! Coronavirus - The importance of social distancing measures, and acting early to implement them.

Coronavirus: Why You Must Act Now. Politicians, Community Leaders and Business Leaders: What Should You Do and When?

This article is the very best analysis I have seen of the coronavirus outbreak, the necessity for social distancing measures, and the importance of introducing them robustly and early. It is well worth a careful read and re-read. The maths checks out, and the author "shows his working" along the way.

Key points:

In countries where the health system becomes overwhelmed the death rate is as high as 5%

In countries where social distancing and containment is introduced early, and is effective, the death rate is around 1%, as everyone who needs it can get effective health care

That reported figures vastly under-represent the true number of cases presently in the community

That delaying social distancing measures by 1 day results in a 40% increase in new infection

Shortly following my post above:
Republic of Ireland to Shut Schools
First death in Republic of Ireland

It looks like RI is jumping on this nice and early in the exponential curve. The UK is currently dragging its feet in comparison.

This is my favourite graphic for understanding why containment measures are so important



Where I live, we are still at the tracing stage.  Every case gets a deep investigation and traced back to where the virus entered the country.  We're still getting about 6 or 7 new cases a day, but we are only getting 6 or 7 new cases a day (at time of writing) in my province instead of the number of cases doubling every 24 hours.  

At this stage, they recommend some voluntary social distancing.  They are working with religious groups to find ways to make it easier for people who are ill to stay home and try things like have more services with fewer people in each.  They are also trying to find ways to do virtual gatherings for the most at risk, by having members of the community take computers to their home and stream the service live. The religious and community leaders are having a lot of good ideas and are working closely in communication with the local health authorities.

Yesterday's briefing the provincial health officer Dr Bonnie Henery said something really awesome (paraphrased from memory): it's about social distancing, not social isolation.  It's important to connect to the most vulnerable members of society and elderly so they don't feel forgotten.


The article could Canada be 'flattening the curve'? has some great insight into just how different each situation is in different countries around the world.  



It compares the number of days it has taken countries to go from 50 confirmed cases to 2,000 (and they say they will update the graphic as more data becomes available, so check out their site for more current info).  Most of the countries were slow to test at the start of the infection which sques the numbers - see the US line goes right up with increased testing.  But countries like (parts of) Canada and Japan have been heavily testing from before the first case arrived.  A much flatter curve and a much stronger chance of pushing back the pandemic until the summer (remember, this is already a particularly bad cold and flu season).



Tomorrow is the last day of school before the 2-week spring break starts.  Which... actually worries me more than the school being in because families travel when the kids are out of class.  I could see extending spring break a week or two if the curve gets too steep.

Estimating number of infections based on deaths.

Detailed working is in the article, but the basic assumptions are

1% death rate - prior to health services being overwhelmed this seems about right. It shoots up afterwards.

Duration from infection to death averages 17 days.

Knowledge of the rate of spread - over 17 days the number of infections will double 3 times... 2x2x2 =8 fold increase.

So each death today = 100 infected people 17 days ago
100 infected people 17 days ago x8 = 800 people infected now.

So even in regions where testing is not prevalent, you can get a feel for the number of people currently infected in a region by taking the death and multiplying by 800. It is a crude tool, but a much better representation than relying on officially confirmed cases which lags way way behind the true number of cases.

The UK hit 10 confirmed deaths today - so expect there to be around 8000 infected people in the population. Officially confirmed cases are, as of writing, 596.

Thanks for this thread.
I applied for a meeting (environmental group) to be cancelled this evening and the person in chief did so promptly.

I still cannot grasp why Germany/Bavaria is so slow in shutting down schools finally.
We have the first confirmed death in Bavaria and expect to have schools closed by Monday. Why not tomorrow at once?

Anita Martini wrote:Thanks for this thread.
I applied for a meeting (environmental group) to be cancelled this evening and the person in chief did so promptly.

I still cannot grasp why Germany/Bavaria is so slow in shutting down schools finally.
We have the first confirmed death in Bavaria and expect to have schools closed by Monday. Why not tomorrow at once?

Good question - and it has an answer.

