Coronavirus

[shyams]

Here in the UK the Government is preparing for the worst case scenario by converting London's Excel centre into a 4000 bed field hospital, specifically for coronavirus cases.

 

https://www.theguardian.com/world/2020/mar/23/nhs-plans-to-turn-excel-centre-into-coronavirus-hospital

 

That is alarming. The epicentre of the epidemic is in London, and if I were a Londoner I would be very scared knowing that they have assigned a contingency plan that involves creating such a large facility to deal with the next few weeks, maybe months, of covid-19.

 

I am not alarmed at all, I look at the news as a positive development. The number of patients will probably rise for a while and the fact that the Govt. is taking concrete, positive actions is welcome.

 

On a separate note, although I have not been very diligently tracking the infection numbers for the UK, early signs are that the new positives have shown a small downturn. It might be due to some of the actions taken last week, or it might be sheer coincidence.

 

However, if the slowdown is real then, fingers crossed, we might see a sharp slowdown in the next week or so provided people continue to obey the social distancing guidelines. I'm hoping this does happen!

[pescetom]

Here in the UK the Government is preparing for the worst case scenario by converting London's Excel centre into a 4000 bed field hospital, specifically for coronavirus cases.

 

https://www.theguardian.com/world/2020/mar/23/nhs-plans-to-turn-excel-centre-into-coronavirus-hospital

 

That is alarming. The epicentre of the epidemic is in London, and if I were a Londoner I would be very scared knowing that they have assigned a contingency plan that involves creating such a large facility to deal with the next few weeks, maybe months, of covid-19.

 

 

4000 extra beds for a 9 million city is hardly a worst case scenario, more like a useful bare minimum precaution.

I prefer not to spell out the worst case scenario unless you really have problems imagining it.

[y66]

There were over 11,000 new confirmed cases in the U.S. today. That's about 2000 more than the *total* number of cases in South Korea.

 

https://ncov2019.live/

[FelicityR]

4000 extra beds for a 9 million city is hardly a worst case scenario, more like a useful bare minimum precaution.

I prefer not to spell out the worst case scenario unless you really have problems imagining it.

 

I agree, Tom. My wording was not quite right. But it's bad enough that in London they expect to have up to another 4000 cases where urgent medical treatment is necessary. Assuming - and this is only an assumption - that 5% of people infected need hospitalisation, that says there will be 80,000 new cases in London alone. That's more than in the whole of Italy since the outbreak began.

 

On a normal day up to 2 million Londoners use the Underground alone. Obviously numbers have dwindled significantly over the past month. But so many people in the UK, until the Government's lockdown 2 days ago, have not adhered to the social distancing rules in place. And I do appreciate it is difficult trying to hold down a job and needing to use public transport to get to work (as I stated in a previous post.)

 

I was actually going to put something along the lines of (in my previous post) "If the government needs a field hospital of 4000 beds in London, then how bad is this epidemic going to get?" But decided against it as that would be scaremongering. But you are right, the actual 'worst case scenario' could be horrifying to even think about. Let's hope for the sake of everyone in the world that finally there is light at the end of the tunnel. I read this article this morning on my computer.

 

https://www.msn.com/en-gb/news/world/province-at-epicentre-of-coronavirus-outbreak-lifts-restrictions-as-china-reports-no-new-virus-cases/ar-BB11F9Ne?ocid=spartandhp

 

There may be an end in sight. Thankfully. Though we all have to accept that beyond China sadly there will be many more deaths until this covid-19 outbreak is finally controlled.

[johnu]

It's not just ICU beds that need to be added to the supply chain. A large percentage of hospitalized COVID-19 patients need mechanical ventilators. In the US, there only about 100K ventilators and a large percentage of them are needed/in use in more or less everyday non COVID-19 emergencies. Once all the ventilators are in use, new patients will have to wait until somebody dies or recovers enough to be taken off ventilation. Potentially hundreds of thousands of people could need ventilators at the same time.

 

Ventilator manufacturers can run their assembly lines in triple shifts if they can get trained workers for all the shifts, but if the entire market for ventilators is only 100K for the entire US, they are going to take a long time to ramp up production to the required levels. Some countries don't have ventilator companies so I'm not sure how they will get increased supplies.

