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Assumptions… wrong June 3, 2020

Posted by WorldbyStorm in Uncategorized.
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Somewhat depressing to see in the news this last evening or so that claims the virus has been beaten back comprehensively in the community appear to be incorrect. 25% of new cases were in the community with no link to other cases.

Of the approximately 500 new cases over the past week, about half occurred in that week, and about half of these were not linked to known clusters in care facilities, meat plants or other locations.
This means about quarter of new cases are arising in the community with no known link to other cases.
Dr Holohan said 54 per cent of last week’s cases involved people aged between 24-55 years, and were spread across 21 counties in Ireland.

This certainly puts in stark focus the demands to reopen and lift the restrictions from media commentators and business (demands that as noted yesterday are not supported by public opinion). It also underscores the necessity to retain social distancing measures and adhere to them and leaves events like the protest at the weekend very much open to question. I’ve felt for a while now that there’s been far too much complacency in the media, far too much a sense that it was all over bar the shouting. The news this last few days suggest otherwise.

Speaking of the pandemic depressing too to see this on RTÉ today:

Sweden should have done more to combat the coronavirus and prevent a much higher national Covid-19 death rate than in neighbouring countries, the man behind the Public Health Agency’s pandemic strategy said.

Nearly 4,500 Swedes have died in the outbreak and criticism has been growing over the government’s decision not to impose lockdown measures as strictly as elsewhere in Europe.

Anders Tegnell, the chief epidemiologist at the Public Health Agency, said that in hindsight Sweden should have done more.

Related to that two pieces caught my eye over the weekend about the pandemic. First up was one on Wired that argued that the Swedish approach had failed fairly comprehensively – that the assumptions that its policy was based on, the arrival at so-called ‘herd immunity’ as the term was used by its proponents, and indeed other aspects of the progress of the virus were simply wrong. I think that’s likely correct, difficult not to think that a very rigid framework of belief about the nature of the virus was applied when that nature was far from clear, but no doubt arguments will wash around for a long time to come (by the by, this is a thoughtful piece for the IT on that subject).

But there was a fascinating point made in the course of the piece that is extremely important.

“It isn’t like influenza,” Einhorn says. “It’s a cluster disease – it digs itself into a spot and it explodes in that spot, and between those clusters it can be very sparse, that’s why the antibodies are so low. It’s a perfect situation for contact tracing and testing.”

Examine the nature of the pandemic here and there seems to be a lot in that assessment with extreme problems located in health care settings, care homes and industrial plants and with transmission more broadly perhaps lower than might have been feared. Of course that latter would have been different without the strong measures implemented but it dovetails with what EUREFERENDUM.com has been saying about how the crisis is one of multiple outbreaks that should be contained individually.

The second piece that was of some utility was the following in the Guardian which neatly deconstructs one of the approaches of the right in this, that is the idea of ‘cocooning’ those who are older. As the authors, Devi Sridhar, chair of global public health at the University of Edinburgh and Yasmin Rafiei, a research assistant at the University of Edinburgh, note:

Two key assumptions underlie shielding use in the UK. First, that if 15% of the population, say, were vulnerable to severe infection from coronavirus, this group could reasonably be isolated from the remaining 85%, who were likely to contract only a mild illness. And second, that those who have contracted coronavirus would develop protective immunity. Yet we still don’t know if people develop immunity once they have become infected with coronavirus.

Again public health policy made with insufficient information to underpin it.

But there’s more:

And in practice, the first assumption falls apart. According to one study in China, 80% of coronavirus transmissions occurred at home, where multi-generational living complicates attempts at shielding. Elderly people living with family members under one roof are especially at risk as countries move to reopen their economies. This risk shouldn’t be understated. In the US, 13 million Americans over 65 live in multigenerational households. Some don’t have the space for their own room. For this group, shielding isn’t really an option.

And the authors note a basic reality. That being:

…elderly people who live alone need regular contact for care and services. According to the Institute on Aging in the US, 65% of older adults rely exclusively on family and friends to provide them with assistance. Another 30% receive paid assistance alongside their family support. Every point of contact in an elderly person’s network of care increases their threat of infection.

Beyond immediate family and friends, the elderly and people with chronic illnesses are also more likely to need regular contact to receive medical care, grocery deliveries, and transportation.

There’s something in limiting interactions during a lock-down as has been applied to all age groups – as has been seen that does blunt the edge of the spread of the virus quite considerably, but the idea of wholesale cocooning in the way it was attempted in the UK in particular doesn’t make a lot of sense. Indeed it merely points up how inter-related our societies are generationally. And that is a good thing.

