UK Is Resolute About Tackling COVID-19 But Ignores WHO Advice - Is This Why? Driven By Simulated Flu Pandemic Not Real Data

Few of us in the UK even know that the UK government is ignoring WHO's advice. Allyson M Pollock, professor of public health at Newcastle university is the lead author of a recent paper in the British Medical Journal: Covid-19: why is the UK government ignoring WHO’s advice?.

The authors say that

Case finding, contact tracing and testing, and strict quarantine are the classic tools in public health to control infectious diseases. WHO says they have been painstakingly adopted in China, with a high percentage of identified close contacts completing medical observation. In Singapore, Vietnam, and South Korea meticulous contact tracing combined with clinical observation plus testing were vital in containing the disease ....

The reasons why tracing was stopped, against WHO recommendations, have not been published. It seems to be connected to a shift from “contain” to “delay” in the government’s action plan, when contact tracing was replaced rather than supplemented with other control measures.

Covid-19: why is the UK government ignoring WHO’s advice?.

Skip to: Why the UK government is ignoring the WHO's advice (or to Contents)

Our policy is derived from table 2 of a paper about effective interventions to delay a simulated flu pandemic. The main problem is that COVID-19 is a most unusual respiratory disease, our first pandemic caused by a novel coronavirus, not flu.

Text: UK stands resolute on COVID-19 but policy comes from table for a SIMULATED flu pandemic with almost no input from not real world data

See Why the UK government is ignoring the WHO's advice.(below) and following.

There is no doubt about UK's resolve and commitment to fight COVID-19. I go into this more in the section: UK Government is resolute about tackling COVID-19 (below)

But why are we ignoring the WHO's advice on how to tackle this crisis?

If you are in the UK you may not be aware of what the WHO's advice is. See What is the WHO advice? (below).

If the WHO is right about this, then returning to the WHO recommendations even one day sooner may save thousands of lives. We may also be able to exit the lockdown sooner in a more controlled way if we have the right measures in place first. See Exiting from a lockdown (below)

I propose an urgent data driven public examination of the scientific evidence base to understand why our policy is so different from the WHO and try to establish what our priorities are now during the lockdown. See Public evidence based science debate on basis of UK policy (below)

Before I go any further I need to say a few words to my most scared readers. I spend much of my time as an admin of the Facebook Doomsday Debunked group, helping people scared of many things, in this case COVID-19. I know some of my readers will be scared of COVID-19, depressed, anxious, some will be having panic attacks right now, and some will be suicidal.

The main thing you need to know is that you can protect yourself and your loved ones. The WHO run safe. They sent some of their top experts to China, to the worst outbreak areas and to Wuhan at the height of an outbreak and these experts don't have COVID-19. You can keep yourself safe from this disease too. See: Reassuring scared readers (below) and then back here to continue reading. You may also like to read some of my other articles in the See also section below including some of my articles with summaries, embedded video, and their transcripts for some of the key WHO press briefings.

Skip to next section: Why the UK government is ignoring the WHO's advice

WHY THE UK GOVERNMENT IS IGNORING THE WHO’S ADVICE

skip to: What is the WHO advice? (or to: Contents)

The reasons why tracing was stopped, against WHO recommendations, have not been published. It seems to be connected to a shift from “contain” to “delay” in the government’s action plan, when contact tracing was replaced rather than supplemented with other control measures.

Covid-19: why is the UK government ignoring WHO’s advice?.

I think that is all that happened, the government moved from following the WHO advice to following the policy outlined in this paper by the Imperial college team. Since this new policy didn't have testing, case isolation (separated from the household) or contact tracing then they stopped doing it.

So, why doesn't the new policy have those measures? It is based on a simulated flu pandemic.

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. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand The earlier paper is here: Strategies for mitigating an influenza pandemic [Imperial college model]

Without any delay they find that there are 510,000 deaths because of the way critical bed capacity is overwhelmed. "Flattening of the peak" lowers that to 250,000 deaths because more patients can get proper critical care.

When Allyson et al say that the mathematical model shows that contact tracing is effective - she means that if you compare the deaths in the countries that have successfully applied the policies recommended by the WHO with the theoretical predictions of the UK policy document then you can see how effective they are.

The mathematical model used by the UK government clearly shows that rigorous contact tracing and case finding is effective: the prediction of 250 000 deaths was predicated on what would happen without contact tracing.

Covid-19: why is the UK government ignoring WHO’s advice?.

But if you examine this internally to the model, using the simulated flu ,that's a different situation. Testing, case finding, isolation, contact tracing and quarantine would not be nearly as effective for this simulated flu as they have proved to be for the real world disease. The reason is that their simulated flu is mostly infectious immediately before and on the day of symptoms, and even case isolation on the first day that the patient notices symptoms has a relatively small effect.

Here the Imperial college team in an earlier paper talk about isolating a case from the rest of the household, not isolating households from the community. This is the policy the WHO recommend for COVID-19.

Like treatment, rapid case isolation reduces the infectiousness of the targeted individual and can have a similar or greater impact —reducing cumulative attack rates from 34% to 27% for R0 = 2.0 if 90% of cases are isolated. Strategies for mitigating an influenza pandemic [Imperial college model]

There from the previous paragraph in that same paper, by rapid case isolation they mean isolation on the day of onset of symptoms.

This does have an impact - but they are talking there about isolating immediately as soon as they notice symptoms ,which is not easy to do. Even then the cumulative attack rates of their simulated flu pandemic reduce only from 34% to 27%. They don't discuss contact tracing.

With the real world disease, however, it is clear from the experiences of China, Singapore, South Korea, and now Italy and Spain that case isolation, including isolating from the rest of the household, has a large effect especially combined with contact tracing and quarantine. This is because it's a different disease.

The infectious period of COVID-19 is much longer than for the simulated flu pandemic, through to death or two two weeks after symptoms disappear (including the cough). SARS is similar, it's infectious through to three weeks after onset of symptoms.

The virus that causes COVID-19 is also infectious for some people several days before onset of symptoms, and contact tracing helps you catch the disease in those presymptomatic stages. None of this can be modeled by them.

I cover all this below in more detail under: Isolation policies

I think this is all that happened. The UK government moved from a policy guided by the WHO recommendations to a policy guided by the recommendations of this paper based on a model of a simulated flu pandemic.

The paper doesn't recommend case isolating or contact tracing, so, the UK government stopped doing it. The paper recommends a much shorter isolation period of 7 days if on your own, and a different way of treating cases found in households (isolate them all, together, for 14 days). All that makes sense for the simulated flu which has a much shorter infectious period. The UK government changed those policies accordingly too.

This paper does cite the joint WHO-China report, but only one cite and they don't use its data to modify the model.

Text: UK paper cites WHO-China report but doesn’t use its data

In all this, there were no political motives as far as I can see. Boris Johnson followed the advice of his chief medical officer who was advised by the Scientific Advisory Group for Emergencies who in turn were influenced by the modelers. The modelers in turn were supremely confident in their model, as is often the case for modelers. They were all doing their best, and I see no sign of anyone doing anything improper here. It's more an issue with the framework or system than any individual. See UK Government is resolute about tackling COVID-19

There doesn't seem any point in trying to assign blame. There may be things to examine later on about how this could happen, and to prevent it happening in the future, but for now the priority is, what do we do next?

If the real life disease had been the same as their simulated flu this would have been the only way to tackle it. And we'd get through it. But if the WHO are right, we can do so much better than that.

