Non-Trump Corona virus news and analysis cont.
June 23, 2020 10:27 AM   Subscribe

 
Chewy!

Details from the one about Ireland: 66% of nurses are out sick, COVID-19 is not considered a work-related injury for them, and no national arrangement for childcare has been made... but the Irish air industry is insisting that isolation for incoming travelers has to be cancelled for economic reasons.
posted by clew at 10:53 AM on June 23, 2020 [9 favorites]


Ironically for all the noise that there has been about them, the tracing apps seem to:

-Not work that well due to bluetooth ranging (not surprising)
-Not work because people don't like to receive exposure notifications from an app (and hybrid app + contact tracing systems like the one the UK attempted to develop have been disallowed by Google and Apple)

I've got some very detailed thoughts about contact tracing apps and the UK implementation of them (not as bad as some think, not remotely as good as it should have been) that I'll post later, for now I'll just share the thought that nobody has a known working contact tracing app (in the sense that it delivers notable reduction in transmission) except for countries that use super-intrusive, panopticon style mobile tracking. Not Germany, certainly not France, and not anywhere in the US.
posted by atrazine at 11:20 AM on June 23, 2020 [1 favorite]


And in the US, a potentially big nurses' strike for staffing and PPE to basic safety levels:
HCA reportedly created a unit focused on strike-related labor shortages, offering nurses who appear for shifts during strikes higher pay than they currently receive and a free continental breakfast.
posted by clew at 11:21 AM on June 23, 2020 [4 favorites]


A relative contacted me claiming that a spanish doctor released something saying that covid is caused by parasites and australia was treating it with anti-parasite drugs and aspirin and that's why they had no cases now(ORLY?). Does anyone have any clue where this comes from so I can point to it while explaining that it's bullshit? I have googled it and found nothing.
posted by If only I had a penguin... at 11:26 AM on June 23, 2020


The closest I got is that the CSIC (the national research institute) is looking into "molecular parasites" to impair the replication of the coronavirus. Not parasites as usually understood, but these molecules. A very poor language choice in my opinion.
posted by sukeban at 11:36 AM on June 23, 2020


I'm a little frustrated at the media's eagerness to write "second wave" stories about other countries.

The South Korea one, for instance has a population of nearly 40 million, and the 'second wave' stories are about localized measures being taken after experiencing 40-60 new cases per day nationwide. That's not a second wave.

The same with the stories out of Beijing. That's around 200 cases, with huge surveillance and testing.

I worry these stories will make it seem inevitable that there will be periodic large outbreaks, and inspire a sort of fatalism about efforts to reduce the spread.
posted by thenormshow at 12:48 PM on June 23, 2020 [16 favorites]


I agree with the above. Last night I saw a story about cases surging in the US, Brazil, and Germany. Surprised to see Germany on the list, I looked up the case trend in that country to find a slight week over week increase from a very low level likely caused by a day with an anomalously high number of cases surrounded by days with little or no cases.

Part of me thinks its American journalists struggling with the fact that other countries seem to be able to accomplish something that the American government failed to do. Another part of me just thinks they are only interested in pushing a story and therefore jamming in any evidence they can find regardless of whether or not it fits.

I think the net effect probably will be for people to tune it all out eventually. I think that already may be happening because the media spent the entire month of May trumpeting "spikes" in cases tied to one day increases. Now that cases actually are spiking in a number of states, people might no be giving it as much attention as they would if the media hadn't "cried wolf" so many times in the past.
posted by eagles123 at 1:03 PM on June 23, 2020 [1 favorite]


nobody has a known working contact tracing app

Italy’s app Immuni (its overpromise right there in the name...) has been downloaded by 6% of the population since it was released a week ago. Germany’s app by twice that proportion. Both need 60% adoption to be functional.

The single case notified in Puglia so far made the news because the lady was told to self-quarantine for 14 days, but was so far denied a test. The fact that France’s app has only notified 13 cases so far also made the Italian news today, as a corolllary to the general feeling of app shmapp, this one’s down to humans aligning with other humans, there’s no tech shortcut that’s going to pass muster.
posted by progosk at 1:05 PM on June 23, 2020 [1 favorite]


Antibody levels in recovered COVID-19 patients decline quickly: research (Reuters, June 23, 2020) Levels of an antibody found in recovered COVID-19 patients fell sharply in 2-3 months after infection for both symptomatic and asymptomatic patients, according to a Chinese study, raising questions about the length of any immunity against the novel coronavirus. The research, published in Nature Medicine on June 18, highlights the risks of using COVID-19 ‘immunity passports’ and supports the prolonged use of public health interventions such as social distancing and isolating high-risk groups, researchers said.
--
Note, it's a super-small study: The researchers compared 37 asymptomatic people to an equal number who had symptoms in the Wanzhou District of China. The investigators found that asymptomatic people mount a weaker response to the virus than those who develop symptoms. (NY Times, June 18, 2020). The sample size is small, however, and the researchers did not take into account protection offered by immune cells that may fight the virus on their own or make new antibodies when the virus invades. A few studies have shown that the coronavirus stimulates a robust and protective cellular immune response. [...] A second paper, published on Thursday in the journal Nature, suggests that even low levels of antibodies might be enough to thwart the virus.
--
Gee, appreciate the context, NYT... Hang on; the NYT article's "cellular immune response" links to "Targets of T Cell Responses to SARS-CoV-2 Coronavirus in Humans with COVID-19 Disease and Unexposed Individuals" from May 20, with "Caveats of this study include the sample size and the focus on non-hospitalized COVID-19 cases. Sample size was limited by expediency." What does that -- "we initially recruited 20 adult patients who had recovered from COVID-19 disease [...] We also utilized peripheral blood mononuclear cell (PBMC) and plasma samples from local healthy control donors collected in 2015–2018."