If you introduce it too early and squash the initial outbreak then you face the risk of a second severe peak coming once the restrictions are lifted. Communities only get herd immunity once a sufficient proportion of the population are exposed and develop immunity, or a vaccination is developed and spread (12 months away). The most desirable compromise, once it becomes endemic, is difficult to find middle ground.

Unfortunately some nations seem to be doing too little too late.

The graph below is from the article linked at the top. In Denver the restrictions on movement were introduced then relaxed too early - prompting a more severe spike later on, as the population hadn't either established resistance or eliminated the underlying disease.

Since the virus is effecting and spreading differently in each country, there is no single solution.  Each country has to assess the risk to the population and the resources of its healthcare system.

Also, every day we have new data which improves how we approach the situation.  

Personally, I've been social distancing since January because a member of our household has a reduced immune system and the flu this year was exceptionally bad. There are a few events I've missed because they will have more than 50 people confined inside (outside gatherings have less likelihood of spreading germs.  But I'm not completely isolating.  I'm still confident enough to go shopping and to attend small gatherings of less than 10 people so long as I don't touch them and wash my hands frequently.  

Something interesting coming out of the UK https://www.bbc.com/news/live/world-us-canada-51847128?ns_mchannel=social&ns_source=twitter&ns_campaign=bbc_live&ns_linkname=5e6a71188d956f0669ae44b0%26The%20message%20is%20clear%20%E2%80%93%20keep%20calm%20and%20carry%20on%262020-03-12T17%3A27%3A53.265Z&ns_fee=0&pinned_post_locator=urn:asset:f4da111e-6d92-4ee1-a8ac-50627358f97f&pinned_post_asset_id=5e6a71188d956f0669ae44b0&pinned_post_type=share

Other countries are closing schools, restricting movement and banning mass gatherings.

But health officials in the UK are taking a much more gradual, step-by-step approach. Why?

The obvious answer is that we have a relatively low number of confirmed cases so there is no need to take steps that will have profound social and economy consequences.

But we are also in this for the long haul. Countries taking drastic steps may well slow transmission. But how long can those steps be sustained?

At some point they have to be lifted and then the number of cases will rise.

If you can have some kind of controlled transmission, where the number of cases are kept low enough to allow the NHS to cope, is that a better way of managing it?

That’s certainly what the experts and ministers in the UK have decided. They believe it gives them the best chance of saving lives in the inevitable spread of the virus across the country.

Here in Denmark they announced about 10pm last night that all schools and government offices would be shut from today. which left people with no time to find childcare or anything. groups over 100 are also advised against (although not outright  banned) The numbers of infected here have caught up with the UK it seems to be spreading much faster than in the UK and remember that Denmark has less than 10% of the population of the UK. It also has a similar healthcare system with I think 0.1 more acute care beds per 100k.. (testing per head of population is about the same)

Then they are acting surprised when there was a run on the supermarkets when they opened at 7am. I mean even if you are not hoarding (called "hamstering!" here) you suddenly need a lot more bread and toppings since your kids now need to eat with you. Children here are generally in full time child care from age 1. so you can imagine how many parents are suddenly stuck. Companies might be sympathetic for a day or so, but not much longer.

here's an update of the chart I posted earlier.  

I too an very fortunate to live in the same province as RRANSON. Our health minister has been incredibly on top of this very fluid situation, and so far, our spread has been as controlled as possible. Due to our population and location I fully expected our situation to be very much worse than others, not one of the best.

Unfortunately it has not stopped the ridiculous panic purchases and hoarding. Nor has it stopped the absurd rumours that fuel panic. I, myself have asthma, my husband is over 80 with bonus co-morbidities, and honestly, yes, he is on home arrest, and I am being very careful when out. But at the end of the day, it is all about good, basic, personal hygiene; hand washing, no face touching, and being aware of contaminated touch points.

To that end I have changed just two things. I keep hand sanitizer in the door of the car, unlock door, sanitize hands. I also keep sanitizing wipes in the car to wipe down exterior touch points and interior surfaces. Further, any box/pkg brought into the car, keys and cell phone are wiped down, as are all packaged grocery items. I view the car as the gateway, and endeavor to stop any contamination, before it enters the home.

R Ranson:  I stole your graph and reposted it, elsewhere, I hope that is okay.