WHAT IS THE WHO ADVICE IN DETAIL?

skip to: Data assumptions compared to real world data - Summary (or to: Contents)

Many in the UK may not know what the WHO recommendations are, or may have forgotten them, so here is a brief summary, with links to the technical details of their recommendations:

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:

Critical preparedness, readiness and response actions for COVID-19

The details for contact tracing are here:

Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19)

DATA ASSUMPTIONS FOR THE MODEL COMPARED TO REAL WORLD DATA - SUMMARY

skip to: Policy of the UK (or to: Contents)

This graphic summarizes some of the main data differences between the Imperial College team's simulated flu pandemic and COVID-19, which has lead to our first pandemic by a novel coronavirus.

Key differences between UK simulated flu and reality

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
For details: skip to: Airborne (below)

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
For details: skip to: third of transmission in each of community, schools and workplaces, and at home

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: skip to: Asymptomatic spread

I will discuss the differences between the assumptions about the simulated flu that were input into the Imperial College model, and the real world data next, but first I’d like to focus on the policy differences between the recommendations in the paper and the WHO advice.

Here is a summary of the main policy differences:

This has had a huge effect on our policy

UK policy compared with WHO recommendations

WHO: COVID19 can be stopped ✔
UK: COVID19 can’t be stopped but it can be delayed X
skip to: Impact on contact tracing and stopping the virus

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

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
skip to: isolation policies

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
skip to: Isolation periods
skip to: Impact on contact tracing

POLICY FOR THE UK - TABLE 2 OF IMPERIAL COLLEGE PAPER

skip to: isolation policies (or to: Contents)

Here is the table from the paper again::

Text: CI: Case isolation in the home

Symptomatic cases stay at home for 7 days, reducing non-household contacts by 75% for this period. Household contacts remain unchanged. Assume 70% of household comply with the policy.

HQ: Voluntary home quarantine

Following identification of a symptomatic case in the household, all household members remain at home for 14 days. Household contact rates double during this quarantine period, contacts in the community reduce by 75%. Assume 50% of household comply with the policy.

SDO: Social distancing of those over 70 years of age

Reduce contacts by 50% in workplaces, increase household contacts by 25% and reduce other contacts by 75%. Assume 75% compliance with policy.

SD: Social distancing of entire population

All households reduce contact outside household, school or workplace by 75%. School contact rates unchanged, workplace contact rates reduced by 25%. Household contact rates assumed to increase by 25%.

PC: Closure of schools and universities

Closure of all schools, 25% of universities remain open. Household contact rates for student families increase by 50% during closure. Contacts in the community increase by 25% during closure

The table is from here: Imperial college study

Our country has adopted all of those measures now, including the closure of schools and many universities and other physical distancing measures. They have also gone further than this now, and banned all public meetings of more than two people, shut down all non essential shops and closed many businesses.

UK PAPER ISOLATION POLICIES COMPARED WITH WHO ADVICE

skip to: Household Isolation (or to: Contents)

I will be focusing on the first two policies, CI: Case isolation in the home and HQ: Voluntary home quarantine. These are perhaps the most significant difference between UK policy and WHO recommendations - the isolation policies and periods

Case isolation in the home

Symptomatic cases stay at home for 7 days, reducing non-household contacts by 75% for this period. Household contacts remain unchanged. Assume 70% of household comply with the policy.

Voluntary home quarantine

Following identification of a symptomatic case in the household, all household members remain at home for 14 days. Household contact rates double during this quarantine period, contacts in the community reduce by 75%. Assume 50% of household comply with the policy.

Imperial college study

The most striking thing here is that the voluntary home quarantine is assumed to increase contact between the COVID-19 case in the household and the rest of the household. As we will see the core of the WHO recommendations is that cases found in households should be isolated from the rest of the household as soon as possible, preferably in a hospital or a temporary ward and only in the home after inspection by a clinician and advice to the family about how to conduct this case isolation safely.

Their previous paper puts it like this:

50% of households are assumed to comply with the policy, and in these, external contact rates are reduced by 75% and within-household contact rates assumed to increase by 100%

Strategies for mitigating an influenza pandemic

The reasoning behind this policy is that this will reduce the number infected in the community. As for members of the household, as we have already seen, they assume that most of the susceptible people are infected immediately before or during the first day of symptoms. This makes it almost impossible to isolate a case of their simulated flu within a household but practical to isolate a household from the community. They have some discussion of the ethics of this which we will come to in the next section: Household Isolation

According to the WHO-China joint report however the secondary attack rate within families is only 3–10%, i.e. you have only a 10% or less chance of being infected by another contact in the same family.

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

Nevertheless, 78% to 85% of the transmission in China did occur in families, making it one of the main drivers of the spread.

It does not mean that most of the people in a household got it however. That does happen sometimes but the 10% attack rate makes it rare. With many cases of COVID-19 within a household, nobody else gets it (balanced by a few cases where nearly everyone gets it). Anecdotally we often get stories in the media about partners where one of them got it and their partner didn’t.

With case isolation, contact tracing and quarantine of contacts, almost nobody transmits it on to anyone else. This is especially clear for Singapore where you can explore all the cases in a large tree here, which was kept up to date through to March 21st 2020.

COVID-19 cases in Singapore

I discuss it here

Yes Your Country Can Stop COVID-19 - Singapore Shows How

So though household spread drove the epidemic in China, the secondary attack rate was low.

This is why isolation of infected individuals from the rest of their family is a top priority for the WHO recommendations, and one of the most effective intervention measures to stop COVID-19.

With the current UK policy all households are isolating together as a household, whether or not they have a suspect case, enforced by law and police action. So near total compliance of their HQ policy is likely - the few that aren’t already isolating as a household anyway are essential workers, including health care workers, who are surely also likely to comply to the policy to remain isolated together with an infected case through to 14 days from the onset of their symptoms.

In their model this doesn’t matter because of the assumption that everyone who is susceptible to infection will get it early on in the first day of symptoms or before symptoms of the index case in the household.

HOUSEHOLD ISOLATION

skip to: Isolation periods (or to: Contents)

The earlier paper that goes into more detail about the Imperial college model says that nearly all the infection happens in the first day after symptoms

Like treatment, rapid case isolation reduces the infectiousness of the targeted individual and can have a similar or greater impact —reducing cumulative attack rates from 34% to 27% for R0 = 2.0 if 90% of cases are isolated. Strategies for mitigating an influenza pandemic [Imperial college model]

There from the previous paragraph in that same paper, by rapid case isolation they mean isolation on the day of onset of symptoms.

The UK government says that if you are in the same household you are likely to be already infected or will be infected

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

That would be good advice if the real COVID-19 behaved like the simulated flu pandemic. However the data from the WHO - China report, and the 3–10% attack rate of households doesn't fit that.

Doubling household contacts instead of the WHO recommendation of reducing them to zero as soon as possible seems likely to increase rather than reduce spread, especially if most of the spread was already happening in households before the lockdown.

In the earlier paper that gives more details of this model, the Imperial College team talk about the ethical dilemma of confining households to delay a flu pandemic

Being a member of a household containing an influenza case is in fact the largest single risk factor for being infected oneself

… Household quarantine is also effective at reducing attack rates in the community (indeed, for low R0 values, pandemic spread can be dramatically slowed), but only if compliance is high. However, given the expected increases in contact rates within the household which would result, a household quarantine policy might pose ethical dilemmas unless excellent infection control was implemented.

Strategies for mitigating an influenza pandemic [Imperial college model]

In the later paper they don't discuss this. From the earlier paper then it just wouldn't be practical to get many people to isolate a patient on the very day they first show symptoms and even that has only a minor effect.

But with COVID-19 of course, isolating from the household has a major effect of reducing the risk that you infect someone else in the same household.

