More detail on Coronavirus in China

[Eddy Edson]

VOX interview with the Aylward, the Canadian epidemiologist who led the recent WHO China mission: https://www.vox.com/2020/3/2/21161067/coronavirus-covid19-china

Adds some very interesting colour to the WHO report: https://www.who.int/docs/default-so...na-joint-mission-on-covid-19-final-report.pdf

New colour:

- Most of China's response has been the kinds of things any country will do in response to an epidemic - case finding, contact tracing, public gathering restrictions. The high-profile authoritarian things like locking down entire cities, big-data'ing every inhabitant etc etc have been less important outside the initial epicentre & Aylward thinks are generally a distraction in looking to China for learnings.

Things now restarting with China primed for rapid response if things flare up again anywhere.

Most important point: all the provinces which have had infection clusters & have contained them without going full-Orwell. [Just 10 new cases outside Hubei province yesterday, zero deaths.]

- Key to containment effectiveness has been speed finding, tracking, isolating.

- To replicate: public has to know symptoms (not runny nose - dry cough + fever) and become the surveillance system. System needs to be set up so that you can report symptoms via mobile devices etc and get effective advice and prompt effective tracing etc action immediately. Have something better than just "call your GP". Don't have people hiting & infecting health system unnecessarily. Have infrastructure in place to do the rapid tracing etc.

- Focus on close contacts for tracing and screening. That's where the virus is.

- Most surprisingly, very little sign of non-symptomatic infection. Completely different to flu. A big bonus for controlling it. Also means that CFR's seen to date are probably about right. Higher at ground zero; < 1% elsewhere.

- But not clear that other countries will be able to get CFR's that low. China has a massive ventilation etc capability and ability to detect and treat very quickly. Maybe CFR's go higher in lots of other places. [Eg: Initially fatality rate for severe cases in Wuhan was 50%+; now down to < 20%.]

- Another bonus: time to infect is 4-5 days versus 1.5 days for flu => easier to break chains and contain, as seen in China and other places.

- Screening. Now becomes evident that screening everybody probably unnecessarily. Beyond close contact screening, probably most effective to leverage existing flu surveillance systems; screen people presenting with flu-like symptoms and atypical pneumonia.

- Smoking definitely a big factor in mortality risk.

- Chinese data can be trusted.

 

[atoll]

here is the initial press conference,very informative in relation to the report
https://www.youtube.com/watch?v=-o0q1XMRKYM

 

[everydayupsanddowns]

VOX interview with the Aylward, the Canadian epidemiologist who led the recent WHO China mission: https://www.vox.com/2020/3/2/21161067/coronavirus-covid19-china

Adds some very interesting colour to the WHO report: https://www.who.int/docs/default-so...na-joint-mission-on-covid-19-final-report.pdf

New colour:

- Most of China's response has been the kinds of things any country will do in response to an epidemic - case finding, contact tracing, public gathering restrictions. The high-profile authoritarian things like locking down entire cities, big-data'ing every inhabitant etc etc have been less important outside the initial epicentre & Aylward thinks are generally a distraction in looking to China for learnings.

Things now restarting with China primed for rapid response if things flare up again anywhere.

Most important point: all the provinces which have had infection clusters & have contained them without going full-Orwell. [Just 10 new cases outside Hubei province yesterday, zero deaths.]

- Key to containment effectiveness has been speed finding, tracking, isolating.

- To replicate: public has to know symptoms (not runny nose - dry cough + fever) and become the surveillance system. System needs to be set up so that you can report symptoms via mobile devices etc and get effective advice and prompt effective tracing etc action immediately. Have something better than just "call your GP". Don't have people hiting & infecting health system unnecessarily. Have infrastructure in place to do the rapid tracing etc.

- Focus on close contacts for tracing and screening. That's where the virus is.

- Most surprisingly, very little sign of non-symptomatic infection. Completely different to flu. A big bonus for controlling it. Also means that CFR's seen to date are probably about right. Higher at ground zero; < 1% elsewhere.

