stop the disease they are attempting to delay the increase.
  2. The UK government approach is confining families together on the assumption that they are already infected. With COVID-19 they most likely most are not yet, so this seems likely to increase the transmission.
  3. The UK approach does not adequately protect health workers and hospitals which were significant factors in some of the clusters. This endangers front-line health workers and vulnerable patients.

    It is also a major route for transmission of COVID-19 from hospitals back to the community, including transmission to vulnerable communities such as care homes (20% or more of elderly people with comorbidities may die) and to communities where spread is likely to be rapid such as our overcrowded prisons.

    The same also applies to our GPs and nurses in the community - midwives, social workers, etc. There is no testing to see if they have COVID-19 and after 7 days of self isolation if they have a cough or fever they will think it is safe to return to work, when it isn’t if they have COVID-19
  4. The UK approach means that people from the UK who have COVID-19 are a source of infection for the rest of the world.

They have not explained to us why we should be basing our policy on this hypothetical disease instead of the evidence based science of the WHO.

We already have our first cases in care homes tested positive for COVID 19

As far as I know most people in the UK are not aware that the UK has a different approach from the WHO.

The WHO say this with every recent press briefing.

WHO continues to recommend that isolating, testing and treating every suspected case, and tracing every contact, must be the backbone of the response in every country. This is the best hope of preventing widespread community transmission.WHO Director-General's opening remarks at the media briefing on COVID-19 - 18 March 2020

When the WHO declared COVID-19 a pandemic, Dr Tedros, Director General of the WHO said:

We are convinced that, although this is the first coronavirus to be labeled as pandemic proportion, at the same time we believe it will be the first also to be able to be contained or controlled.

Transcript for WHO Emergencies COVID-19 Press Conference, 11th March 2020

The WHO were responsible for overseeing the eradication of smallpox, also eradicating malaria from many countries and near eradication of polio. They have stopped many outbreaks of Ebola including one in the Congo that has been successfully stopped with no new cases now for a month. They respond to 200 or more epidemics every year. These people are absolute experts on this topic.

I think the UK people and the UK government need to be told clearly that their policy is based on a hypothetical variant of flu, that the WHO recommendations are based on measures that have been proven to work for COVID-19 and given the reasoning of the Imperial College team for why we should follow their approach instead of the approach of the WHO.

I think we also need to hear what the WHO recommend for the UK.

I think we should have a proper debate - but with no delay. This has to be resolved quickly because if the Imperial College approach is mistaken, every day of delay not only costs lives but greatly increases the difficulty of ending the epidemic in the UK.

Every day of delay also greatly increases the difficulty of ending the UK’s position as a source of infection for COVID-19 in the world, and not only that it increases the risk and difficulty in dealing with this pandemic for the rest of the world, especially those with weaker health care systems and countries with vulnerable populations such as malnourished children in refugee camps and people with AIDS in sub Saharan Africa.

If this is the wrong direction that the UK is headed on, we have no time for the luxury of experiment. We must stop this right NOW.

LETTER TO THE PRIME MINISTER BORIS JOHNSON

skip to: So what should we do?

I sent this letter to Boris Johnson

Screenshot

Dear Prime Minister,

The WHO say we have a precious second window of opportunity to win against the COVID-19 pandemic. But as Italian scientists said, "the virus is very fast and really lethal. Every minute is exceptionally important as it means saving lives."

I am asking with great urgency for a public evidence based science debate with WHO experts on the basis for your COVID-19 policies. They differ from WHO recommendations radically putting not only us but other countries at risk from COVID-19.

They are based on a fictional flu pandemic, but the real virus is most unusual and different from flu, a rare type of respiratory virus that can be contained and stopped

The WHO say there is a precious second opportunity. With the country in lock down we can go after the virus in the community, find it, contain it and stop it.

It will take a massive scale up in contact tracing. However the legendary British fighting spirit can rise to this challenge.

Yours sincerely

Robert Walker

Dear Boris Johnson - UK's Policy On Covid-19 Needs Evidence Based Science Debate - We Must Not Delay - Every Minute Saves Lives

This is what Italian professors wrote to the rest of the EU on the 12th March:

In just 3 weeks from the beginning of the outbreak, the virus has reached more than 10.000 infected people.

...

If Italy had strongly acted just 10 days ago, and that is more or less where you are now, there would have been much fewer deaths and economic tumble.

South Korea and China should be taken as the example to follow to stop this epidemic. There is no other way.

So please, make your best effort to urge your government to act now! Time is our common enemy as the virus is very fast and really lethal.

Every minute is exceptionally important as it means saving lives. Don’t waste it!

Take care.

Open letter to the scientific community (click through to see the letter, signed by many professors)

SO WHAT SHOULD WE DO?

skip to: Precious second window of opportunity

We urgently have to update our guidance.