There is a silver lining to this cloud. The UK government is going beyond these recommendations and advising people to isolate themselves from any vulnerable person in the house.

The Scottish branch of the NHS goes further than this. In Scotland ALL people who have COVID-19 like symptoms are advised to isolate themselves from EVERYONE ELSE in the household - to isolate from the rest of the household with separate cutlery etc.

This is not as stringent as the WHO advice. But it is certainly a lot better than the which the Imperial study policy where we do nothing to reduce these contacts.

However, neither the UK government or NHS Scotland attempt to reduce household contacts to zero as the WHO recommends.

The effects of all this would depend on how many of the households comply with this guidance, and on how effective these suggested methods are in reducing transmission within the household.

ISOLATION PERIODS FOR THE UK PAPER COMPARED WITH WHO ADVICE

skip to: Airborne (or to: Contents)

In the UK, mild cases are not tested to see if it is real COVID-19.

With most households under lockdown and isolated from other households, the NHS guidelines mainly apply now to essential workers including doctors and nurses.

Essential workers can leave isolation after 7 days so long as they no longer have a fever. Many will still have a cough after 7 days. The guidelines specifically say that if you have a cough, which can persist for up to several weeks, then you can leave isolation.

This can’t be reconciled with real world data. SARS patients were infectious for up to three weeks, and the virus was detected up to a month after symptoms started.

For SARS coronavirus, viral RNA is detectable in the respiratory secretions and stools of some patients after onset of illness for more than 1 month, but live virus could not be detected by culture after week 3

Understanding COVID-19: what does viral RNA load really mean?

It is similar for COVID-19 - patients shed virus for a long time. Through to death for those that die. They shed virus for over a month for those that survive.

Duration of viral shedding ranged between 8 and 37 days. The median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but continued until death in fatal cases. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

For more background and details, see my

UK's Isolation Period Of 7 Days For COVID-19 Is Too Short - WHO Advises Isolation To 14 Days After Symptoms Resolve

If essential workers are isolating together with a household, then they can leave isolation 14 days after the first onset of symptoms in the household even if other patients have had new symptoms start later on.

The basic assumption here is that once one person in the household has symptoms, that everyone else is already infected and variations in onset of symptoms are only due to the incubation period.

You can read the details in the NHS guidelines

Meanwhile, the WHO recommend that mild cases found at home should be separated from the rest of the household in hospitals. If this is not possible because of the burden on the health system, then they can be separated in temporary wards in stadiums, community centers etc. If this also is not possible then they can isolate at home but this requires careful clinical judgement and assessment, and the patients and household members need to be educated on how to do it, and provided with on going support.

In cases in which care is to be provided at home, if and where feasible, a trained Health Care Worker should conduct an assessment to verify whether the residential setting is suitable for providing care; the Health Care Worker must assess whether the patient and the family are capable of adhering to the precautions that will be recommended as part of home care isolation (e.g., hand hygiene, respiratory hygiene, environmental cleaning, limitations on movement around or from the house) and can address safety concerns

Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts - WHO

The patient and carer both need to wear clinical masks and know how to use them. This is the one situation where the WHO say that members of the public should wear medical masks.

To contain respiratory secretions, a medical mask should be provided to the patient and worn as much as possible, and changed daily. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene;

Caregivers should wear a medical mask that covers their mouth and nose when in the same room as the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty from secretions, it must be replaced immediately with a new clean, dry mask.

Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts - WHO

As for isolation then the WHO recommend that isolation continues for as long as there are any symptoms (so, that’s including a cough of course) and for an additional 14 days after the symptoms resolve (i.e. until your cough and other symptoms completely disappear) or until there are two negative PCR tests 24 hours apart:

For mild laboratory confirmed patients who are cared for at home, to be released from home isolation, cases must test negative using PCR testing twice from samples collected at least 24 hours apart. Where testing is not possible, WHO recommends that confirmed patients remain isolated for an additional two weeks after symptoms resolve and monitoring should continue for the duration of home care.
WHO Director-General's opening remarks at the media briefing on COVID-19 - 16 March 2020

Detailed advice here: Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts

UK PAPER ASSUMPTION OF AIRBORNE TRANSMISSION IN THE COMMUNITY

skip to: third of transmission in each of community, schools and workplaces, and at home (or to: Contents)

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.

Imperial college study

The latest advice of the WHO as of 29th March continues to be that airborne transmission has not been reported.

According to current evidence, COVID-19 virus is primarily transmitted between people through respiratory droplets and contact routes.

In an analysis of 75,465 COVID-19 cases in China, airborne transmission was not reported.

In the context of COVID-19, airborne transmission may be possible in specific circumstances and settings in which procedures or support treatments that generate aerosols are performed …

Science brief on 29th March.

UK PAPER ASSUMPTION THAT A THIRD OF TRANSMISSION IS IN THE COMMUNITY, A THIRD IN SCHOOLS AND WORKPLACES, AND A THIRD AT HOME

skip to: Not modeling transmission in hospitals etc (or to: Contents)

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.

Imperial college study

This assumption is clearly inconsistent with the report from China of 78% to 85% of the transmission occurring on households.

As far as I can see their only reason for discounting this is this one, given later in the paper

The WHO China Joint Mission Report suggested that 80% of transmission occurred in the household, although this was in a context where interpersonal contacts were drastically reduced by the interventions put in place.

I.e. they have no direct evidence of transmission in workplaces, schools, and randomly in the community but assume that it fits the flu model of a third for the community, third for workplaces and schools and a third for households on the basis that the data from China is skewed because of the lockdown.

Incidentally this seems also to be their only cite of the joint WHO - China report in the paper.

If you look at other data such as the data from Singapore, then contact tracing suppressed the outbreak, with almost no spread in the community.

Yes Your Country Can Stop COVID-19- Singapore Shows How

The Singapore schools and universities were not closed and they didn’t do a lockdown. They are are going to close schools now, from 8th April but they ramped all the way down from 1000 cases a day to below 100 a day without needing to do this. They need stricter measures now to deal with the large numbers of imported cases from other countries.

The Imperial college paper continues:

We predict that school and university closure will have an impact on the epidemic, under the assumption that children do transmit as much as adults, even if they rarely experience severe disease

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 get asked about this from time to time in the press briefings and continue to say that the extent of transmission via schools is unknown. The Imperial College team's assumption that children do transmit as much as adults does not yet seem to have support from data.

AFAIK there have been no cases of major outbreaks started through schools or universities but many cases of large transmission clusters started in hospitals, care homes, prisons and of course cruise ships.

UK PAPER NOT MODELING TRANSMISSION IN HOSPITALS, CARE HOMES ETC

skip to: Concern for health care workers (or to: Contents)

Of the remaining transmission, then some of it happens in prisons, hospitals and long-term living facilities.