[FelicityR]

It's not just ICU beds that need to be added to the supply chain. A large percentage of hospitalized COVID-19 patients need mechanical ventilators. In the US, there only about 100K ventilators and a large percentage of them are needed/in use in more or less everyday non COVID-19 emergencies. Once all the ventilators are in use, new patients will have to wait until somebody dies or recovers enough to be taken off ventilation. Potentially hundreds of thousands of people could need ventilators at the same time.

 

Ventilator manufacturers can run their assembly lines in triple shifts if they can get trained workers for all the shifts, but if the entire market for ventilators is only 100K for the entire US, they are going to take a long time to ramp up production to the required levels. Some countries don't have ventilator companies so I'm not sure how they will get increased supplies.

 

Yes, John, that is a big factor in the whole coronavirus equation, too. Just over a week ago the UK government asked non-ventilator manufacturing companies to consider making additional ventilators. See this link from the BBC.

 

https://www.bbc.co.uk/news/technology-51909812

 

Edit: This another interesting academic article (that I read this morning) from the Financial Times about covid-19 effectively saying half the UK have been infected.

 

https://www.msn.com/en-gb/news/coronavirus/coronavirus-may-have-infected-half-of-uk-population-—-oxford-study/ar-BB11DVwS?li=BBoPWjQ

[y66]

From Noah Smith at Bloomberg:

 

The U.S. is still not doing enough coronavirus testing. South Korea, famous for its success in containing the virus, does about 10,000 to 18,000 tests a day, which is 200 to 350 tests per million people. Despite recent increases, the U.S. is only at the lower range of that level in per capita terms.

 

At first, the failure to ramp up testing came from federal agencies. The Food and Drug Administration failed to approve most tests, allowing only a single product developed by the Centers for Disease Control and Prevention. When the CDC bungled the rollout of that test, the U.S. lost crucial weeks in the fight. Eventually, the FDA approved a broad range of tests, including from private companies, alleviating the shortage. As a result, testing rose from insignificant levels two weeks ago to the mediocre level they’re at now.

 

But a new problem threatens to reverse even this tepid progress: a shortage of personal protection equipment. Medical workers who do coronavirus testing need to wear masks, gowns and other items to prevent them from being infected after dealing with large numbers of infected patients. Another problem is a shortage of the cotton swabs used to carry out the tests.

 

It seems almost unthinkable that shortages of these simple materials could hamstring the medical system of the country with the biggest economy on the planet. Economist and long-time policy adviser Larry Summers wondered how this could happen:

 

Thoughts at the end of a long week:

 

Why can’t the greatest economy in the history of the world produce swabs, face masks and ventilators in adequate supply?

The reason is offshoring. Over the years, the U.S. has outsourced the production of items such as masks, mostly to China -- which is now reluctant to allocate any of its production capacity to the U.S., given its own needs and the deteriorating relations between the two countries. Making these objects is technologically somewhat challenging, but it’s also a low-margin, commoditized business -- there’s little in the way of network effects or brand value or patents to yield big profits. So it made sense for the U.S. to focus on higher-value things at the beginning and end of the supply chain -- medical services that make use of masks, marketing and distribution, and innovation of technologies used to create better masks.

 

This was an example of thinking on the margin. Economics predicts that businesses decide what to produce based on what makes a little bit more profit. The siren song of marginal profit drew the U.S. relentlessly away from mask production.

 

The problem is that when the economy suffers a huge shock such as a war or a pandemic, the margin vanishes. The U.S. economy is projected to shrink by 30% or more in the second quarter as a result of the coronavirus, and the necessity of doing mass testing has created an abrupt shift in the demand for protective equipment and swabs. What made economic sense yesterday doesn’t make sense today.

 

Eventually the U.S. will reconfigure its economy in response to these shocks. Domestic mask and swab factories will open, or existing facilities will be repurposed to make them. But that will take time, and the U.S. needs more testing now. Lockdowns can suppress the virus, but only at great economic cost; as soon as restrictions end and people go back to their jobs, coronavirus will come roaring back unless the country has a strict regime of widespread testing and contact tracing in place. Thus, every day that the economy fails to provide enough masks and swabs is another day that it has to remain in shutdown.