For example, Boris Johnson is isolating at home for 7 days. If he follows the WHO recommendations instead of the recommendations of Dr Whitty, he should be quarantined until he gets over his symptoms and for an additional 14 days after he feels completely better.

If he follows the WHO recommendations, they should trace all his contacts since he got infected - the previous few days (Singapore go back to 14 days before infection) - anyone he had lunch with, talked to at close quarters etc and they should all self isolate for the 14 days. For most people this means 20- 30 people need to self isolate for 14 days

I would imagine most of his cabinet need to self isolate with the WHO guidance - the reason for doing this is that people are infectious for two days before they develop symptoms. Only 2 of those 20 contacts on average got COVID-19 from him, but they will be infecting others before they develop symptoms.

It is the same for Neil Fergusson, the lead author of the Imperial College study. The Guardian reports that he saw many people before he developed symptoms. For instance he or Boris Johnson could have got it off each other. He also says many of his academic collegues in other universities are showing symptoms so it is also spreading in universities (which often have elderly academics in them). Then he also has had many interviews so could the press and the BBC have got it from him?

“I’ve been in so many meetings in the last few weeks, and a number of my colleagues from other universities who have been advising the government in those meetings have also developed symptoms.”
...

“I have to say central London is the hotspot in the UK at the moment. There almost certainly are thousands of cases in central London, so it’s not that surprising. I’ve been in lots of meetings and contacting lots of people,”

...
“We think there’s infectiousness for about a day before symptoms, and I was actually at a Downing Street press conference that day. I mean there is a slight risk I may have infected someone but that probably is quite slight.”

The WHO say that it is infectious two days before symptoms onset. That's three groups of people he may have infected - BBC staff, colleagues at other universities, and politicians.

If the UK was doing contact tracing they would all be traced and told to self isolate for two weeks to see if they got symptoms. But instead they are continuing their normal activities and some may be unaware that they are a possible contact of him.

They should rapidly increase testing far more than they are at present. They have nowhere near the testing capacity that is going to be needed to control this outbreak.

They should prioritize hospitals and care homes first and GPs and as soon as possible test every single hospital, all the staff and patients in every hospital.

They have created a huge problem for themselves as there are1.2 m illion full time staff working in the NHS and by now, after two weeks of spreading through our health system unchecked, any of these could have COVID-19 and be passing it on to their patients they treat.

Any of those with symptoms have to be tested urgently, and quarantined if they have it (or maybe the mild cases can treat patients who already have COVID-19??). Then what do you do about their contacts who are also in the NHS workforce and may infect others before they develop symptoms?

They are bound to find hospitals with major outbreaks by now. But they don't know, and it's spreading to the patients and from patients back to their community when they return home or through out patients, also emergency response teams etc.

They are prioritizing testing to those who care for patients in intensive care. That is right but they are only going to test a few hundred this weekend. They need to test thousands with utmost urgency.

Currently, about 6,000 people are tested daily. But by the end of March it wants to test 10,000 people a day, rising to 25,000 by mid-April.

Can I get tested for coronavirus?

It is not impossible to scale up to much larger numbers of tests per day. The Roche Diagnostics cobas 8800 can test 2,500 samples a day.

The widely available Roche’s cobas 6800/8800 Systems, which are used to perform the cobas SARS-CoV-2 Test, provide test results in three and half hours and offer improved operating efficiency, flexibility, and fastest time-to-results with the highest throughput providing up to 96 results in about three hours and a total of 384 results for the cobas 6800 System and 960 results for the cobas 8800 System in 8 hours. The test can be run simultaneously with other assays provided by Roche for use on the cobas 6800/8800 Systems.
Roche’s cobas SARS-CoV-2 Test to detect novel coronavirus receives FDA Emergency Use Authorization and is available in markets accepting the CE mark

This means the 6800 can do over 1000 tests a day. The 8800 can do over 2500 a day. For an example: St. Paul’s Hospital adds automated testing system to COVID-19 fight

A thousand of those cobas 8800s would test 2.5 million samples a day. I think it is so serious we should urgently figure out how to help them increase manufacture to produce thousands of those machines for the world. No expense spared.

As of writing on 27th March, the UK has 14,543 confirmed cases, with 2,975 new cases identified yesterday.

Most of those required at least one day hospitalization of the ones detected since 11th March when we had 460 cases. About 20% need hospitalization. So there probably are four times as many not yet tested, or about 56,000 mild cases.

At our current rate of 6,000 tests a day and 3000 a day needed for the new cases it leaves only 3000 a day to try to find those 56,000 mild cases. But that 3000 yesterday of hospitalized cases (mainly) probably means 12,000 yesterday of new mild cases. So even at 10,000 a day they won’t be able to keep up with the mild cases never mind deal with the backlog.