"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 has continued to be a significant driver, especially for new outbreaks. Especially, outbreaks of COVID-19 have often started in health care systems

For instance this was one of the main sources for the first few cases in Italy. Wikipedia summarizes it like this (Wikipedia is reasonably reliable on COVID-19)

On 16 February, as the man's condition worsened, he went to Codogno Hospital, reporting respiratory problems.[33] Initially there was no suspicion of COVID-19, so no additional precautionary measures were taken, and the virus was able to infect other patients and health workers.[34] … On 20 February, three more cases were confirmed after the patients reported symptoms of pneumonia. [35] Thereafter, extensive screenings and checks were performed on everyone that had possibly been in contact with or near the infected subjects.[36]

… Afterward, he was transferred to Policlinico San Matteo in Pavia,[40] and his wife to Sacco Hospital in Milan.[41] [42] On 21 February 16 more cases were confirmed – 14 in Lombardy, including the doctor who prescribed treatments to the 38-year-old Codogno man,[33] and two in Veneto. On 22 February, a 77-year-old woman from Casalpusterlengo, who suffered from pneumonia and visited the same emergency room as the 38-year-old from Codogno, died in Lombardy.[43] … Of the 76 newly discovered cases, 54 were found in Lombardy, including one patient in San Raffaele Hospital in Milan[45] and eight patients in Policlinico San Matteo in Pavia,[46]

SPREAD THROUGH HEALTH CARE WORKERS HAVE BEEN OF ESPECIAL CONCERN FOR COVID-19

skip to: Asymptomatic spread (or to: Contents)

Dr Bruce Aylward talks about all this here:

(click to watch on Youtube)

If your health system goes down you can't run your response early days of Ebola in West Africa it was one of the big big challenges we had and it's a common thing when emerging disease nobody knows It enters through the healthcare system remember that's where a virus is going to enter often because they come in looking for care and and all of a sudden boom it blows up

...

Most healthcare workers got infected in the community not in the health care system.

The Imperial college model doesn’t include any modeling of spread in health care facilities, prisons, or care homes.

The effects of the spread in health care facilities can be serious indeed. It is infecting patients who are already in hospital with other conditions that put them at risk, e.g. weakened immune system, cancer, respiratory conditions etc.

It is also infecting the health care workers. I did a rough calculation, based on the numbers of health care workers in the various age groups and the early reports of case fatality rates for Italy and the US.

If half the doctors get it, I estimate that around 1000 will die (compared to 94 doctors that have died so far in Italy as of writing this). I estimate that around 750 nurses will die.

See my: Devastating effect on doctors and nurses in my earlier article: UK's Coronavirus Advice Is Based On A Fictional Influenza Pandemic NOT Recommendations Of WHO And Real World Data For COVID19

The deaths happen starting at the end of the second week most in the third or later weeks of symptoms. So most won't happen for a few weeks yet.

There are many health care workers self isolating right now for the first 7 days of mild symptoms. So far four doctors and four nurses have died. For those that are already infected, there is little we can do to stop progression of the disease in the next several weeks, though it is possible that the large scale clinical trials in the SOLIDARITY campaign of the WHO will find drugs that can slow down progress of the disease and reduce fatality.

As for hospitalization of NHS health workers, I didn’t try a detailed break down but if you go by the rough estimate that 20% need hospitalization and 5% need critical care, and assume half of the 1.2 million full time staff working in the NHS get COVID19 - then 120,000 of the full time NHS staff need hospitalization and 30,000 need intensive care.

Those are rough ballpark figures in both cases. It could be more or less than those numbers.

I didn’t try to estimate the number of patients that would die in hospitals who are there for other conditions.

UK PAPER’S ASSUMPTION OF ASYMPTOMATIC SPREAD COMPARED WITH WHO - CHINA REPORT

skip to: Impact on contact tracing and stopping the virus (or to: Contents)

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.

As they say there, most were symptomatic when identified. The asymptomatic cases were mainly identified through contact tracing - the contacts were tested daily and some were tested positive for the virus before they developed symptoms. The majority of these eventually went on to develop symptoms.

If the Imperial college team's assumption was correct, that 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.

In Singapore, anyone with mild symptoms resembling COVID-19 who asks for treatment anywhere in Singapore has been automatically tested for COVID-19 since the 28th January. Most of the cases they find belong to known clusters or they are imported cases from other countries.

For instance when I wrote my Singapore article, on the 20th March, Singapore had 40 new cases. Of those, most were imported cases or contacts of recently imported cases. Only 3 were new cases within Singapore, not already contact traced to another cluster, and another 3 were contacts of previous new cases within Singapore. None of the big clusters had any new cases on the 20th.

How can observations like that be modeled on an assumption that a third of the Singapore cases are asymptomatic (never symptomatic) with 50% of the infectivity of the symptomatic cases?

Yes Your Country Can Stop COVID-19 - Singapore Shows How

It would of course be possible to have large numbers of asymptomatic cases 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.

HOW THESE ASSUMPTIONS IMPACT ON CONTACT TRACING AND ABILITY TO STOP THE VIRUS

skip to: This virus can be suppressed and controlled (or to: Contents)

With 'flu then 33% are asymptomatic. So you can never stop more than 67%.

You also have a third of the transmission happening randomly in the community with 'flu because it is airborne over short distances.

Combine those together and short of extreme physical distancing in the community, you can never stop more than 44.44% of 'flu transmission.

With ‘flu, contact tracing and isolation can at most slow it down, except for as long as you use extreme physical distancing, which a society can’t keep up for long.

However Singapore and other countries have shown that with extensive testing, and rigorous contact tracing you can stop well over 75% of COVID-19 transmission. To give a simple example of how this works, suppose 100 patients would normally infect 200 others. Then it continues

100 → 200 → 400 → 800 → 1600

If this happens every 3 days say, then 12 days later you have 3,100 cases from your original 100.

If you can break 3/4 of the chains of transmission it goes

100 → 50 → 25 → 13 → 6 → 3 → 2 → 1

Now it stops at 200 cases after 21 days. Of course in practice it’s more variable than this but it is going to stop well within a month starting from 100 cases.

THIS VIRUS CAN BE SUPPRESSED AND CONTROLLED - THE CHALLENGE IS NOT WHETHER WE CAN BUT WHETHER WE WILL - WHO

skip to: Contact tracing has to be methodical (or to: Contents)

In a WHO press briefing Dr Tedros said:

"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."

Virtual press conference on COVID-19–11March 2020

In the press briefing on the 18th March he said

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

We can stop it. We can still turn this around. As Dr Tedros said:

We also need to celebrate our successes. Yesterday, Wuhan reported no new cases for the first time since the outbreak started. Wuhan provides hope for the rest of the world, that even the most severe situation can be turned around.

WHO COVID19 Mar 20 - Message Of Courage And Hope In Difficult Times - First Pandemic In History With Power To Change Way It Goes

(click to watch on Youtube)

Do you think it will be contained?

I think it can be contained. It is a controllable disease and I'm a great optimist in the fact that people will contain it.

I just hope that they will take the necessary actions early enough that it doesn't do the damage this virus is capable o.

Everywhere you look as this escalates you see countries taking extraordinary measures that a few weeks ago everyone said impossible.

The classic is they did something in China that could never be done anywhere else in the world.

How different is what's happening in Italy to what happened in China?

Seriously let’s never say never because you don’t know this virus

Here is Bruce Aylward talking about this, and the need for solidarity

(click to watch on Youtube)

Talking about the Chinese he says that the way they responded, they were the pro-league and what we're seeing in their places is sometimes the amateur league.

If one country is sloppy and it gets out of control and it does not contain that affects the next country and the next country and it's like a falling dominoes.

It is an interconnected world and if the country next door has a bit of a sloppy approach and the virus comes across you still have a duty and responsibility to your citizens to minimize the potential impact this could have.

So make sure they're educated make sure you find those cases an isolated, make sure you find the contacts and quarantine them make sure that you shut down any kind of events that are amplifying this and and and use the evidence to drive your response because you'll save a lot of people from the disease and you'll save a lot of people from dying.

CONTACT TRACING HAS TO BE METHODICAL AND THOROUGH

skip to: Herd immunity possible mismatch (or to: Contents)

One of the papers that may have influenced SAGE and the Chief Medical Officer professor Chris Whitty to move from the contain to the delay phase was "The Efficacy of Contact Tracing for the Containment of the 2019 Novel Coronavirus (COVID-19)."