As for the other link... "Here we report on 149 COVID-19 convalescent individuals," so that second Thursday paper isn't as heartening as one would expect given the framing, either.
posted by Iris Gambol at 1:55 PM on June 23, 2020 [1 favorite]


Antibodies are only part of the immune system story, and it is not necessarily the case that declining antibody counts mean that a recovered person (whether asymptomatic or symptomatic) can catch the disease again or that they will necessarily be substantially contagious if they do.

It does suggest that reinfection is at least possible, however, and that's another reason (along with highly unreliable antibody tests) that it's too soon to contemplate "immunity passports".
posted by jedicus at 2:34 PM on June 23, 2020 [5 favorites]


An interesting article that provides some context regarding research into the immune response to COVID-19:

Thoughts on Antibody Persistence

From the article:

."....So my advice is not to panic, but not to be complacent, either. The complexities of the immune system mean that we have a whole range of possible situations in how this pandemic is unfolding. At the most optimistic end, it is possible that a larger percentage of the population than we realize might already be protected (to some degree) from the coronavirus. Unfortunately, it’s also possible that almost everyone is, in fact, still vulnerable and that we just haven’t seen the virus run through most of the population yet. Everyone will have seen the various population surveys with antibody testing that have suggested, in most cases, that a rather small percentage of people have been exposed. Think of the various ways you could get such a result: (1) it’s just what it looks like, and most people are unprotected because they have so far been unexposed. (2) the antibody results are what they look like – low exposure – but people’s T-cell responses mean that there are actually more people protected than we realize. (3) the antibody results are deceiving, because (as this latest paper seems to show) the antibody response fades over time, meaning that more people have been exposed than it looks like. And that means you can split that into (3a) the antibody response fades, but the T-cell response is still protective and (3b) the antibody response fades and so does the T-cell response. That last one is not a happy possibility......"

I would strongly encourage reading the article because it provides a good summary of the sometimes counterinuitive and seemingly always complex emerging research regarding the immune response to SARS-COV-2.
posted by eagles123 at 3:42 PM on June 23, 2020 [5 favorites]


A relative contacted me claiming that a spanish doctor released something saying that covid is caused by parasites and australia was treating it with anti-parasite drugs and aspirin and that's why they had no cases now(ORLY?). Does anyone have any clue where this comes from so I can point to it while explaining that it's bullshit? I have googled it and found nothing.
posted by If only I had a penguin... at 11:26 AM on June 23 [+] [!]


Probably due to the use of ivermectin to treat it in some places, which is also an anti-helminthic medicine.
posted by fshgrl at 4:11 PM on June 23, 2020




A relative contacted me claiming that a spanish doctor released something saying that covid is caused by parasites and australia was treating it with anti-parasite drugs and aspirin

IoIhap: it's one of the myriad WhatsApp fake claim chains making the rounds.
posted by progosk at 1:44 AM on June 24, 2020


more on European digital contact tracing efforts: France's embattled StopCovid app, which eschewed the Apple/Google API, saw 1.8 million downloads so far, but also 460.000 subsequent uninstalls. And: a Latvian insider questions the ramifications of the stark choices governments found themselves facing, given the technological bottleneck/stranglehold implicit in the design of these apps.
posted by progosk at 2:20 AM on June 24, 2020


Track & trace, apps & overall effectiveness

First, we need to consider the overall role of contact tracing in pandemic control and how effective it is likely to be for SARS-CoV-2 only then can we consider various app designs in that context and see what different apps might be able to do for us.

Contact tracing when a substantial number of people are asymptomatic and when transmission peaks at or before symptom onset is really hard.

For example, taking the most recent UK data:

The ONS estimated that from the 31st of May to the 13th of June, there were an average of 3,800 new infections a day in the community. You would expect rather more at the beginning and rather less by the end of that period. The Kings College symptom tracker is about the same.

About 1.5k a day are testing positive.

In the week 4th to 10th of June (most recent, the next data release is tomorrow for the week after that), about 6k were referred for contact tracing. It is fair to assume these were all community acquired rather than hospital acquired as the latter are internally traced.

That means that of the 26.6k community infections, 23% are testing positive and being referred for contact tracing.

Of those, 75% were reachable and 90% of their contacts were reached (67.5% contacts reached in total)

Therefore:
77% are not being caught at all
23% are being traced at 67.5% effectiveness

Total effect on community (non-institutional transmission) is about a 16% reduction in community transmission. So if your community transmission had an Rt of 1.1 before tracing, it would 0.93 after tracing.

When these figures were released, the press was very loud on a quarter being unreachable and on 10% of contacts not being reached but these are actually not such a big deal compared to only 23% of the estimated primary infections being spotted.

If I were in charge of improving the test & trace service, I would want to improve the 75% contactable known primaries (as that is just sloppy NHS record keeping, not getting good contact information) but it might not be my primary concern when I was getting less than quarter into the system to begin with. Of course, as contact tracing improves, that number improves as well - you would expect that every week the fraction improves because many new infections will be contacts from the week before. We will see if that does in fact occur.

Where will an app help us? Capturing people who are nearby but not known to the primary infected person. At the moment, this will be very few people anyway, this will change.
posted by atrazine at 6:35 AM on June 24, 2020 [3 favorites]


There are two ways we can use the fact that we all carry pervasive location trackers with us at all times.