 

If businesses will always make decisions on the margin, then it’s government’s job to insure the country against big shocks such as pandemics and wars. The U.S. could have used trade barriers and government support to make sure that the entire supply chain for medical equipment stayed in the country. But government action against offshoring has long been stigmatized, including by Summers himself, who in 2012 lambasted offshoring skeptics as “Luddites.”

 

The coronavirus crisis should cause advocates of unrestricted free trade to rethink their blanket opposition to protectionism. An economy based entirely on far-flung supply chains is more profitable in normal times, but when a crisis hits, it can quickly become a liability. Items such as masks and swabs are too crucial to be left to the whims of international markets.

[pescetom]

Today's statistics in Italy: positive 54030 (+6%), dead 6820 (+10%), no longer infected 8326 (+12%). Intensive care 3396 (+3%). Fatality rate 11.5%.

So the drop from 20% to around 7% in growth rate of positives is confirmed but not necessarily heading further downwards, we will see.

There has been significant although not dramatic growth in Tuscany and Lazio, perhaps taking the shutdown less seriously than the north.

 

11 new cases in our town today, but the local hospital can still cope. The health service problem is not just Covid19, however, the knock-on effect on capacity to treat other illnesses is as yet undiscussed but almost equally frightening. A young mother I know has just been diagnosed with liver cancer and urgently needs to be operated, but there is no possibility to plan the operation at all, even privately. Normally she would have been operated the same day.

[pilowsky]

On a personal note, like most of you that I have spoken to, I have all of the risk factors in the list. I don't have cancer yet but most of my family die of it. I am a doctor, a scientist and a statistician but I still get colds and I still get fooled by simple things. But I do learn quickly. I have just been in self-isolation for three weeks. Fortunately i have a good GP who tests his patients for viruses so the department can know when the annual influenza pandemic starts. It turns out I had a rhinovirus. Also a RSV respiratory syncytial virus that you can die of. I had to be on antibiotics for two weeks and started taking lessons with Pete Hollands. Now i can play in a 4/4 fit much more successfully. I improved after 2 weeks but then got worse again. My doctor sent me to a drive-in lab. where I had a swab that came back positive for rhinovirus and negative for sars-cov-2!

It took me a while to discover that Covid-19 is a disease caused by a virus called sars-cov-2. And I thought bridge was a difficult game. Well I hope you guys keep healthy. Keep thinking: as the Sundance Kid said: that's what we're good at.

[FelicityR]

11 new cases in our town today, but the local hospital can still cope. The health service problem is not just Covid19, however, the knock-on effect on capacity to treat other illnesses is as yet undiscussed but almost equally frightening. A young mother I know has just been diagnosed with liver cancer and urgently needs to be operated, but there is no possibility to plan the operation at all, even privately. Normally she would have been operated the same day.

 

I am sorry to hear that, Tom. I also had a situation where my best friend's sibling in Ireland needs to be transferred from one hospital to another to have a major operation (cancer, too) and their transfer has been delayed, as before they can go they need evidence that the patient hasn't got covid-19.

 

The Irish viral testing service has been inundated with tests and is now working 24 hours around the clock. However, given the seriousness of the operation, they have made every effect to fast track it. Thankfully, it looks like the operation will go ahead now. But it has been extremely worrying time for my friend who has had to wait a few extra days, many in tears.

[y66]

I have no idea if a homemade mask will have any helpful effect.

 

But it can't hurt to try making one and wearing it, as long as you don't go outside or go near people any more than you otherwise would have without the mask.

The Czech Republic went from zero mask usage to 100% in 10 days, and in the process they halted the growth of new covid-19 cases.

 

How? They made their own! They didn't need government help; they did it themselves.

 

It's time for #masks4all. See why:

[FelicityR]

A medical mask, or for that matter any mask covering the mouth and nose, even a scarf - if you cannot get or make a mask - is a semiotic way of showing that you are taking this covid-19 epidemic seriously.

 

I'm still surprised at how many people are still walking around outside without one. They're easy enough to order online, and the sellers I used despatched them quickly.

 

They are not a guarantee that you won't be infected with covid-19, but they are a form of protection, and it's better to have some protection than none at all. And, if you have the covid-19 virus, you are also less likely to pass it on to someone else if you wear a mask.

 

Edit: This academic article from Scientific American I found a very interesting read.