At any rate, it 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 there are several issues with this. First, the most important contacts to isolate are other members of the same household - which requires no tracing at all. Other close contacts that you can find with a few minutes of discussion with the case are also top priority because of the need for prolonged or close contact to transmit this disease.

Then, COVID-19 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 through the 14 days they would be required to quarantine, and back to two days before symptoms started. They then isolate them. This is not just theoretical; it is an intervention that has been proven to work in China, Singapore, and now in Spain, Italy and other places.

For details see my

What Is Contact Tracing And Why Is It So Effective At Stopping COVID-19?

HERD IMMUNITY ASSUMPTION AND POSSIBLE MISMATCH WITH DATA FROM SARS

skip to: Not likely to do much flattening of curve (or to: Contents)

The Imperial college policy modeling is done on the basis of herd immunity as a central hypothesis.

Although the UK has said it is not the aim to develop herd immunity in the entire population, the working assumption behind their modeling is that the virus can be slowed down through developing sufficient immunity in the population to slow down its spread, combined with physical distancing. This is of course based on all the previous assumptions of a third of the infected population being asymptomatic spreaders as well as being immune and their assumptions about how it is transmitted.

On recovery from infection, individuals are assumed to be immune to re-infection in the short term. Evidence from the FluWatch cohort study suggests that re-infection with the same strain of seasonal circulating coronavirus is highly unlikely in the same or following season (Prof Andrew Hayward, personal communication).

This is the basis for their modeling of the effects of the interventions. Their model is that if you do nothing, then at the peak of infection in mid May, over 250 intensive care unit beds will be needed for every 100,000 in the population. The aim of the policies currently adopted is to reduce this to less than 100 intensive care units per 100,000 of population which still way overwhelms the current critical care unit capacity, which is why they are urgently building all these new hospitals; we need many times the current number of intensive care unit beds to treat them all.

The blue curve there is the result of applying all the current policies, but doesn’t include the effect of isolating everyone at home or some of the other major policies the UK has done in addition to the recommendations in this paper.

Herd immunity is central to this prediction and their strategy. They explain:

The aim of mitigation is to reduce the impact of an epidemic by flattening the curve, reducing peak incidence and overall deaths (Figure 2). Since the aim of mitigation is to minimise mortality, the interventions need to remain in place for as much of the epidemic period as possible. Introducing such interventions too early risks allowing transmission to return once they are lifted (if insufficient herd immunity has developed); it is therefore necessary to balance the timing of introduction with the scale of disruption imposed and the likely period over which the interventions can be maintained. In this scenario, interventions can limit transmission to the extent that little herd immunity is acquired –leading to the possibility that a second wave of infection is seen once interventions are lifted.

However this is a novel coronavirus and this is not known. Our experience of short term herd immunity for the four coronaviruses that have adapted to humans over thousands of years may not match what happens with the three novel coronaviruses that have recently leapt to humans.

What’s more SARS had a perverse reaction to reinfection. It had antibodies that could actually make the disease worse on reinfection like Dengue fever.

In rare cases dengue can be very serious and potentially life threatening. This is known as severe dengue or dengue haemorrhagic fever.

People who've had dengue before are thought to be most at risk of severe dengue if they become infected again. It's very rare for travellers to get it.

Dengue

The belief is that low levels of antibodies cannot neutralize or kill the invading viruses. But they do bind to them and effectively usher them into susceptible cells, where the viruses then replicate.

Scientists solve a dengue mystery: Why second infection is worse than first - STAT

SARS is one of the very few viruses that have this immune system backfiring.

Since the 1960s, tests of vaccine candidates for diseases such as dengue, respiratory syncytial virus (RSV), and severe acute respiratory syndrome (SARS) have shown a paradoxical phenomenon: Some animals or people who received the vaccine and were later exposed to the virus developed more severe disease than those who had not been vaccinated (1). The vaccine-primed immune system, in certain cases, seemed to launch a shoddy response to the natural infection. “That is something we want to avoid,” says Kanta Subbarao, director of the World Health Organization Collaborating Centre for Reference and Research on Influenza in Melbourne, Australia.

This immune backfiring, or so-called immune enhancement, may manifest in different ways such as antibody-dependent enhancement (ADE), a process in which a virus leverages antibodies to aid infection; or cell-based enhancement, a category that includes allergic inflammation caused by Th2 immunopathology. In some cases, the enhancement processes might overlap. Scientific debate is underway as to which, if any, of these phenomena—for which exact mechanisms remain unclear—could be at play with the novel coronavirus and just how they might affect the success of vaccine candidates.

News Feature: Avoiding pitfalls in the pursuit of a COVID-19 vaccine

This has caused problems with vaccine development for SARS. An early candidate vaccine caused the immune system to attack the lungs, and this was solved by a new approach where only one spike from the SARS virus was used to trigger antibodies.

When SARS, also a coronavirus, appeared in China and spread globally nearly two decades ago, Hotez was among researchers who began investigating a potential vaccine. In early tests of his candidate, he witnessed how immune cells of vaccinated animals attacked lung tissue, in much the same way that the RSV vaccine had resulted in immune cells attacking kids’ lungs. “I thought, ‘Oh crap,’” he recalls, noting his initial fear that a safe vaccine may again not be possible.

But his team revised their approach. Instead of producing the whole spike protein of the virus, they built just a tiny piece of it—the piece that attaches to human cells, called the receptor-binding domain. Subsequent animal tests showed that this strategy did provide the desired protection without the unwanted immune enhancement. With funding from the NIH, Hotez’s team continued on to manufacture the vaccine and were ready for clinical trials.

News Feature: Avoiding pitfalls in the pursuit of a COVID-19 vaccine

So the “herd immunity” not only might not protect against reinfection.

There is a possibility that can’t yet be ruled out that the antibodies make reinfection more deadly.

Details here:

Why Antibody Tests Will NOT Prove You Are Immune To COVID19 - Problems For UK's "Immunity Passports" And "Herd Immunity"

HAVE THESE MEASURES SUCCEEDED IN "FLATTENING THE CURVE"?

skip to: Exiting from a lockdown (or to: Contents)

The large scale physical distancing, as we have seen, is likely to have a relatively minor effect on the transmission, certainly a lot less than they expect with their assumption of airborne transmission like flu, with 33% of the transmission happening in the community based on physical distance.

The isolation of households together is likely to increase household transmission, as they assume contact rates in households will be doubled for much of the population. Thankfully this may be reduced if cases in households follow the NHS recommendations to do some measures to try to isolate from vulnerable members in England and from all members in Scotland.

The inadequate isolation periods for health care workers gives a route for COVID-19 to spread from the community back to the hospitals, and then from hospitals via patients back to the community. In particular, this could spread it to care homes for the elderly, prisons, and other crowded conditions with lots of patient to patient contact.

None of this is modeled by them, because of their use of data for flu instead of data for COVID-19.

On the other hand, these measures have reduced transmission from one household to another, as most people are not visiting other households. It also reduces the transmission through the workplace, where there are examples of this happening, for instance the cases in Germany where they got the virus from a colleague visiting from China.

So, it seems you can reason both ways, some features of this lockdown may be acting to increase the spread, and others are acting to reduce the spread, so which have most effect?

Sadly, it's not easy to monitor our population to see what the result of this policy has been so far, and as well, we don't have good data about what was happening before the transition to the delay phase, and what effects it had.

It's also not easy to see what the current situation is.