It is a massive problem now for the UK. But if they don't get onto this fast it is going to be just AWFUL.

No other country has let COVID-19 spread unchecked in its health care system - it's going to be far worse than Italy

In Italy, nearly 5000 health care workers have got the virus as of March 20th. As of writing this, 73 Italian doctors have died so far. That includes 20 GPs, and 4 dentists, amongst others. You can read the list here with Google Translate (continually updated).

We don’t even know how many of our health care workers have got the virus, but surely far more than for Italy.

The deaths will most of them happen in early April or late March. We haven't seen them yet. Next week we will start to have vast numbers on ventilators - and they don't know how many. We likely won't be able to find enough ventilators for everyone.

20 to 50% of staff in some London hospitals are off sick or self isolating because someone else in their household is off sick.

If this spreads to 50% of NHS staff then we will have over 1000 doctors and getting on for 1000 nurses die of this and thousands of doctors and nurses on ventilators and likely tens of thousands hospitalized.

It has also spread unchecked in our care homes for two weeks now. They have to test all patients in care homes with utmost urgency - if it spreads throughout a care home then a fifth or more may die. We already know it is in two homes, one in Shetland and one in East Sussex.

* Care home residents test positive for Covid-19 - The Shetland Times (Care home residents test positive for Covid-19 - The Shetland Times)

* Is the NHS ready for the surge in coronavirus cases? (Is the NHS ready for the surge in coronavirus cases?)

This will all be obvious to everyone by this time next week but so far, few are aware how bad it has got.

PRECIOUS SECOND WINDOW OF OPPORTUNITY

skip to: Contact tracing has to be methodical and thorough

The WHO call this a second precious window of opportunity. Dr Mike Ryan put it like this.

All that we get from movement restrictions and people staying at home and all of these measures; we buy some time, we take the heat out of the epidemic or the pandemic, we buy some time.

But we may then need to find strategies and tactics that get us to move forward and we have to make those decisions.

Each government will have to make those decisions. We're working hard to provide advice to governments on how to do that but very, very clearly in order to move forward a scale-up - and I mean a massive scale-up - in public health capacities to do case finding, isolation, quarantine of contacts and being able to go after the virus rather than the virus coming after us, is one of the key ways we can move forward and we'll be coming back to governments and in public around our advice on this to governments.

There is a very, very precious window now in which we can prepare to do that.

WHO - on Netherlands and UK - precious second window of opportunity to chase after the virus with case finding and contact tracing

As he says, it requires a massive scale up, but it is not impossible, countries are innovating and rising to the challenge. South Korea traced over 300,000 contacts of over 8000 people. China at its height traced all the contacts of more than 70,000 people. Singapore has released an app that they use for automatic proximity sensing via bluetoooth for later contact tracing.

Anyone can do this tracing; they don't have to be health workers. The more the UK delays the larger the operation will be to trace them all and civil servants and voluntary organizations will be needed in vast numbers for the operation, and software and databases to co-ordinate it all but we can do it. We have to try, it's the only way to save thousands of lives.

CONTACT TRACING HAS TO BE METHODICAL AND THOROUGH

skip to: You can protect yourself

The Chinese did that very thoroughly and methodically. They also did it in Singapore, and South Korea. With Italy I am not sure how thoroughly they are doing it - it is the most important part of the whole thing. It seems some areas are doing it more thoroughly than others. It is not the same as just isolating everyone in the same building. This virus is not airborne and others in the building are not at risk unless they are close or prolonged contacts with the patient with COVID-19.

It means that e.g. if they were staying over with a friend for a couple of nights - you phone up that friend and get them to self isolate, if they had an evening out with another friend you contact them and so on. It is straightforward stuff. Anyone can do it. Civil servants or volunteers can do it. You can re-use civil servants from other branches of government or local community organizations. You don't need to have any experience as health workers to do this.

But you have to be organized and methodical and thorough about it. This is not so hard with a dozen cases, but it gets much harder as it scales up unless you have good tools to track them all.

This process has to be very organized to keep track of, say, 100,000 contacts. Not just find them all, also to keep in touch with them all and get them tested as needed and retested. This was something the Chinese did with large databases and software and the West can learn from them how they achieved the co-ordination to get it working. Countries should be looking into how to do this before their outbreak starts.

One of the papers that may have influenced SAGE in their decision was "The Efficacy of Contact Tracing for the Containment of the 2019 Novel Coronavirus (COVID-19)."

This is one of the resource papers listed here: Scientific Advisory Group for Emergencies (SAGE): Coronavirus (COVID-19) response

They define "close contact" as being within 2 meters for 15 minutes or more
They then estimate that there would be an average of 36 individuals (between 0 and 182) to trace per contact and they say this is logistically challenging.