- But not clear that other countries will be able to get CFR's that low. China has a massive ventilation etc capability and ability to detect and treat very quickly. Maybe CFR's go higher in lots of other places. [Eg: Initially fatality rate for severe cases in Wuhan was 50%+; now down to < 20%.]

- Another bonus: time to infect is 4-5 days versus 1.5 days for flu => easier to break chains and contain, as seen in China and other places.

- Screening. Now becomes evident that screening everybody probably unnecessarily. Beyond close contact screening, probably most effective to leverage existing flu surveillance systems; screen people presenting with flu-like symptoms and atypical pneumonia.

- Smoking definitely a big factor in mortality risk.

- Chinese data can be trusted.

Thanks @Eddy Edson

This is very helpful.

 

[Eddy Edson]

A NY Times interview with Aylward, with some further China colour: https://www.nytimes.com/2020/03/04/health/coronavirus-china-aylward.html

The whole thing is worth reading, but picking out one detail: "80% of cases are mild" doesn't mean just like a little cold: it means not needing oxygen. So it includes being quite unwell - eg pneumonia.

"Taking it on the chin" has a good chance of being pretty unpleasant.

Picking out some other bits:

Is the virus infecting almost everyone, as you would expect a novel flu to?

No — 75 to 80 percent of all clusters are in families. You get the odd ones in hospitals or restaurants or prisons, but the vast majority are in families. And only 5 to 15 percent of your close contacts develop disease. So they try to isolate you from your relatives as quickly as possible, and find everyone you had contact with in 48 hours before that.

You said different cities responded differently. How?

It depended on whether they had zero cases, sporadic ones, clusters or widespread transmission.

First, you have to make sure everyone knows the basics: hand-washing, masks, not shaking hands, what the symptoms are. Then, to find sporadic cases, they do fever checks everywhere, even stopping cars on highways to check everyone.

As soon as you find clusters, you shut schools, theaters, restaurants. Only Wuhan and the cities near it went into total lockdown.

How did the Chinese reorganize their medical response?
First, they moved 50 percent of all medical care online so people didn’t come in. Have you ever tried to reach your doctor on Friday night? Instead, you contacted one online. If you needed prescriptions like insulin or heart medications, they could prescribe and deliver it.

What’s the difference between isolation and hospitalization?
With mild symptoms, you go to an isolation center. They were set up in gymnasiums, stadiums — up to 1,000 beds. But if you were severe or critical, you’d go straight to hospitals. Anyone with other illnesses or over age 65 would also go straight to hospitals.


What were mild, severe and critical? We think of “mild” as like a minor cold.
No. “Mild” was a positive test, fever, cough — maybe even pneumonia, but not needing oxygen. “Severe” was breathing rate up and oxygen saturation down, so needing oxygen or a ventilator. “Critical” was respiratory failure or multi-organ failure.

So saying 80 percent of all cases are mild doesn’t mean what we thought.
I’m Canadian. This is the Wayne Gretzky of viruses — people didn’t think it was big enough or fast enough to have the impact it does.

How good were the severe and critical care?

China is really good at keeping people alive. Its hospitals looked better than some I see here in Switzerland. We’d ask, “How many ventilators do you have?” They’d say “50.” Wow! We’d say, “How many ECMOs?” They’d say “five.” The team member from the Robert Koch Institute said, “Five? In Germany, you get three, maybe. And just in Berlin.”

How did people in Wuhan eat if they had to stay indoors?

Fifteen million people had to order food online. It was delivered. Yes, there were some screw-ups. But one woman said to me: “Every now and again there’s something missing from a package, but I haven’t lost any weight.”

Lots of government employees were reassigned?
From all over society. A highway worker might take temperatures, deliver food or become a contact tracer. In one hospital, I met the woman teaching people how to gown up. I asked, “You’re the infection control expert?” No, she was a receptionist. She’d learned.