The data for UK confirmed cases is incomplete because they rarely test mild cases (only for key figures, such as our prime minister, his cabinet, some members of the royal family, and now, some NHS workers self isolating at home and a few others). So far most of the tests have been for patients admitted to hospital. It's hard to extrapolate from that to the total numbers per day of all cases.

Then the data for deaths from COVID-19 is also incomplete because they don’t test cases that die in care homes or at home with COVID-19 like symptoms. They currently only test for COVID-19 if the cases die in hospitals.

The UK's overall death figure, which is confirmed cases reported up to 17:00 BST the previous day, only includes people who died in hospital and tested positive for coronavirus. It does not include deaths in the community, for example in care homes, or people who have died in their own homes.This means that the true death toll will be higher.
Coronavirus in UK: How many confirmed cases are there in your area?

Whether it's succeeded in delaying things a bit or not, we still have to find a way out of our lockdown.

EXITING FROM A LOCKDOWN

skip to: Reassuring scared readers (or to: Contents)

The WHO say that once you raise a lock down you have to have an alternative method to suppress the infection, namely the test finding, case isolation, contact tracing etc.

Dr Mike Ryan put it like this:

Once you raise the lock-down you have to have an alternative method to suppress the infection. The way to do that is active case finding, testing, isolation of cases, tracking of contacts, quarantining of contacts and strong community education and participation and ownership around normal physical distancing, hygiene and giving communities the power to control infection by in effect managing their own physical distance, managing their own capacities to support the response.

In that situation, if you've strong public health capacity, if you've got a community that's mobilised and empowered and if you've strengthened your health system then you're potentially in a position to start unlocking or unwinding the lock-down.

COVID-19 virtual press conference -6 April, 2020

For more details see the rest of his reply at 00:34:29

REASSURING SCARED READERS

skip back to top

skip to Physical distancing (or to: Contents)

I know many of you find the situation in the UK scary, and understandably so. I help run the Facebook Doomsday Debunked group, to help scared people. So, here is a short word to reassure you:. I have added a link to this section to the head of the article so you can read it first if you are scared before you get to the main part of the article.

If you are scared of COVID-19 and living in the UK or indeed anywhere with COVID-19 in the community - you need to continue to take the precautions to protect yourself. They work. Sadly many in the UK government, royalty and even the medical advisors didn't take this advice themselves. They were far too lax about that early on but it is history now.

The WHO who fight 200 epidemics a year run safe and they recommend these precautions and use them themselves to stay safe in China and in Wuhan for the big WHO-China report. WHO's Maria van Kerkhove, and Bruce Aylward who both did a 9 day study of China visiting the worst hot spots in Wuhan followed these precautions and didn't get it.

You can stop it by thorough hand washing before you touch your eyes nose or mouth and by keeping a physical distance of 1–2 meters from anyone talking, sneezing or coughing. This is not so effective for flu or some colds as they are airborne. However this method is very effective for COVID-19. This protects you and also protects others who could otherwise be infected through you in a transmission chain. You need to practice these things until they become an automatic sequence like tying your shoelaces or brushing your teeth. This is how Bruce Aylward put it when interviewed by W2 in Canada:

(click to watch on Youtube)

This is a respiratory disease at the end of the day which means it can move very easily from me too you well not right now cuz you're too far away [1 meter away]

If your population knows how to protect itself you're gonna be very successful with this disease.

If I'm washing my hands, if I'm [doing] proper respiratory hygiene avoiding the others social distancing and know what to look for not just in myself but in others I'm going to be safe, or quite safe. There's no such thing as zero risk but you can really reduce the risk. I spent two weeks nearly three weeks in the epicenter of the biggest outbreak in history. I'm fine.

For details see my

How To Protect Yourself From COVID-19 - And Help Stop The Spread

If you know someone who has COVID-19 - they can die of this but it is not like it is a death sentence. For many it is a mild disease that they hardly notice, and by far the majority recover at all ages. If you end up in critical care you still have a fighting chance of pulling through (three chances out of four or better except for very elderly patients).

Even at age 90+ then 800 out of 1000 recover and for those under 40 it is something like 999 out of 1000 recover (possibly more, if there are more mild cases and asymptomatic cases than they thought).

Babies barely notice COVID19, and it is rare for teenagers to die of this disease. For preteens it is almost unknown to die of this. I link to some of the sources here in my

Deaths in Italy from Covid19 - similar to China - higher case fatality rate is due to more elderly patients affected

But for sure you don't want to get this disease. You don't want to risk that small chance of dying, or the larger risk of spending weeks unconscious under a ventilator depending on expert attention to stay alive. Also around 14% need to go to hospital. This is not flu. It has a low case fatality rate compared to many of the worse diseases but if you get it bad it is way worse than flu.

Why young people should NOT try to get COVID-19 - instead protect yourself

I often get people send me PM's scared that this pandemic will lead to human extinction. No, it doesn't mean everyone is going to die. At those case fatality rates, that is literally impossible. Indeed, the AIDS pandemic was far worse in terms of numbers of deaths. Over a million dying in the worst year and an estimated 32 million total have died of AIDS since it started. Global HIV & AIDS statistics — 2019 fact sheet.

For more on this:

Deaths from Aids, Flu, Measles far greater than for COVID-19 - and why COVID-19 cases per day in Europe might peak soon - apart from the UK

And yes we will get over this, and we can stop this disease. We should have a vaccine some time in 2021 and can then vaccinate most of the world's population.

Or we can suppress it. Many countries are doing this. In the countries that do so, then typically a few tenths of a percent get the disease, and it can be as low as a few hundredths of a percent by the time it is controlled and stopped. In some of the regions of China then it's over already at only a few in a million that ever got infected.

If the government can turn around and act promptly using the WHO recommendations then it's my best understanding of the WHO data that we could be back down to hundreds of cases a day some time in late May and be down to almost zero some time in June.

PHYSICAL DISTANCING AND LOCK DOWN A PRECIOUS SECOND WINDOW OF OPPORTUNITY

Skip to next section: Should a nation's health policy be guided by models when they differ from real world data?. (or to: Contents)

The physical distancing can be useful when it is combined with protection of the health care system, careful separation of patients and care workers with COVID-19 from others, isolation of mild cases from households, and contact tracing.

If we combine it like this we can not only flatten this curve, we can crush it right back down to zero cases per day.

As Dr Mike Ryan put it, in the WHO press conference on 30th March:

Mike Ryan: 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.

COVID-19-virtual press conference -30 March 2020

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

COVID-19-virtual press conference -30 March 2020

Italy and Spain are already having success, and many other countries are now following their example.

Only the UK, Netherlands and Sweden are doing policies based on this simulated flu assumption.

I am writing this in a hope that this can lead to a change of direction in UK policy.

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)

SHOULD A NATION'S POLICY BE GUIDED BY MODELS WHEN THEY CONFLICT WITH REAL WORLD DATA?

skip to: UK Government is resolute about tackling COVID-19 (or to: Contents)

It is natural for modelers to have great confidence in their models. In normal scientific dialog then these models are compared with the results of other modeling teams and tested against the real world data. Over several months or years, as it becomes clear that the data does not match the model, the models are changed.

However in the fast pacing world of a newly discovered disease, should such a model guide a nation's health policy? This was a question about another mathematical model that Dr Mike Ryan of the WHO answered:

Jamie (Associated Press):: "Dr Mark Lipsitch, an epidemiologist at Harvard, was quoted in The New Yorker yesterday saying that as many as 40 to 70percentof the world’s five billion adults could at some point contract coronavirus. I guess I just wanted to know, is it really that dire, in your perspective? ..."