The obvious way is to directly use the phone location data, either through cell data or through mandatory phone-level geolocation and transmission to a central system. This was done after the Salisbury poisoning to find the contact information of everyone who had been near the Skripals (very good drama on the BBC if you have access to that).

China and South Korea do this. They have teams of people who combine credit card data, CCTV, and phone location data to find anyone who has been near an infected person. In SK, they also publish a summary of that data. In one recent case there was a cluster of infections from several gay clubs, not great to have that published if you're in the closet which is still rather common there.

We know that this works.

The second way to do is to use a "minimally disclosive" technique. This means designing a clever way to use technology like Bluetooth + cryptography to reveal just enough information to notify people of contacts. All such technology reduces privacy. Different groups have had different ideas of what constitutes "minimal" in this context. There are two broad designs out there. DP3T and PEPP/Robert.

It is important to emphasise that there are no known working implementations of minimally disclosive contact tracing apps out there. Germany has an app, many people have downloaded it. Does it work in reducing transmission? We don't know that yet. I hope so. If it works well then we're on track to being rid of coronavirus. Note that South Korea with its much more intrusive and complete panopticon of contact tracing still has flare ups though...

They are actually very similar. Both use rotating Bluetooth keys which they exchange with other devices to develop a distributed list of who was near whom. Neither system records location data, both systems require a trusted state party.

There are limitations to using Bluetooth this way because radio waves propagate very differently. Using signal strength to measure proximity is limited by the other things which attenuate signal. Walls are one but that is actually fine, if you're on the other side of a wall you might register as being 10m+ away and therefore not a risky contact which is actually correct. Pockets and bags are more of a problem since that can affect signal strength without affecting transmission of the virus.

NHSX built up a dataset of distance vs signal strength curves that corrected for whether a phone is being used and therefore "in the open" or not being used and therefore presumably in a pocket or bag. This has apparently been shared back to Apple and Google to improve the ranging protocol. I'm honestly not clear how useful this is or whether it was NHSX just trying to save face. We'll see.

DP3T is what Apple and Google have chosen to build their API for. There are distributed attacks against it that can deanonymise / reidentify users but the state party to the system has no special insight. One reason they have chosen this is because it has to work everywhere. I might be ok with my government being able to track me in the UK (partially because I know that they already can, so the incremental loss of privacy is minor) but that is not true everywhere since most countries do not have such pervasive surveillance.

In this protocol, exchanged keys are never sent to the central server. Instead, they give you an unlock code when you test positive. You use that to sign a message which lists the secret keys of all the phones your phone was near. Other phones download that list and check to see if one of their keys is on it. If so, you are a contact.

In PEPP which was used by NHSX in the UK and by the French, you send your list of recorded secret keys to a central server if you develop symptoms. They can then match those keys to phones and notify users that they need to isolate. This is not vulnerable to a distributed re identification attack but does allow the state party to build a view of the social contact graph based on the shared keys.

There are several disadvantages to DP3T over PEPP.

First, there is no way to combine this with traditional contact tracing. You can run them alongside each other but you cannot feed that data into your contact tracing team.

Second, the PEPP design as implemented by NHSX allowed you to warn users if you felt symptoms and then confirm if you got a positive test. Given the timing of transmission this can give you critical time. People might get a message overnight to preemptively quarantine but then be released 24 hours later if the primary had a negative PCR or clinical diagnosis. Yes that would be annoying but it would also massively reduce infections.

Third, PEPP's central design allows you to revoke notifications if there is abuse. This is necessary in a design that allows "warn on symptom" as otherwise people could flood the system. Suspicious notifications can also be preemptive reviewed and potentially filtered.

Fourth, PEPP allows you to assign different cohorts to risk classes. Imagine that you have 50 contacts of a known infected person spread evenly over five days. Do they all have the same risk? Probably not. As we develop knowledge of infection/transmissibility time dynamics we can improve our risk assignments.

If by day 7 post exposure, zero of the 10 people from day 1 have developed symptoms then we can make distributional assumptions and potentially release them all from quarantine before the 14 days are up. The 14 is a long-stop for developing symptoms, if nobody has developed them by day 7 from a group of 10 we might determine that the primary was not infectious on that day.

All that being said, Apple and Google have to consider their global customer base and would put themselves in a very difficult position if they supported PEPP for the UK and France and not for other countries. I understand their position but I do think it is strange to think it is so virtuous that tax dodging multinationals can essentially thumb their noses at the requests of notionally sovereign nation states during a pandemic.

This is ultimately what doomed the NHSX PEPP implementation. Apple will background and switch off bluetooth apps over time. They developed a very clever workaround which involved using bluetooth slightly differently on android and IOS devices, essentially ping ponging "keepalive" signals between each other. It did work rather well as long as people stayed in crowds but when an iphone user walked away from the crowd (and away from Android devices doing keepalive broadcasts) their app would background. Imagine that you walk to the train station - you could switch the app on as you leave the house and it would be off by the time you get to the station.

For all its advantages in theory, if Apple won't support it on their devices with special privileges then it won't work in practice.

Every two-bit javascript developer and his dog has been out insisting that "obviously" this wouldn't work and why didn't they just use the Apple/Google solution to begin with. I object to this because of the public health advantages of the PEPP design. It's fine to believe that these do not outweigh the privacy downsides as long as you acknowledge that it is not known whether either of these apps will work to reduce transmission. It's frankly dumb to claim that picking the DP3T design comes with no trade-offs in efficacy, especially since we don't know the absolute efficacy of either design.