 

https://www.scientificamerican.com/article/how-chinas-bat-woman-hunted-down-viruses-from-sars-to-the-new-coronavirus1/

[pescetom]

Today's statistics in Italy: positive 62013 (+8%), dead 8165 (+10%), no longer infected 10361 (+11%). Intensive care 3612 (+4%). Fatality rate 11.6%.

So the new rate around 7% seems stable, unfortunately.

 

The local hospital received 50 more today and is full, even after having given over three wards including orthopedics.

[Cyberyeti]

When looking at the UK statistics, remember there is a blip over the last day or so, they've changed the time of day they're taking the calculation so there will be one aberrant number where (I think) a short day is measured.

[y66]

It's encouraging to see what

, MIT engineers and Czech engineers are doing to expand ventilator capacity asap.

 

Edit: This NYT story has more info about Dr.Babcock's ventilator hack: https://www.nytimes.com/2020/03/26/health/coronavirus-ventilator-sharing.html?action=click&module=Top%20Stories&pgtype=Homepage

[shyams]

It's encouraging to see what

, MIT engineers and Czech engineers are doing to expand ventilator capacity asap.

Thank you. I have copied the links (especially the Charlene Babcock video) and shared on WhatsApp so that the doctors in my contacts can see this. If it gets circulated widely, it might generate the necessary awareness to ensure hospitals adopt it where practical.

[y66]

Thank you. I have copied the links (especially the Charlene Babcock video) and shared on WhatsApp so that the doctors in my contacts can see this. If it gets circulated widely, it might generate the necessary awareness to ensure hospitals adopt it where practical.

I edited my post to link to this NYT story which is where I read about Dr. Babcock's ventilator hack: https://www.nytimes.com/2020/03/26/health/coronavirus-ventilator-sharing.html?action=click&module=Top%20Stories&pgtype=Homepage

[pescetom]

Today's statistics in Italy: positive 66414 (+7%), dead 9134 (+12%), no longer infected 10950 (+6%). Intensive care 3732 (+3%). Fatality rate 12.1%.

The new rate around 7% remains stable, as does the fatality rate around 11.5%.

 

I read that Israel is testing 64 samples at once on the assumption that often all will be negative - somehow I don't think that would work well here.

[FelicityR]

Today's statistics in Italy: positive 66414 (+7%), dead 9134 (+12%), no longer infected 10950 (+6%). Intensive care 3732 (+3%). Fatality rate 12.1%.

The new rate around 7% remains stable, as does the fatality rate around 11.5%.

 

I read that Israel is testing 64 samples at once on the assumption that often all will be negative - somehow I don't think that would work well here.

 

Surprisingly, in the UK 'experts' - I use that term very, very loosely - expect the epidemic to peak next Sunday, April 5th.

 

https://www.mirror.co.uk/news/politics/coronavirus-outbreak-peak-could-next-21769853

 

I am not so convinced. They used the Chinese model to base those figures. In the UK we are, in most respects, 2 weeks behind Italy. Like Italy, we are a European country with a similar population distribution, but upside down by location. Only a difference of just over 10% in population numbers, too.

 

The statistics taken from Wikipedia bear this out (Italy first): First death 21/2/2020, 5/3/2020; 1000 cases 29/2/2020, 14/3/2020; 1000 deaths 12/3/2020, estimated 28/3/2020; 10,000 cases 10/3/2020, 26/3/2020, etc.

 

The biggest difference is that parts of Italy were first put under quarantine on the 22nd February, whereas in the UK that happened on the 23rd March. That is four weeks, not two.

 

The outbreak hit some large towns in Italy, but the epicentre of the outbreak in the UK is London and Birmingham, the two largest cities. I honestly cannot see the lockdown being relaxed in 2 weeks time. Common sense just says to me that this is going to on for months, perhaps over 3 months before restrictions are lifted. That's not being pessimistic, but realist. What do you think? I'm always interested in other people's views.

[Cyberyeti]

Surprisingly, in the UK 'experts' - I use that term very, very loosely - expect the epidemic to peak next Sunday, April 5th.

 

https://www.mirror.co.uk/news/politics/coronavirus-outbreak-peak-could-next-21769853

 

I am not so convinced. They used the Chinese model to base those figures. In the UK we are, in most respects, 2 weeks behind Italy. Like Italy, we are a European country with a similar population distribution, but upside down by location. Only a difference of just over 10% in population numbers, too.