I am most struck by how many misconceptions people have. Hoarding hand sanitizer? Hand sanitizer is a stopgap for when you can't get to soap and water; soap and water is much more effective. And yet, for a while, I was seeing hand sanitizer in public restrooms, on the sink next to the soap and water.

Imperial College, London just published the result of their computer modelling of the impact of coronavirus spread, the implications on the health care systems of the UK and US, and the various strategies that governments have to slow spread. It is a long and technical read, but well worth it.

Modelling COVID-19 interventions

Key conclusions seem to be:

Mitigation strategies - the delay and spread the peak of the epidemic approach - cannot work, and will exceed ICU capacity many times over.
Suppression strategies - as per Wuhan - can stop the disease in it's tracks, but the long term implication is that there will be a second serious outbreak later in the year when restrictions are lifted.

This paper outlines a third approach: Use suppression strategies to bring the number of ICU admissions per week drastically down. Then temporarily relax those restrictions to allow the virus to spread again. In this way the virus can be allowed to spread in stages through the population without either overloading the health services, or risking a major uncontrolled outbreak. This seems like the approach that leads to the best long term outcomes - herd immunity for the masses, and fewest deaths. But it looks like a tricky path to follow.

Jason Hernandez wrote:I am most struck by how many misconceptions people have. Hoarding hand sanitizer? Hand sanitizer is a stopgap for when you can't get to soap and water; soap and water is much more effective. And yet, for a while, I was seeing hand sanitizer in public restrooms, on the sink next to the soap and water.

. IF they only have air dryers, how do you turn tap off without recontaminating your hands? Perhaps that is why there was ALSO sanitizer...always dry with paper towel, then use towel to turn tap off and open door before disposing towel.

On a bit of a lighter note (pun intended), to play their part in social distancing/isolation but still deliver happiness to people, the Melbourne Symphony Orchestra is live-streaming their concerts for FREE on Youtube.

MSO


MELBOURNE SYMPHONY ORCHESTRA


In an interview this morning with the Orchestra's Managing Director, she said they received 100,000 views world wide and more income via donations than having it played at their home theatre.

Bringing it to the people but not needing them to be 'there'.

As my husband is over 80 AND has leukemia and I have asthma I am endeavoring to keep us safe. In addition to social distancing...

I keep a pump hand sanitizer in my car door so I can use it BEFORE entering vehicle.

I keep sanitizing wipes in car to wipe down my phone, all touch surfaces (door handles, buttons, seat belt buckles, shifter, steering wheel), keys, take out food, shopping bags etc. I also use them on shopping carts.

I wipe down all packaged grocery items before putting away, and/or dispose of external packaging immediately.

I wipe down all deliveries (food, groceries, mail, amazon...) before bringing into house.

I wipe down all touch surfaces in home at least twice daily (appliance knobs/handles, light switches, doors and knobs, faucets, garbage can, cupboard knobs, keyboards, remotes, phones etc.).

Take our temperatures twice daily.

My goal is for our home and vehicles to remain "safe zones".

I see your graphs and raise you'all one!

This graph shows a city that had a big public get-together and street march  during the Spanish Influenza Pandemic, versus a city that implemented isolation and closures - be the judge of which is more effective.

In case you wondered...

Michael Cox wrote:

This paper outlines a third approach: Use suppression strategies to bring the number of ICU admissions per week drastically down. Then temporarily relax those restrictions to allow the virus to spread again. In this way the virus can be allowed to spread in stages through the population without either overloading the health services, or risking a major uncontrolled outbreak. This seems like the approach that leads to the best long term outcomes - herd immunity for the masses, and fewest deaths. But it looks like a tricky path to follow.

You know, my biggest fear in all this is that it will in some ways be like another 9/11: after the threat passed, the new restrictions didn't. History has shown that many countries have found ways to have functioning economies while still restricting freedom of movement. Two that come to mind are Medieval times, when serfs were considered part of the landed estate; and apartheid South Africa, when black people were only allowed to leave the bantustans if they had papers showing that they were employed by a white person. I cannot escape the fact that the business of closing the borders to all but "essential" traffic plays right into anti-immigration sentiment. After all, there will always be another infectious disease out there.

The serf and landed estates that you mention are interesting.