Luckily NHSX started working on a backup app in late May which is based on the supported Apple/Google protocol. (and then very strangely denied that they were, really weird comms strategy since that would only have reassured people and was indeed the right thing to be doing!)

The real kicker is that they found from their trial on the Isle of Wight that people really do not like receiving this info from an app in the first place. So the strategy has shifted to getting people used to the idea of contact tracing before launching an app.

I do still hope that they are able to improve ranging performance and get adoption up worldwide of these things, even if they only reduce transmission by 10% or 20%, that is freedom to relax other measures that we would otherwise not have.
posted by atrazine at 7:20 AM on June 24, 2020 [8 favorites]


Health BC (Canada) has been doing a really good job of communicating with the public. Here is their latest technical briefing. It might help people in other regions understand the variables involved in responsible planning; it helped me.

It estimates BC's Rt (average new infections per case) at a hair under 1 (margin of error +/- 0.25). We're on a knife edge between stability at our current low case count and exponential growth.

The briefing includes the following two key pieces of information, and explains how they are interrelated:

- Mobility index, a measure of how often people are interacting. There's a neat graph of smartphone GPS data showing how often residents are going out and where we are going. Currently, contact rates are estimated at about 65% of normal.

- Projected consequences of various levels of track-and-trace efficiency (graphed by percent of contacts traced, and by how quickly they are traced)

What it's describing is a race between slowly increasing contact rates and slowly improving track-and-trace capabilities. It provides some appropriately terrifying projections of exponential growth if contact rates rose to 80% of normal.

I find this report encouraging, both because the reasoning behind current policy seems sound and because being provided with detailed information makes me feel as though I'm being treated like an adult.
posted by justsomebodythatyouusedtoknow at 8:44 AM on June 24, 2020 [5 favorites]


Here in Edmonton (Canada) with a population of 1.3 million, we had actually made it down to about 1 new case per day a couple of weeks ago. Now, we have added approximately 160 cases in the last week alone. And the attitude I'm seeing is "Yeah, this was expected, no biggie, we are never locking down again". Mind you, this is on reddit, but the government has made no noises whatsoever about this rise being concerning.

This province only cares about the economy. I was very proud of our response up until we moved to phase II (larger gatherings allowed, more businesses opening) earlier than projected. The - perhaps unintended - effect of doing this was communicating to people that there is nothing to worry about any longer. Now we have have 2 hospital outbreaks, I think 3 long term care outbreaks, an outbreak at a waste management facility...And five restaurants have shut down because of cases and potential transmission. I'm so disappointed. Why can we not make masks mandatory?

This rise in cases especially concerns me because I would really, really like my child to be able to attend in-person school in the fall. At this rate, I can't see it happening.
posted by kitcat at 9:03 AM on June 24, 2020 [3 favorites]


Back in May, Erin Bromage wrote an excellent blog post outlining what we know about how SARS-CoV-2 spreads: The Risks - Know Them - Avoid Them. Now he’s written a piece for CNN about the role of people under 40 in spreading the virus: People in their 20s and 30s are spreading the virus (sorry for linking to the AMP version but on the regular site there’s an unrelated auto-playing video on the page). A friend of mine pointed out that we don’t know whether people under 40 are going out irresponsibly because they feel safe (and are unconcerned about others), or if people under 40 are more likely to hold jobs that force them to be exposed. Regardless, I think it's useful to discuss details of how the virus is still being spread. And this is a good reminder that the measured death rate might appear to be dropping not because the virus is less dangerous than we thought, but because the demographics of who is being infected don't match the demographics of the population as a whole.
posted by Tehhund at 11:48 AM on June 24, 2020 [5 favorites]


Surprised to see Germany on the list, I looked up the case trend in that country to find a slight week over week increase from a very low level likely caused by a day with an anomalously high number of cases surrounded by days with little or no cases.

There was an outbreak at a meat processing factory in Nordrhein-Westfalen, which has been pushing up the numbers in Germany, particularly the R number - it was over 2. (Though the RKI report from today seems to have it down below 1 again.) I think it was this, rather than the actual increase in the number of cases that was being reported - I know that's what my mother was asking me about. (I'm in Germany, whereas she isn't.)

This isn't a small outbreak - there were reports of over a thousand cases associated with it, and one of the areas (Kreis) Gütersloh has had more cases in the last 7 days than it had up to then. However, so far it is pretty localised, and they are doing their best to keep it that way, and the affected areas have been locked down hard.
posted by scorbet at 12:30 PM on June 24, 2020 [3 favorites]


So, recently re-opened Italy now has its own new Covid-19 hotspots and, surprise surprise, they're along the same socio-economic faultlines as other countries', the main ones still in various old-age care facilities, plus in a northern logistics hub and in a southern undocumented-worker domitory neighborhoods, and it's bringing out the basest reactions in folks...
posted by progosk at 7:54 AM on June 26, 2020


This, in my opinion, is the direction we need to be heading in. Locking down entire countries and preventing people from seeing family and friends or doing anything meaningful with their lives on a long-term basis is not sustainable.

I tend to agree with this, but I think its worth pointing out the difference between relatively localized outbreaks in countries with established infrastructure to test, trace, quarantine, and contain, and the US, where it is impossible to speak of containment or source-able outbreaks. There are US states where cases are rising exponentially, and even in states where cases aren't rising, the existence of such containment infrastructure has yet to be proven. We'll find out in the coming weeks.