So how to tackle this? The authors argue that “a general strategy of suppression, where governments make a commitment to keeping daily new cases as low as possible through an active testing-and-tracing programme and real-time monitoring of transmission” is the way forward. As indeed has been posited from the off by the WHO and so on. And based on best practice in Asia from the off.

Comments»

1. Joe - June 3, 2020

That jumped out at me when I scanned the IT online this morning. 25% of new cases were in the community with no known links to other cases. And as you put it, WBS, this contradicts claims that the virus has been beaten back comprehensively in the community.

But does anyone know where these claims originated? A neighbour or mine, a senior civil servant in a quite relevant department to all this, said to me quite confidently a week or so ago that the virus had been pretty much eradicated in the community. And, silly me, I believed them.
What is it? Wishful thinking? Somebody says it, someone else hears it and wants to believe it, and passes it on, and so on?
Or is it the work of vested interests – the ‘business people’ who want ‘the economy’ to ‘open up’ again more quickly?

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WorldbyStorm - June 4, 2020

A mate of mine is adjacent to the HSE and he was at a meeting of heads of various bodies where it was said outright that community transmission was effectively zero. But… those figures suggest otherwise. I don’t know. It all seems very fragile.

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2. crocodileshoes - June 3, 2020

Long account in this week’s New Yorker about how Iceland has flattened the curve to nothing. No masks, only a partial shutdown of businesses, strict adherence to social distancing, closed borders, more test-and-tracing than anywhere. New Zealand similar. Even the Aran Islands, according to Monday night’s RTÉ News.
Trouble is, the isolation of these places is a healthcare strength and an economic weakness. The people are well, but their businesses are going broke. And almost all the resurgence of infection in places like South Korea seems to stem from incoming travellers. It’s a macro version of the choice each of us makes: I haven’t left my village for 3 months and nobody’s visited me. I feel safe, but only half alive.

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idi amin - June 4, 2020

Will there be spike in Ireland of Covid-19, because of the BLM marches (lol) and also across the US .

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WorldbyStorm - June 4, 2020

I understand people’s wish to express solidarity with those in the US, but I don’t think the last march or the one that is/isn’t going ahead at the weekend is wise as the way to do that. I think it is possible it will add to cases – but I’d be more worried about those workers who came into contact with larger numbers of people not social distancing or breaking the 5k rule, that is transport workers and so on who have it more than risky enough as it stands. And the response I’veheard from non-left people who have been social distancing has been absolutely enraged. As to the US given hw patchy social distancing seems to have been who can tell?

crocodileshoes, those are very good points. I guess realistically while trade will continue more or less uninterrupted travel, holidays and entertainment is the area that is going to be most hit. And that’s going to be global and for quite a while.

Re the constraints at the moment, I think that will change here sooner. I know what you mean, no-one has visited here (except to drop off books and as they said it was like ringing the doorbell and running away). It’s a strange situation. Are you working from home?

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crocodileshoes - June 4, 2020

Yes, working from home. With a father in hospital 100 miles away. A friend in Dublin Bus commented when he saw the lack of social distancing on the march last weekend ‘all lives matter – except our grandparents’’. I dread a medium-term ‘living alongside’ COVID scenario in which the young seldom think of it, the old and vulnerable are pretty much confined to home and yet, for economic reasons, the former resent the latter.

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WorldbyStorm - June 4, 2020

That would be the worst possible outcome wouldn’t it? young pitted against all others.

Again, the sincerity of those involved was good, just… Christ, I was listening to the IT political podcast on the BLM issues and so on and there not even a pretence of saying that one could think the cause was one someone could be 100% standing with whereas the march was not the best way forward in the midst of a pandemic. It just seemed to be taken that good intentions trumped every other consideration including community health. In a way I can’t blame the participants when the media message for weeks now has been we have to take risks, we have to open up for business, sure everything is fine. But it’s a capitalist message and one, that as you point to, ignores the very very dangerous potential for negative outcomes for large swathes of people in this society (I’ve friends in their 30s and 40s who have relatives of the same age with chronic health issues that would if they caught COVID be put at enormous risk. They too are vulnerable but the attitude seems to be that they don’t exist).

I hope your father is okay. That’s very difficult the distance side of it. And added to all the other stresses that this causes it’s unimaginable. My mother had a stroke a month before shut-down but thankfully was able to go home. Still scary and she has appointments back at the hospital on a regular basis starting next week.

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