Historically, post epidemic times have been times of innovation and societal change.  The liberation of large parts of the poor from serfdom seems to be linked with the black death, which drastically disturbed the entrenched systems.

It could well be that this is the catalyst for positive societal change, and I think many people would accept that that could be a good thing.

I think we will find that measures required in metropolitan areas will be far greater than in smaller communities where populations are lower, housing is primarily houses rather than apartment towers, and population density is low. How do you social distance in a building with communal elevators? Even if you only use the elevator when empty, it wasn't empty five minutes ago... These are the people that should seriously consider wearing respiratory protection, assuming the responsibility of wiping down public surfaces in communal areas every chance they get, and do everything to keep their building disinfected, personally.

Based on what we have seen here in BC, and the rest of Canada, the key to slowing the spread of the virus is absolutely NO PUBLIC OR GROUP GATHERINGS (birthday parties, weddings, funerals, religious gatherings...), period.  Have contact ONLY with those WITHIN your household, insist on social distancing of at least 6-7 feet when in contact with those outside your home.  Do not touch railings, playground equipment etc.  Do not use use public tennis courts, basketball courts, gyms.  Do not take reusable bags to the grocery store.  Do not visit family that does not reside with you, do not visit hospitals or care homes.  Yes, go outside, but keep your distance, do not let others pet your dog, don't touch anything or your face.  If you are in a heavily populated metropolitan center, or a residential building, do not go out, the common areas like elevators or stairs are impossible to keep clean.  ASSUME everyone, including yourself, is infected.  The key is to SLOW the spread so that health facilities are not overwhelmed.  We have learned here that the EARLIER you go on a vent, the better; fewer deaths, quicker recovery, and it provides greater protection for the health care workers dealing with those patients.  BC is aggressively fighting this virus, we ramped up restrictions in a timely manner, focused testing on travelers (tracking and stopping community spread) heath care workers and health care residents.  We have been very fortunate to have "flattened the curve" very quickly, preventing the overwhelming of our health care resources.  Other provinces, slower to respond, have experienced exponentially greater spread, contraction and death.  Please, learn from us.  Immediately assume self protective measures, especially in densely populated areas.

If you, or any family members residing with you are elderly, have lung or immune issues, diabetes, heart disease etc...the entire family unit MUST avoid contact with others.  No going for coffee, play dates, restaurants, bars, gyms, yoga, swimming, church, mosque, synagogue, choir, no social gathering outside the home AT ALL for any member of the family unit.  The healthy can be infected, 80% will have minor to no symptoms, but they can unknowingly pass it to compromised family members who may not be so lucky.  

ASSUME everything at the grocery store is contaminated, do not get "bulk food", only packaged food that allows for external sanitation, wash all produce as soon as it enters your home or switch to frozen.  ASSUME everything ordered on line is contaminated, everything delivered is contaminated, wipe down everything with appropriate disinfecting solutions, including mail.  ASSUME the items inside your mail order packages are contaminated, and disinfect them.  Adopt a twice daily sanitation routine within your home, wiping down touch surfaces (railings, light switches, door handles, appliance knobs and handles, cupboard handles, drawer pulls, faucets, and those places you touch with out thinking - doors, chair arms etc.).  Don't forget phones, remotes, calculators, keyboards.  Literally do everything you can to ensure you create a safe bubble within your home, if you have a health compromised family member.

Here, in BC and Canada the political figures agree with the health professionals projections that this will be affecting us for as long as 18-24 mths - until herd immunity or a vaccine is available.  Look to other countries for info on best practices, use common sense, protect your at risk family members, and keep safe.

Lorinne Anderson wrote:
...Do not take reusable bags to the grocery store. ...do not get "bulk food", only packaged food that allows for external sanitation, ...

In other words, this tragedy is a step backwards, away from the environmental gains that have been made against plastic waste. And against reducing our carbon footprints, too, since it means that for a long time afterward, people will be afraid of public transportation and feel safer "individually wrapped" in cars.

Yes, for a time, reusable is not safe. Perhaps, after all this, with new understanding and rigorous washing of shopping bags, cups etc., we will once again, safely, embrace the "no throw away" path we were on.  

Fortunately there are other environmental bonuses to C19, particularly in regards to the use of fossil fuels. The massive decrease in personal travel by car, transit, train and plane has dramatically reduced pollution and, just maybe, we will learn to do more with less.