All that being said, and to your overall point, I get the feeling many in the US government and business elite are sort of giving up short of overruns of hospital capacity such as Texas is currently experiencing. Beyond the mental health and social impacts, the US economy and US society simply can't sustain prolonged shutdown until we get to a vaccine. The effects on school-aged children, for one, would be catastrophic. Moreover, shutdowns of such length and severity would be somewhat unprecedented. We didn't even have such prolonged shutdowns during the Spanish flu; although, of course we had shorter localized shutdowns at the height of the epidemic and we instituted social distancing measures such as wearing masks for longer time-periods, which people also complained about at that time.
posted by eagles123 at 1:57 PM on June 26, 2020 [1 favorite]


The peak
Inside the mind of Dr Jim Down, one of the consultants in charge of critical care at London’s University College Hospital, on the night of the peak number of deaths from Covid-19.
posted by adamvasco at 2:47 PM on June 26, 2020 [1 favorite]


Coronavirus: Warning thousands could be left with lung damage (BBC, June 23, 2020) "Tens of thousands of people will need to be recalled to hospital after a serious Covid-19 infection to check if they have been left with permanent lung damage, doctors have told the BBC. Experts are concerned a significant proportion could be left with lung scarring, known as pulmonary fibrosis. The condition is irreversible and symptoms can include severe shortness of breath, coughing and fatigue.

"NHS England said it was opening specialist rehabilitation centres."

Ireland will quarantine British travellers because of the UK's 'significantly poorer' response to the coronavirus (Business Insider, June 25, 2020), as "Ireland has suffered a much lower coronavirus death toll than the UK, with just 1,726 fatalities to date, compared to more than 43,000 in the UK," & "Just 6 coronavirus deaths were recorded in Ireland on Wednesday compared to 154 in the UK," yet:
Irish churches exempted from 50 person limit during coronavirus reopening (Catholic News Agency, June 26, 2020) "Churches and other places of worship in Ireland will be permitted to open to more than 50 people, following a new exception to the country’s Phase Three coronavirus reopening. The exception was announced on Thursday evening. Ireland’s Phase Three reopening sets a limit of 50 people for indoor gatherings, and 100 people for outdoor gatherings. In Phase Four, the indoor limit will be raised to 100. Ireland enters Phase Three on Monday."
posted by Iris Gambol at 4:19 PM on June 26, 2020


Mod note: Please keep discussion of US coronavirus response over here.
posted by Eyebrows McGee (staff) at 5:12 PM on June 26, 2020 [2 favorites]


Thanks for the numbers, atrazine. It's easy enough to believe claims that app-based contact tracing is like mask wearing - it doesn't have to 100% effective to help the situation, but seeing the numbers really helps! Even with those numbers, moving R0 to be less than one means the disease stops propagating.

With fast AND widespread virus-presence testing, life's managing to resume, even before there's a vaccine. Take the test, wait for results, and then it's safe to go see other people with negative test results. It'll take a while before that becomes totally normalized but that seems like that's the new normal for now. It's nowhere near Before Covid (BC) levels, but it's a start.
posted by fragmede at 5:46 PM on June 26, 2020


We have to be able to nip local outbreaks in the bud and close/lock down the places where they occur - whether that's a factory, a bar, a school or university or even an estate or town. Then the contacts of the people in those settings need to be traced and those people isolated and tested

That’s pretty much the German strategy, though they are also prepared to be a bit broader in their re-lockdown/ quarantine. They’ve been basing it on potentially locking down Kreisen (county/local authority area.) There’s a national limit of 50 new cases per week per 100 000, though some states have set lower ones. If a Kreis goes near or above the limit, then there’ll be some sort of response, depending on the reasons for it. It may be shutdown and quarantining of a particular area, or the entire Kreis.

At least my state (Hessen) is slowly allowing more and more group activities to take place (including events up to 250 people with weddings specifically mentioned), generally with the proviso that there is a register of people available, and that as much social distancing as possible takes place. They’re also trying to cut down on the random transmission by making masks compulsory in public indoor spaces and public transport. It’s slowly getting back to a new (masked) normal, to the point where I’m actually down in Konstanz on a holiday at the moment with only minor Covid related inconveniences.
posted by scorbet at 12:22 AM on June 27, 2020 [2 favorites]




Lyce Doucet - BBC
A terrifying mix of violence and the virus will soon overwhelm countries such as Yemen, Afghanistan and Somalia, where Covid-19 has yet to reach its peak. Already, in southern Yemen, gravediggers can’t keep up with the dead and dying. Conflict will also be magnified and multiplied by impoverishment, starvation and despair.
posted by adamvasco at 12:22 PM on June 27, 2020 [1 favorite]


Coronavirus: China ‘seals off’ province as worldwide cases exceed 10 million

Authorities have put almost half a million people in Hebei province, which surrounds Beijing, under lockdown after a fresh outbreak in China’s capital.

Anxin county, about 145km from Beijing, has “sealed off” residential areas and restricted people from leaving their homes. Only one person from each household can leave once a day with a special pass to get necessities such as food or medicine, according to the measures announced and put into immediate effect on Sunday.
[...]
Officials said Anxin was adopting stricter measures out of an abundance of caution, not because the outbreak there was severe. State media reported that there had been 12 confirmed cases in Anxin county, where businesses had supplied fish to the Xinfadi market - the centre of the new cluster of cases in Beijing. Eleven of the cases were linked to the market, according to the Global Times.
posted by roolya_boolya at 1:14 AM on June 29, 2020


Coronavirus: China ‘seals off’ province as worldwide cases exceed 10 million

Just as a note - this headline is a bit misleading, though the article is clearer. It's only Anxin County that is under lockdown, not the entire Hebei province. (Proportionally by population it would be a bit like a headline claiming that Ireland was under a strict lockdown, when in reality it's only Leitrim.)