Dr Mike Ryan (WHO):: ".... We will listen to all good science. Having said that, there are obvious real things happening in the real world that contradict that. If we look at China, today, 20 provinces in China have today downgraded their public health emergency risk level. That’s 20 of 31 have actually gone in the reverse.

They’ve gone from red to yellow, or from yellow to green. Now that’s flying in the face of that prediction.

I’m not saying which one is correct. What I’m telling you, in the real world today, China is moving back towards the green. 11 provinces in China today moved to green, which is their lowest level of risk.

They’ve five levels of risk. On the 29th January, all provinces in China were at level one risk, the highest possible risk. Red, red, the whole of China was red.

So there’s hope in that. In the last 24 hours, only four cases of confirmed COVID-19 infection outside Hubei, were actually from China. Most cases outside Hubei, in China yesterday, came from other countries.

So when I look at that, which is happening in the real world, and then I look at predictions, I need to look, and we need to look at both of those.We need to see what’s happening in Singapore. And the DG has said in his speech, this is not a drill. We need to fight. We need to fight now. Because our predictions will come true if we do nothing. So we have choices today. Some countries are stepping forward and turning to face the fire. And we need all countries to do that right now.

WHO press briefing, 5th March 2020

When you have models say one thing and the real world says another thing - then you need to look at both.

It seems that the UK government is just looking at the model and not paying enough attention to this real world data that Mike Ryan mentions.

I am going to propose a way of resolution of this, if I have indeed identified an issue here. We could have a public scientific debate streamed on YouTube, say, like the WHO press briefings, between the Imperial college theoreticians and those with hands on knowledge of the real world data such as some of the authors of the joint WHO-China report. This will help to ensure the widest scrutiny, as well as help with public confidence that we are using evidence based science to guide our policy. I go into this in detail below: Public evidence based science debate on basis of UK policy

First, some context.

UK GOVERNMENT IS RESOLUTE ABOUT TACKLING COVID-19

skip to: Letter to Boris Johnson (or to: Contents)

The good thing here is that the UK government is tackling this with a huge amount of determination and resolve. They are prepared to take major steps to protect our people from COVID-19. They are doing an "All of government all of the people" response. They have often compared this to a war effort and told us all that they are depending on us to follow policy, and that we can get through this together.

Here for instance is the Queen's speech asking us all to follow the government's policy on physical separation, and that we will get through this together to better times where we can meet up again.

(click to watch on Youtube)

Also earlier on the 19th March:

(click to watch on Youtube)

I see this as a matter of understanding, not motivation.

Our prime minister Boris Johnson is not a scientist. He read Classics, ancient literature and classical philosophy at Baliol college Oxford. He was advised by his chief medical officer that this is what to do. They in turn were advised by the scientific advisory group for emergencies, SAGE who also advised that this was what to do. All this is based on projections of a model based on a simulated flu disease that has almost none of the characteristics of the real disease. The UK policy comes directly from table 2 of the paper about this disease where it simulates the effects of various policies on the simulated flu.

As you see, Boris Johnson did everything properly according to how it should be done. He did as his chief medical officer said, in turn advised by SAGE, and he clearly believes that it can't be suppressed and that we have to delay it as long as we can to reduce the pressure on our health system.

He is also prepared to take resolute policies to stop it. Unfortunately this seems to consist mainly in stepping up on the physical distancing more and more, as they find it has less effect on the increase in cases per day than expected. Indeed so far there is no clear noticeable effect.

One of their main focuses at present is to ramp up on their restrictions on physical distancing, possibly they might even close local parks. The Communities Secretary Robert Jenrick asked about whether they will close parks and open spaces in our cities said it was an absolute last resort:

'it would be very unfortunate if we had to do so and make it harder for people, particularly people who live in flats in towns and cities, to get the exercise they deserve.'

Coronavirus: Here's the latest on the UK exercise rules

So it is not a question of resolve. It is of the data that feeds the policy. They believe that stopping airborne transmission by physical distancing irrespective of whether people are talking to each other, coughing or sneezing, is the absolute top priority to try to slow down this virus. They don't believe that isolation of cases, contact tracing, testing for the virus in hospitals, prisons or care homes, or isolating patients from their own homes are policies that are worth focusing on. Just more and more of the physical distancing.

His advisors should have explained to him that what he was doing conflicts with the WHO recommendations. It is not at all clear that any of our decision makers are aware of this. You wouldn't expect them to listen to the WHO briefings; they hear about them filtered through the media and their medical advisors.

The UK media gives only the briefest mentions of these briefings. I often watch the UK news and coronavirus programs, and read the BBC website articles on COVID-19. Although you see short segments of video from the press briefings such as the "test test test" statement, they don't go on to show video of Dr Tedros giving the WHO's complete recommendation of test, isolate and care, trace contacts and isolate them too. When talking to other people in the UK via PM as part of my work trying to help scared people, I find that there is almost no knowledge of this unless they have seen my articles first.

Dr Tedros does talk to world leaders in person, and on the phone and he addressed the G20 countries. However, the WHO never criticize member governments publicly. They said many times that the countries should not move to mitigation only but continue with contain, but didn't specifically mention any country.

If my analysis here is correct, the main issue here is not the motivation of anyone involved.

The main issue is that a particular group of modelers were given direct access to guide UK policy. These had great confidence in their model, as is common for modelers. They will have a huge personal shock if they come to realize they have guided us based on a flawed model.

So it is not any single person's fault it is more the entire nexus of conditions.

LETTER TO BORIS JOHNSON - PM OF THE UK

skip to: Rejected petitions to UK government (or to: Contents)

This is a letter I sent to our PM on March 27th

Dear Prime Minister,

The WHO say we have a precious second window of opportunity to win against the COVID19 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

I also sent copies of this letter to the leaders of all the main UK parties and the green party, and to anyone else I could think of including the health secretary and the shadow health secretary.

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

I also did tweets to the PM, and the Scottish Government, and the leaders of the main parties and to various public figures. You can find them if you scroll down through my most recent tweets and replies. I have so far had no response to any of those emails or tweets.

REJECTED PETITIONS TO UK GOVERNMENT

skip to: In depth responsible science blogging (or to: Contents)

This is a petition that I put to the UK Government on the 13th March using the option for the public to submit petitions via the petitions website:

The UK government must immediately return to the contain phase for COVID-19

The UK should immediately restart contact tracing, containment and testing of mild cases of COVID-19. Also, following recommendations of the report from the WHO-China Joint Mission headed by Dr Aylward & Dr Liang on 25th February, we should do widespread surveillance in the community to find cases.

Petition: The UK government must immediately return to the contain phase for COVID-19

The petition was rejected 7 days after I submitted it, on the basis that it was not clear what it was asking the UK government to do.

I divided it into two separate petitions submitted on the 20th March. The first one was rejected 11 days later on March 31st.

Test everyone with influenza-like illness for COVID19

The Government must test everyone with influenza-like illness for COVID19 as recommended by the WHO-China Joint Mission headed by Dr Aylward and Dr Liang and published on 25th February

Petition: Test everyone with influenza-like illness for COVID19

This petition was rejected on the basis that there is already a petition on this issue. They say that this is a petition on the same issue:

Provide publicly accessible testing for the covid-19 virus around the UK now.

I don't see how it is the same petition. Public access points would not necessarily lead to all those in hospitals and presenting to doctors with flu like symptoms being tested, and the other way around, testing all with flu like symptoms would not likely be done through public access points.

The other petition is still awaiting moderation 17 days later. The text is not publicly available yet but this is what it says:

Find and quarantine COVID-19 cases and isolate all their contacts

The World Health Organization recommend that countries test every suspected case of COVID19, and isolate and treat every confirmed case. It also recommends that they trace every contact and isolate those until they are free of the virus. We call on the UK government to do all these things.

Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said: "Several countries have demonstrated that this virus can be suppressed and controlled. The challenge for many countries ...is not whether they can do the same; it's whether they will. ." The UK is one of the few countries to stop contact tracing and quarantine. The world needs to join in solidarity to suppress and control this virus, both for ourselves and other countries that we may infect, especially with weaker health care systems

Petition: Find and quarantine COVID-19 cases and isolate all their contacts

[BTW if I could edit it, I'd edit the title to "Find and isolate COVID-19 cases and isolate all their contacts" - in a recent press briefing Dr Mike Ryan explained that in the WHO terminology they isolate the confirmed cases and they quarantine the contacts who are not yet confirmed to have it - which makes sense. However you can't edit a petition once it is submitted - if they do eventually approve it, the meaning is clear enough from the text of the petition].

If anyone knows of anything else I can do, please say.

And if any of you can think of anything else to do, please share this widely and try to get some attention to what is going on.

THIS ARTICLE IS IN DEPTH RESPONSIBLE SCIENCE BLOGGING, NOT RESEARCH

skip to: Public evidence based science debate on basis of UK policy (or to: Contents)

My understanding of this topic of COVID-19 comes mainly from watching all the WHO press briefings to date on COVID-19, taking notes from them, and reading up the research that they mention in the press briefings. My understanding of the Imperial college model comes only from the two papers I cite here.

My aim here is to do responsible science bogging (this is unpaid voluntary work, my "day job" is as a self employed software developer). I am most definitely not an expert on any of this.

However I have a first class BSC in maths, an M.Hum, and have done several years postgraduate study in the philosophical and logical foundations of maths. I also have a long term interest in science, watching how it has developed for the last 40 years. I know how to read scientific papers and for me the maths here is straightforward, easy stuff really.

I hope this article speaks for itself.

My request is for the topic to be debated by experts. I see a major difference between the UK policy and the WHO recommendations. The objective with this article is just to draw attention to that difference amongst a wider audience. I hope that what I have said here is sufficient for you to see that there is a significant difference, and that this difference is something to do with the way the Imperial college model is based on data for flu rather than the real world COVID-19.

As far as I can tell the experts that guide the UK policy are not engaged in any public discussion with the experts that guide the WHO recommendations. I am asking for this discussion to begin with great urgency and the aim of this article is just to be one of the voices asking for that discussion. To do that it was necessary to look at the Imperial college paper and the WHO data in some depth.

MY REQUEST FOR A PUBLIC EVIDENCE BASED SCIENCE DEBATE ON THE BASIS OF THE UK GOVERNMENT’S COVID-19 POLICIES

skip to: See also (or to: Contents)

This was the central point in my letter to Boris Johnson

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.

We need an urgent debate of this - of why the UK policy is based on a simulated flu pandemic instead of the real world data of COVID-19.

This I think should be public and done with utmost urgency with public dialog with the authors of the joint WHO-China report who have the best on the spot data from China and how they succeeded and with other experts on COVID-19 and on the successes in Singapore, South Korea and now also the medical experts in Italy and Spain.

This does not need to be a physical meeting. A public teleconference could be arranged at short notice and should be televised publicly in my view. It should be detailed and technical and examine all the issues involved and needs to directly confront the UK model’s assumptions with the real world data. It can also include experts working on other models with other assumptions more in accord with the real world data.

There are many in the UK population who, though not expert on this topic, are scientifically literate enough to follow the details of such a teleconference. In my view, we need widespread urgent debate in the scientifically literate communities about the science basis for our government’s policy.

What do you think? Please say in the comments and please share this and get more awareness of what is happening.

DO COMMENT AND SHARE

Please say if you spot any mistakes in this article however minor and I will fix them. Especially 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 contact me, or say in comments.

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.

Everyone, do share your thoughts on this. Thanks!

skip back to top (or to: Contents)

Doomsday Debunked

Seven tips for dealing with doomsday fears

If you are scared: Seven tips for dealing with doomsday fears which also talks about health professionals and how they can help.

If in the middle of a panic attack, see

Facebook support group

Facebook group Doomsday Debunked has been set up to help anyone who is scared by these fake doomsdays.

If you need help

Do message me on Quora or PM me on Facebook if you need help.

There are many others in the group who are available to support scared people via PM and who can also debunk fake Doomsday “news” for you if you get scared of a story and are not sure if it is true. See our debunkers list

If you are suicidal don’t forget there’s always help a phone call away with the List of suicide crisis lines - Wikipedia

CONTENTS

WHY THE UK GOVERNMENT IS IGNORING THE WHO’S ADVICE

WHAT IS THE WHO ADVICE IN DETAIL?

DATA ASSUMPTIONS FOR THE MODEL COMPARED TO REAL WORLD DATA - SUMMARY

POLICY FOR THE UK - TABLE 2 OF IMPERIAL COLLEGE PAPER

UK PAPER ISOLATION POLICIES COMPARED WITH WHO ADVICE

HOUSEHOLD ISOLATION

ISOLATION PERIODS FOR THE UK PAPER COMPARED WITH WHO ADVICE

UK PAPER ASSUMPTION OF AIRBORNE TRANSMISSION IN THE COMMUNITY

UK PAPER ASSUMPTION THAT A THIRD OF TRANSMISSION IS IN THE COMMUNITY, A THIRD IN SCHOOLS AND WORKPLACES, AND A THIRD AT HOME

UK PAPER NOT MODELING TRANSMISSION IN HOSPITALS, CARE HOMES ETC

SPREAD THROUGH HEALTH CARE WORKERS HAVE BEEN OF ESPECIAL CONCERN FOR COVID-19

UK PAPER’S ASSUMPTION OF ASYMPTOMATIC SPREAD COMPARED WITH WHO - CHINA REPORT

HOW THESE ASSUMPTIONS IMPACT ON CONTACT TRACING AND ABILITY TO STOP THE VIRUS

THIS VIRUS CAN BE SUPPRESSED AND CONTROLLED - THE CHALLENGE IS NOT WHETHER WE CAN BUT WHETHER WE WILL - WHO

CONTACT TRACING HAS TO BE METHODICAL AND THOROUGH

HERD IMMUNITY ASSUMPTION AND POSSIBLE MISMATCH WITH DATA FROM SARS

HAVE THESE MEASURES SUCCEEDED IN "FLATTENING THE CURVE"?

EXITING FROM A LOCKDOWN

REASSURING SCARED READERS

PHYSICAL DISTANCING AND LOCK DOWN A PRECIOUS SECOND WINDOW OF OPPORTUNITY

SHOULD A NATION'S POLICY BE GUIDED BY MODELS WHEN THEY CONFLICT WITH REAL WORLD DATA?

UK GOVERNMENT IS RESOLUTE ABOUT TACKLING COVID-19

LETTER TO BORIS JOHNSON - PM OF THE UK

REJECTED PETITIONS TO UK GOVERNMENT

THIS ARTICLE IS IN DEPTH RESPONSIBLE SCIENCE BLOGGING, NOT RESEARCH

MY REQUEST FOR A PUBLIC EVIDENCE BASED SCIENCE DEBATE ON THE BASIS OF THE UK GOVERNMENT’S COVID-19 POLICIES

SEE ALSO

DO COMMENT AND SHARE

Doomsday Debunked

Seven tips for dealing with doomsday fears

Facebook support group

If you need help

Related articles

Comments

Know Science And Want To Write?

Donate or Buy SWAG