How did technology play a role?
They’re managing massive amounts of data, because they’re trying to trace every contact of 70,000 cases. When they closed the schools, really, just the buildings closed. The schooling moved online.
Contact tracers had on-screen forms. If you made a mistake, it flashed yellow. It was idiot-proof.
We went to Sichuan, which is vast but rural. They’d rolled out 5G. We were in the capital, at an emergency center with huge screens. They had a problem understanding one cluster. On one screen, they got the county headquarters. Still didn’t solve it.
So they got the field team. Here’s this poor team leader 500 kilometers away, and he gets a video call on his phone, and it’s the governor.

What about social media?
They had Weibo and Tencent and WeChat giving out accurate information to all users. You could have Facebook and Twitter and Instagram do that.

Isn’t all of this impossible in America?
Look, journalists are always saying: “Well, we can’t do this in our country.” There has to be a shift in mind-set to rapid response thinking. Are you just going to throw up your hands? There’s a real moral hazard in that, a judgment call on what you think of your vulnerable populations.
Ask yourself: Can you do the easy stuff? Can you isolate 100 patients? Can you trace 1,000 contacts? If you don’t, this will roar through a community.

Isn’t it possible only because China is an autocracy?
Journalists also say, “Well, they’re only acting out of fear of the government,” as if it’s some evil fire-breathing regime that eats babies. I talked to lots of people outside the system — in hotels, on trains, in the streets at night.

They’re mobilized, like in a war, and it’s fear of the virus that was driving them. They really saw themselves as on the front lines of protecting the rest of China. And the world.

 

[nonethewiser]

Hand washing, in B&M Friday woman had cleared shelve of hand soap, basket overflowing, no consideration for anyone else who might be old & sick, times like this you realise that we live in dog eat dog society.

Same day, Vine on R2 was saying people were panic buying toilet roll.

 

[grovesy]

An ex colleague of mine was posting on Facebook that they went buy Paracetamol, as they had run out and suffer from headaches and the store was down 2 packs.
I don't need, I usally have a small stock in my medicine cabinet. Top up as and when.

 

[Abi]

Wilko had plenty of toilet roll, tissues and hygeine products such as bleach and other disinfectants today in case anyone is struggling...

 

[Eddy Edson]

Another interview with Aylward: https://www.npr.org/sections/goatsa...says-coronavirus-containment-remains-possible


"As long as you have these discrete outbreaks ... there is the opportunity to control them — to get on top of these and contain them and prevent a lot of disease and ultimately death," says Dr. Bruce Aylward, a senior adviser to the director-general of the World Health Organization. "That's the big message we saw in China — and one of the big surprises."

Aylward led a fact-finding trip in China in February on behalf of the World Health Organization. He says the experience there altered his view of what can be done.

"They actually changed the course of a respiratory-borne outbreak without a vaccine, which was extraordinary," says Aylward. The number of daily new cases in China went from around 2,000 just a few weeks ago to less than 100 in recent days.

But Aylward says other countries may be taking the wrong lesson from China by attributing its success to the government's unprecedented restrictions on daily life in several cities, most famously Wuhan, the city of 11 million people where the outbreak began. There, the government has suspended transportation out of the city and for the most part required people to remain in their homes — with only brief forays permitted to stock up on food and other supplies.

"China has 31 provinces, thousands of cities," notes Aylward. "And it was only a few cities where they took those draconian measures. In the vast majority of them, they ... really went back to fundamentals of public health."

These included ensuring that there was enough testing capacity to quickly identify cases, isolating infected patients, tracing anyone who had contact with them and, when necessary, placing those contacts in quarantine facilities so they wouldn't get infected by the sick person or spread the disease further. Also, in places where clusters of cases were emerging, authorities prohibited mass gatherings.

"That's how they stopped it in the areas with over 1.3 billion people," says Aylward.