Der Spiegel International has an article on why meat-processing plants are badly hit. There's also an article (in German) explaining the current rules in the German states with regards to stopping people from high-risk areas from travelling. Most of them are not allowing people from districts with over 50 cases per 100 000 in the last week from staying overnight in hotels, etc. without either a negative test, or a valid reason (e.g. medical reasons).
posted by scorbet at 3:28 AM on June 29, 2020 [2 favorites]


Indeed. All that is happening in Leicester is that they are going back to where the whole country was only a few weeks ago and probably not even for very long.

I hope that PHE is able to streamline their interactions with local public health as it seems to have been a little clunky and they need to be smoother if they're going to be doing this a lot (and they are) but fundamentally this is exactly what should be happening. We now have the surveillance capability to spot local infection clusters very early and to take measures locally and quickly. That means no more national lockdowns, no more 8 week long total lockdowns, instead we'll close schools, workplaces, and pubs for a few weeks at a time when infections rise locally and we're not able to localise them to specific workplaces (there have been a number of workplace and hospital based closures for some weeks now).

I don't understand why some parts of the media are treating this like a bad thing, that we should worry about when it is actually the system working as intended.

On a good news note: a lot of recent data is indicating that a substantial number of people (50%+) who only had mild disease have a T-cell response but not an antibody response. If this provides some form or adaptive immunity, it might mean that in some places like London, we're already at a point where herd immunity starts to slow spread.

London has about 18% antibody +ve, if there's another 18% T-cell but not antibody +ve and this give partial immunity for at least a few months (good reason to believe both but no direct evidence yet) then transmission will be noticably slower than it otherwise would be.

If Rt without existing immunity would otherwise be 1.5, then 36% of people immune would bring it down to 0.96. That's if "immunity" prevents them from spreading it completely, if it only reduces their ability to spread infection then the effect will be less.
posted by atrazine at 5:02 AM on July 1, 2020 [2 favorites]


I hope that PHE is able to streamline their interactions with local public health as it seems to have been a little clunky and they need to be smoother if they're going to be doing this a lot

That's the part that I found most alarming, to be honest. According to the Financial Times, even the local authorities were not given proper information on how many cases there were in a given area. They also couldn't compare numbers - they were only given info for their particular area when they finally got it.

I do agree that local lockdowns are the best approach, once the overall rate is sufficiently low that a national lockdown is no longer necessary, but you need the data to be available. I can see the cases for my city updated on a daily basis, as well as the rest of the state and country, broken down to both a state and district level. It's helpful to me - allowing me to gauge the risk of doing things and change my plans, if necessary, even if we are far from the threshold for a lockdown scenario. I can't understand why anyone would feel that not even the local officials should have that info.
posted by scorbet at 7:06 AM on July 1, 2020


That's the part that I found most alarming, to be honest. According to the Financial Times, even the local authorities were not given proper information on how many cases there were in a given area. They also couldn't compare numbers - they were only given info for their particular area when they finally got it.

Apparently as of Thursday local directors of public health now have the postcode level data which is good. I really think that PHE / NHS England have over-centralised to a fault here and I hope we can take valuable lessons from that in a healthy, blame-free environment (which is how actual effective change happens in safety critical industries).
posted by atrazine at 10:06 AM on July 1, 2020 [2 favorites]


Yeah, about the private testing data being given to Local Authorities.
Ooooops
posted by fullerine at 4:19 AM on July 2, 2020


Christ, these people are idiots.
posted by fullerine at 7:13 AM on July 2, 2020 [3 favorites]


I would rather have expected PHE to get data protection agreements with local public health teams in place some weeks ago so that they could be prepared to share this data. Why this has waited until last week is strange.

That twitter link means nothing except that this is a very evasive answer that just literally answers the question as written without any attempt at giving context. The question was "does the contract say they are required to share cases with PHE and local authorities" and the answer was, "the contract doesn't require that". It's a bad answer and a bit of a "fuck you" to the person asking it but it also doesn't mean what people seem to think it means.

If, for instance, the data goes to DHSC and they pass it on to PHE and to local authorities, then the answer is still correct. I don't understand why the actual role of Deloitte and the actual flow of this data could not have been explained in the answer to the original question though as the Q/A now makes it look like they are saying, "they're not required to share that data with anyone at all" which is obviously nonsense. There is also a difference between what is in a contract, which is often quite minimal in professional services, and what has actually been agreed. Again, not clarified in the answer which could easily have been expanded to disclose that information.
posted by atrazine at 7:25 AM on July 2, 2020


Latest prevalence data for England from the ONS is out.