 

The statistics taken from Wikipedia bear this out (Italy first): First death 21/2/2020, 5/3/2020; 1000 cases 29/2/2020, 14/3/2020; 1000 deaths 12/3/2020, estimated 28/3/2020; 10,000 cases 10/3/2020, 26/3/2020, etc.

 

The biggest difference is that parts of Italy were first put under quarantine on the 22nd February, whereas in the UK that happened on the 23rd March. That is a four week difference.

 

The outbreak hit some large towns in Italy, but the epicentre of the outbreak in the UK is London and Birmingham, the two largest cities. I honestly cannot see the lockdown being relaxed in 2 weeks time. Common sense just says to me that this is going to on for months, perhaps over 3 months before restrictions are lifted. That's not being pessimistic, but realist. What do you think? I'm always interested in other people's views.

 

How long it goes on for and when it peaks are different questions. Ideally a flat peak rather than a sharp one is what we're aiming for so the problem will go on for a long time after the peak.

 

Italy and the UK are very different population profiles, Italy has twice as many over 65s and nearly twice as many smokers, so while the spread may not be different, Italy is likely to have more deaths per same number of cases.

[pilowsky]

The comment about different smoking habits is accurate, but it must also be remembered that the Italian diet differs markedly from the British diet. In addition, there are genetic subtleties such as thalassemia (Italy) or sickle cell (African-American) disorder that could have differential effects. Finally, I recall being at a hypertension conference where the head of a British Heart Institute (Prof. Anna Dominiciak) remarked that she sometimes referred to the British as "the control group of Europe because they never took their tablets". The point is that there are multiple risk factors in each population that contribute. We still know very little. I congratulate BBO again on picking up the slack as the worlds physical bridge clubs close.

[pescetom]

Today's statistics in Italy: positive 70065 (+5.5%), dead 10023 (+10%), no longer infected 12384 (+13%). Intensive care 3856 (+3%). Fatality rate 12.5%.

So maybe a first sign of the rate dropping again, or maybe just a reporting hickup, see in next few days.

Ten thousand dead is no hickup though.

The Prime Minister is giving a press conference right now, see what he has to say beyond extending the lockdown.

[cherdano]

I know pescetom tried to tell us, but I still didn't appreciate how quickly the virus becomes personal.

5 days ago I didn't know anyone personally of whom I knew they had the virus.

Then I've learned that our next door neighbours are quite sure she had/he currently has the virus. (Both are fine.) Yesterday I learned that a family that are some of our best friends have all four tested positive, and that a collaborator had stopped his lecture before everything was getting closed because he started having symptoms compatible with coronavirus. And just now I learned two people in my street are in hospital with covid-19, and the third one in their flat was bad enough to call an ambulance earlier today (but he is staying home for now).

 

Stay home. If you do go out, wear a mask. (Home-made is fine.) Wash your hands.

[Cyberyeti]

I know pescetom tried to tell us, but I still didn't appreciate how quickly the virus becomes personal.

5 days ago I didn't know anyone personally of whom I knew they had the virus.

Then I've learned that our next door neighbours are quite sure she had/he currently has the virus. (Both are fine.) Yesterday I learned that a family that are some of our best friends have all four tested positive, and that a collaborator had stopped his lecture before everything was getting closed because he started having symptoms compatible with coronavirus. And just now I learned two people in my street are in hospital with covid-19, and the third one in their flat was bad enough to call an ambulance earlier today (but he is staying home for now).

 

Stay home. If you do go out, wear a mask. (Home-made is fine.) Wash your hands.

 

I personally know nobody with it, but the list of well known people with it grows.

 

What's the current opinion on masks ? I heard many doctors in the early days of the virus saying they weren't effective.

[hrothgar]

What's the current opinion on masks ? I heard many doctors in the early days of the virus saying they weren't effective.

 

I think that there was a deliberate attempt to downplay the effectiveness of masks during the early stages of the pandemic in order to try and prevent hoarding and preserve capacity for medical professionals who are the ones who most need them.

 

I think that the conventional wisdom wrt masks remains unchanged

 

Masks are quite effective at stopping infected individuals from spreading the virus

Masks are somewhat effective at stopping people from contracting the virus

The material that masks are made from matters enormously (linen and silk are much better than loose cotton)