For contact tracing to be an effective public health measure requires secondary cases to be discovered before they become infectious; hence the time from the primary case becoming infectious to the tracing of their contacts needs to be shorter than the incubation period.

... Therefore, while contact tracing has the potential to control COVID-19 (and other close-contact pathogens) the ultimate success relies on the speed and efficacy with which suspect contacts can be contained.

"The Efficacy of Contact Tracing for the Containment of the 2019 Novel Coronavirus (COVID-19).

However - for COVID-19 then those infected remain infectious to others for a long time, through to two weeks after they have recovered from even mild symptoms. So, no, you don't have to find them before they become infectious to have a significant impact. The contact tracers look for all of a patient's contacts back to 14 days before the onset of symptoms if they don't know when an individual was infected.

The numbers that need to be traced are not far off, Singapore traced 6000 contacts for their first 243 cases which works out at 25 contacts per case, see:

Coronavirus: The detectives racing to contain the virus in Singapore

Singapore has released a new app which uses bluetooth to help keep track of who you are in proximity with automatically. This helps speed up contact tracing if you test positive.

Help speed up contact tracing with TraceTogether

South Korea has tested 300,000 people for 8,413 cases as of 18th March. Not all of those would be contacts but that makes a ratio of 36 tests to each case.

South Korea is reporting intimate details of COVID-19 cases: has it helped?

The Chinese though are the ones to trace most people so far. At the height of their epidemic they were tracing all the contacts of 70,000 people. Dr Bruce Aylward talks about it here (joint lead of the WHO-China joint mission)

17:02 When it came to the response they had to manage massive amounts of data massive numbers of contacts because remember they're trying to find every case trace every contact of 70,000 cases across vast areas and know where they were follow that up so you manage all of that data and then you've got to be able to map that to other sources of data etc

20:01 finding and contact tracing - they did this in an extraordinary way with an extraordinary rigor of application and discipline and differentiated approach incredible collective action repurpose the machinery of government to make it work technologically powered and science driven and they applied that then to what was an escalating remember the exponential growth of the disease that you were seeing and remember every place that's hitting these days you're seeing exponential growth again ... we've got to tackle super fast to prevent a pandemic ... actually what China demonstrates is where this goes is within the control of our decisions to apply this kind of rigor and approach to to to this disease

It is a major challenge, sure. But nations are rising to it,and it being a challenge is not a reason to give up. It is a reason to innovate and rise to the challenge.

YOU CAN PROTECT YOURSELF

Meanwhile, a reminder again, you can do a lot to protect yourself with simple effective measures. If you are in the UK and aren’t doing these yet, I recommend starting on them right away. Our government hasn't explained this clearly enough - at least most that I talk to via private messaging in the UK who contact me scared of COVID-19 do not fully understand the importance of this when they first contact me. It is a bit like people not bothering to wear seat belts in cars before "Clunk click Every Trip".

Do you do these four things?

  1. Wash hands thoroughly
  2. Stay 1-2 meters from anyone coughing.
  3. Wash your hands before you touch your eyes, nose or mouth [try to get out of the habit of touching your face in the day]
  4. Cough or sneeze into your elbow OR cough or sneeze into a tissue and put it into a bin immediately.

Do this as thoroughly as the experts, and you can say:

"I don't have COVID-19 - I am very low risk".

Dr Bruce Aylward said that immediately after he returned from Wuhan. He knew he was safe because he did those things.

The WHO stress that these simple measures save lives. They are not hard to do if you make them into a habit. More details here:

We all need to carefully follow the instructions to protect ourselves and your loved ones and tell everyone else about what they need to do to stay safe. These instructions work. You also help others too, every time you do this you are also helping to break the transmission chain to others

SEE ALSO

skip to Do comment and share

See also my

Then there's the previous article about the Imperial College study, which has some extra sections

UK's Coronavirus Advice Is Based On A Fictional Influenza Pandemic NOT Recommendations Of WHO And Real World Data For COVID-19

Sections for PREVIOUS article (to make it easier to jump direct to a section that interests you)

DO COMMENT AND SHARE

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I hope that by writing this article I have helped to communicate the findings of the experts on COVID-19 and help spread awareness of why it is that the WHO say this can be controlled, and how they say we should do it.

Do comment with your thoughts on this.

Also do share with others you know including experts and politicians. This needs to be discussed widely and openly in the larger scientific community and in our political establishments.

Also please say if you spot any mistakes in this article however minor and I will fix them. Thanks!

If anyone reading this is an expert on any of this and notices anything I got wrong here, or have anything to add or correct please say in comments. And do share your thoughts on this. Thanks!

This is based on sections of my larger article here:

For the latest WHO press briefings go to

Press briefings

There is still much we can do and great hope. See

See also my