I expect to see a lot of companies re-evaluating having employees travel to job supplied offices, computers, and meetings. My hope is the corporate world recognizes the cost savings, both financially and environmentally, leading to more folks staying home, working from home and having on line meetings. Not only would this eliminate the environmentally unfriendly commute, it would lower "take out" meals that produce waste; lessen the need for multiple family cars; lessen the need for daycare spaces; free up "commercial" spaces for conversion to human habitation...

We are feeling under siege; all this fear, the devastation of economies, the horrific loss of life and coccooning at home. Soon, we can take solace that the opportunity for a much better, healthier, happier world is more within reach, than ever before.

So, it's been a month since this thread has been posted to...time to see what seems to be working, and what does not.  I live in Canada, BC to be specific, so for me using stats from Canada and the USA is most simple and accessible - I am not judging, only presenting the statistics and trends around me.

My personal views on many things Corona have changed over time.  In some ways, I still view it as a PANICdemic, in that there is unfounded rumours and hysteria.  On the other hand, I am now very pro-mask, and find myself getting annoyed with those who seem to think this is "just the flu".  So this is the first thing I would like to address.

In the USA: "CDC estimates that the burden of illness during the 2018–2019 season included an estimated 490,600 hospitalizations, and 34,200 deaths from influenza." https://www.cdc.gov/flu/about/burden/2018-2019.html   Considering the USA is now at 100,000 deaths and that number is rapidly climbing....THIS IS NOT THE SAME AS THE FLU!!!

TRANSMISSIBLITY:  this is another hot button for me, and it boggles my mind daily that people don't take this seriously.

Monday, North Carolina had over 1,000 new cases, in a single day!!! Their population (https://www.census.gov/quickfacts/NC) of 10.1 million is approximately double that of BC at 5.03 million (https://www150.statcan.gc.ca/t1/tbl1/en/tv.action...) - our province (at time of writing) has 2,562 cases, in total, since the pandemic began.  I can only conclude we have fared as well as we have due to our wonderful Dr. Bonnie Henry and her refusal to give in, despite many adamant protests when she chose to differ from elsewhere, and set her own course to sail us through these rough waters.

CAN WE FLATTEN THE CURVE:  or as many wondered, should we flatten the curve, should we "shut down", should we risk jobs....this is how we, in BC, have dealt with Covid 19, I am both relieved and proud to say, we are kicking Covid's butt!  Below is a brief synopsis of how our province has, thus far, managed the Covid 19 fight.

At times people thought Dr. Henry took too long to implement certain recommendations, other times they complained the suggestions were too strict or silly.  Somehow she took appropriate steps, at appropriate times.  When cases moved from contact tracing to community spread, she took it seriously, and started the very strong recommendations to stay home, institute social distancing, and practice proper hygiene, based on the results, three months later, her strategies have worked.  

When it became clear, in March, through contact tracking that certain industries (personal care, eat in restaurants) were hot spots she DID shut down that minor portion of our economy.  No other business were forced to close, ever.  It was her calm, constant confidence that WE ALL had a part to play that led most businesses to shut down, or figure out a contact-less way to continue operating. It soon became apparent that schools would be at risk when vacationing kids returned to class; so she shut down schools just BEFORE spring break.  Beyond that we have only had required quarantine for those returning from away - everything else has been voluntary, and with Dr. Henry watching you from the TV, you just had to listen and do as she so gently but firmly and logically suggested.  

Care homes were and are still the hardest hit - given the nature of their work, in some ways it was to be expected...but the low wages and refusal to offer full time employment has meant most Care Aids had to work multiple part time jobs in multiple facilities.  This has and continues to cost our province and our country the most lives.  BC quickly instituted a plan to consolidate Care Aid workers to a single facility, this was and is (in my experience) the single most successful action in stopping the spread, outside of social distancing, in our province.  It took weeks for some communities to comply, due to staffing issues - those that were forced to delay, suffered greatly, with continued outbreaks, and the heartbreak of loved ones dying in isolation as non-essential contact was banned by all care homes.