Period 14th of June to 27th of June has about 3.5k newly infected / day. If you combine that with the case data from the NHS you find that about a third of infections are being identified as cases by the NHS. Given that previous ONS data has found that about 70% of infections are asymptomatic (or only very mildly symptomatic), it's hard to see how you can catch any more than that without mass testing of asymptomatic people.
posted by atrazine at 7:35 AM on July 2, 2020 [2 favorites]


My local theatre is closing permanently following financial problems related to the coronavirus. Awful news for the arts here.
posted by paduasoy at 1:02 PM on July 2, 2020 [1 favorite]




I was fairly careful to frame it as "related to the virus", rather than "caused by", as I think there was more going on locally - our development of the Cultural Quarter and the opening of a second Nuffield Theatre there, plus I haven't been able to work out how the university's support or lack of support for the Nuffield has played out. But yes, of course, I agree that central govt has not supported the arts enough and should have done.
posted by paduasoy at 1:10 AM on July 3, 2020 [2 favorites]


I tend to agree with this, but I think its worth pointing out the difference between relatively localized outbreaks in countries with established infrastructure to test, trace, quarantine, and contain, and the US, where it is impossible to speak of containment or source-able outbreaks. There are US states where cases are rising exponentially, and even in states where cases aren't rising, the existence of such containment infrastructure has yet to be proven. We'll find out in the coming weeks.

I just read an article that described how Chicago had just chosen a company to oversee the development on their test and trace program. Just this week! They expect (hope may be more accurate) the test and trace program to be operational by mid-September.

WTF they have been doing for the last 3 months I don't know. Everyone knew this was needed as quickly as possible and yet they can't even get it rolling before schools are supposed to re-open. This pandemic is really exposing the pathetic ineffectiveness of governments at every level in the United States.
posted by srboisvert at 6:04 AM on July 5, 2020 [2 favorites]


pathetic ineffectiveness of governments at every level in the United States. when there is no leadership whatsoever provided from the head of the executive branch. Nota bene: Fish rots from the head.
posted by From Bklyn at 8:00 AM on July 5, 2020 [1 favorite]


Universities and research centres have released studies that show the actual number of cases of COVID-19 in Brazil is between four to five times greater than the figures officially issued by the Ministry of Health.
Fake News, Hiding Data and Profits: How COVID-19 Spun Out of Control in Brazil.

posted by adamvasco at 1:16 PM on July 5, 2020 [2 favorites]


The WHO continues to drop the ball:

239 Epidemiologists Urge WHO to recognize SARS-CoV-2 airborne transmission.

Also:
Comprehensive article in Science on airborne transmission. "Increasing evidence ...suggests the 6 ft CDC recommendation is likely not enough udner many indoor conditions where aerosols can remain airborne for hours, accumulate over time and follow airflows over distances further than 6 ft."
posted by storybored at 6:50 PM on July 5, 2020 [2 favorites]


So, what to make of the CEBM’s take, that the origin story of SARS-CoV-2 is yet to be written? The presence in Milan and Turin waste-water samples from December I was aware of, but not of the Spanish story regarding a March 2019 presence... the Italian media mention of that Barcelona study was very cautious about its result.
posted by progosk at 11:30 PM on July 5, 2020


what to make of the CEBM’s take

Consensus I'm seeing is it's awfully speculative, false positives in this kind of testing are very common. Eg here's Ed Yong of the Atlantic:
I’d point out that badly done sequencing studies have prev found signs of plague in the NYC subway, platypuses around the entire world, and all kinds of microbes in sterile water. So. The default assumption shld be that the wastewater stuff is throwing up tons of false positives
More rigorous testing and peer review needed, I think.
posted by Two unicycles and some duct tape at 12:21 AM on July 6, 2020 [3 favorites]


Bolsonaro tests positive.
“Just look at my face: I’m fine,” Bolsonaro says, taking off his mask in front of journalists after announcing he has just tested positive for coronavirus.
This man is a Pig and I really don't care if he lives or dies.
posted by adamvasco at 9:30 AM on July 7, 2020 [5 favorites]


That man is absolutely beyond belief. Thank god that Brazil and the US have federal systems so that at least some competent people can ameliorate the damage but this is just madness.
posted by atrazine at 1:29 AM on July 8, 2020


Bolsonaro made Brazil a Pandemic Pariah but locally and internationally, some Brazilians have traced a road map for crisis response that exhibits the country’s strengths.
posted by adamvasco at 3:20 AM on July 8, 2020




Belgium's health minister writes a defensive of their covid response.
Belgium was definitely not the worst country in its response to the pandemic. The virus hit our country hard, but the high numbers in deaths attributed to COVID-19 are also the result of diligent counting by independent epidemiologists who did not want to miss a single potential victim of the coronavirus, whether the patient had been tested or not.

This was a courageous choice driven by the desire to protect every Belgian citizen from potential new outbreaks. The transparent manner in which we report our figures has been praised by the scientific community as a good practice that should be followed.

Unlike other countries, Belgium has not had to cope with dramatic scenes of people lying on hospital floors waiting for treatment, or been the scene of horror stories as doctors are forced to choose between treating the old or the young. Even during the peak of the pandemic, the occupancy rate of our intensive care units never exceeded 60 percent, resulting in a relatively high survival rate of patients in those facilities.
In other Belgian news masks will be mandatory in shops, museums and cinemas. This is probably just as well as masks have all but disappeared apart from on public transport as the lockdown has eased.
posted by roolya_boolya at 11:36 AM on July 10, 2020


There way up there in terms of deaths per 1m. Like, second after San Marino. Which suggests something is going on there, that isn't great.
posted by Windopaene at 4:39 PM on July 10, 2020


Which suggests something is going on there, that isn't great.

There is quite a lot of variation between countries as to which deaths were "counted" as being associated with COVID and which not, which can make comparisons a bit difficult. For example, the UK was initially only publishing the number of deaths in a hospital setting. (That’s since changed.) There can also be different delays before deaths are fully reported in different countries.