April came and went, the federal government stepped up adding aid packages, as needed, and did a great job to ensure everyone had what they needed.  We continued to hunker down at home, voluntarily, going out only to shop or if one was an essential/front line worker.  Roads were deserted, wildlife flourished and appeared where it had not been seen in ages, we accepted the new normal, and as we were assured every day when Dr. Bonnie did her briefings, this is not forever.  She somehow managed to mark each newly diagnosed case, admission to the ICU or death with honest, solemn dignity.  We helped our neighbors, perfect strangers, we all repeated her mantra "Be Calm, Stay Safe, Stay Home and Be Kind", and took it to heart.  She did gradually ban gatherings of more than 50 people, then more than 10 people then more than five people, but never actually to the point of fines or threats.  The naysayers were frowned upon, but mostly treated with respect and sighs of concern.  Businesses like grocery stores added signage "stand here" or "keep social distance"; they added plexiglass barriers between staff and customers, closed every second checkout to ensure social distancing.  We got used to standing in line as stores limited the number of patrons inside at any given time.  The bulk of the population did as they were asked, stayed home, supported our front line workers, and every night at 7pm we salute them with cheers and pot banging.  

May arrived, fortunately the gorgeous weather has continued for us all to enjoy, as out of doors is relatively safe, and Dr. Bonnie encouraged us to get out, but stay safe, and continue our social distancing.  We learned some new phrases and definitions.  "Family unit" now means those we LIVE with, be they biological or not, in the same home, sharing the same toilets and kitchen; "Stay Home", means don't travel, stay in your local community; as things continued to improve we were told we could cautiously "expand our social bubble", meet up with a FEW friends, while maintaining social distancing etc.  The last week of May saw the gradual re-opening of all businesses - gradual not because of government regulations but because only those who feel ready to open are doing so, others are still making tweaks and adjustments.  Schools re-open next week, but attendance is voluntary.

I am so grateful for the calm thoughtful leadership of Dr. Bonnie Henry, her careful plans that thankfully were followed by the majority of the population here - we have not only slowed the curve, we have damn near halted it, not a single new case on Tuesday, vs over 1,000 in North Carolina.  We do still add newly diagnosed cases, and sadly, new deaths most days,I call that, the power of social distancing, effective hand washing, and staying home whenever possible.  We have not been unscathed, BC has, as of today, 2,562 confirmed cases; to date, our country has 90,909 confirmed cases, other provinces have not fared as well as we.  Ontario has roughly triple the population of BC (https://www150.statcan.gc.ca/t1/tbl1/en/tv.action...), with TEN TIMES OUR CASES AT 28,700; Quebec has less than double our population - they have TWENTY TIMES OUR CASES AT 50,232.  At some point we will learn the why and how things differed so greatly from province to province...for now we are grateful that over half of our confirmed cases nationwide, 47,905 have been given the all clear and recovered.  Canada is a country of 37,742,154 (https://www.google.com/search?client=firefox-b-d&q=population+of+canada) people and have, to date, lost just shy of 7,000 citizens to Covid 19; BC has lost a precious 164 lives to date (https://www.google.com/search?client=firefox-b-d&q=jcovid+deathtoll+in+bc) our curve is definitely flattening, in BC it has more than flattened.  The United States has approximately ten times the population of Canada, at 331,002,651; they have suffered in excess of 100,000 deaths...sadly, I fear they may have shut down too late and may be opening too early - based on what we have seen here in the provincial differences in contraction, spread, and deaths.  In Canada we are fortunate that most seem willing to focus on the public good, as opposed to infringement on personal freedoms.  I fear, where the rigid upholding individual rights and freedoms supersedes public good, it may hinder the fight against Covid 19.

Any loss of life is unacceptable, please learn from our example.  Shrink your social bubble, do not gather in groups (extended family, friends, funerals, birthday parties, places of worship); stay home when possible, practice strict social distancing, hand washing, and mask wearing.  If BC is any example, the answer to the question does early implementation of social distancing work, I will say a hearty and resounding YES and shout it from the rooftops.  Honestly, these habits cost us nothing financially, and we can adapt to other ways to socialize; the penalty if we don't is the loss of lives, possibly a friend or loved one.  Know that your actions DO make a difference, we have proved that, here.  Be Calm, Stay Safe, Stay Home and most of all, BE KIND.