Ireland had an approach similar to Belgium - including suspected cases in the total, and not just those confirmed by a test. But some analysis of excess deaths and death notices on rip.ie has shown that the numbers in Ireland could be overstated (1100-1200 rather than the 1700 reported.)

The FT has been looking at excess deaths in various countries as well, and according to that analysis, Belgium’s death count looks about right, if not a little high, but several other countries would appear to be drastically undercounting. See UK, Spain, Italy, for example, particularly considering the excess mortality data is not up to date.
posted by scorbet at 2:49 AM on July 11, 2020 [7 favorites]


Actually, after rereading what I wrote above, I realized I managed to delete the bit about wanting to make it clear that the Belgian response was obviously not good, and that a number of places have responded considerably better (particularly outside the "Western" world), but that it probably shouldn’t be topping the list (excluding micro states).

(Also, I currently feel a bit heartless being all analytical about people’s deaths.)
posted by scorbet at 4:54 AM on July 11, 2020 [4 favorites]


Engineered llama antibodies neutralize COVID-19 virus (Science Daily, July 13, 2020) Summary: Antibodies derived from llamas have been shown to neutralise the SARS-CoV-2 virus in lab tests, researchers have found. They hope the antibodies -- known as nanobodies due to their small size -- could eventually be developed as a treatment for patients with severe COVID-19.

The peer-reviewed findings: "Neutralizing nanobodies bind SARS-CoV-2 spike RBD and block interaction with ACE2," (Nature Structural & Molecular Biology, July 13, 2020) The SARS-CoV-2 virus is more transmissible than previous coronaviruses and causes a more serious illness than influenza. The SARS-CoV-2 receptor binding domain (RBD) of the spike protein binds to the human angiotensin-converting enzyme 2 (ACE2) receptor as a prelude to viral entry into the cell. Using a naive llama single-domain antibody library and PCR-based maturation, we have produced two closely related nanobodies, H11-D4 and H11-H4, that bind RBD (KD of 39 and 12 nM, respectively) and block its interaction with ACE2.

Coronavirus: Llamas provide key to immune therapy (BBC, July 13, 2020) As Fifi the llama munches on grass on a pasture in Reading, her immune system has provided the template for a coronavirus treatment breakthrough. Scientists from the UK's Rosalind Franklin Institute have used Fifi's specially evolved antibodies to make an immune-boosting therapy. The resulting llama-based, Covid-specific "antibody cocktail" could enter clinical trials within months.
posted by Iris Gambol at 5:00 PM on July 13, 2020 [2 favorites]


Seriously writers? No Drama Llama is our saviour???
posted by LizBoBiz at 12:40 AM on July 14, 2020 [6 favorites]


First Trial of Moderna's Coronavirus Vaccine Produces Immune Response in All Participants
posted by adamvasco at 3:50 PM on July 15, 2020


^The preliminary report of the trial, published in The New England Journal of Medicine Tuesday, reveals that all 45 participants developed so-called neutralizing antibodies that bind to the virus and stop it from attacking other cells. I think the May sneak peek showed 8 patients developed these specific antibodies, and it's exciting the remaining 37 did, too.
Moderna's Phase 3 trial is set to begin July 27 with 30,000 participants, half of whom will receive a placebo. Yowza.
posted by Iris Gambol at 1:35 AM on July 16, 2020 [1 favorite]


Covid-19 pandemic could cause civil unrest in up to 37 countries by early 2021.
New analysis finds economic shock of pandemic coupled with existing grievances makes widespread public uprisings ‘inevitable’.
The ripple effects from COVID-19 may substantially raise the death toll from HIV, tuberculosis and malaria, according to a new study.
Food companies profit while global hunger trends upward.
The problem is everywhere. Indeed, some of the most vulnerable nations, including Yemen, Afghanistan, Venezuela and Haiti are “extreme hunger hotspots,” according to Oxfam’s statistics. But wealthier countries are not immune from food insecurity. That includes the U.S., where Oxfam cited data suggesting consumer prices have risen 2.6 percent, even while farm income has decreased.
posted by adamvasco at 8:56 AM on July 17, 2020 [2 favorites]


Long article about the closure of our local theatre I mentioned above. This makes the case that the closure was not related to the virus but was caused by sudden withdrawal of funding from the Arts Council England.
posted by paduasoy at 2:40 AM on July 20, 2020


Oxford vaccine triggers immune response (BBC, July 20, 2020) Trials involving 1,077 people showed the injection led to them making antibodies and T-cells that can fight coronavirus.[...] The study showed 90% of people developed neutralising antibodies after one dose. Only ten people were given two doses and all of them produced neutralising antibodies.
posted by Iris Gambol at 4:32 PM on July 20, 2020 [2 favorites]


Masks mandatory in France amid fresh outbreaks (BBC, July 20, 2020) France has made face masks compulsory in all enclosed public spaces amid a fresh bout of Covid-19 outbreaks. Masks were already mandatory on public transport, but from Monday they must also be worn in places like shops.

Health Minister Oliver Véran warned that France had between "400 and 500 active clusters" of the virus.

posted by Iris Gambol at 5:56 PM on July 20, 2020 [1 favorite]


Unsung Heroes: 'We suffer in silence': coronavirus takes heavy toll on Brazil's army of gravediggers.
Alcoholism and depression ‘part and parcel’ for those who bury the bodies of Covid-19 victims – more than 80,000 so far.
posted by adamvasco at 5:00 AM on July 22, 2020 [2 favorites]


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