‘This suggests the Chinese are really good at keeping people alive with this disease’ Might NHS Scotland be doing the same?

Image NY Times

From sam

Better treatment [in Scottish hospitals] is likely to be the answer. This extract from an interview with WHO’s Bruce Aylward suggests that may well be the reason.

“In Guangdong province, for example, there were 320,000 tests done in people coming to fever clinics, outpatient clinics. And at the peak of the outbreak, 0.47 percent of those tests were positive. People keep saying [the cases are the] tip of the iceberg. But we couldn’t find that. We found there’s a lot of people who are cases, a lot of close contacts — but not a lot of asymptomatic circulation of this virus in the bigger population. And that’s different from flu. In flu, you’ll find this virus right through the child population, right through blood samples of 20 to 40 percent of the population.

Julia Belluz
If you didn’t find the “iceberg” of mild cases in China, what does it say about how deadly the virus is — the case fatality rate?

Bruce Aylward
It says you’re probably not way off. The average case fatality rate is 3.8 percent in China, but a lot of that is driven by the early epidemic in Wuhan where numbers were higher. If you look outside of Hubei province [where Wuhan is], the case fatality rate is just under 1 percent now. I would not quote that as the number. That’s the mortality in China — and they find cases fast, get them isolated, in treatment, and supported early. Second thing they do is ventilate dozens in the average hospital; they use extracorporeal membrane oxygenation [removing blood from a person’s body and oxygenating their red blood cells] when ventilation doesn’t work. This is sophisticated health care. They have a survival rate for this disease I would not extrapolate to the rest of the world. What you’ve seen in Italy and Iran is that a lot of people are dying.

This suggests the Chinese are really good at keeping people alive with this disease, and just because it’s 1 percent in the general population outside of Wuhan doesn’t mean it [will be the same in other countries].

Julia Belluz
That’s really concerning for the rest of the world. Are you suggesting this is the big one — the once-a-century pandemic people have been bracing for?

Bruce Aylward
It’s not. It can be the big one but like, for flu — whether you have a pandemic with flu, it’s a function of the virus. That’s a virus with a very, very high infectivity rate, a very, very high transmissibility rate. The time [the virus] takes to go from [one person to the next] can be as short as 1.5 days. For Covid-19, it’s longer — four to five days. Look around the world. We’re seeing a whole bunch of outbreaks controlled with the right responses, and even turned around if they get to a bad state.”

https://www.vox.com/2020/3/2/21161067/coronavirus-covid19-china

9 thoughts on “‘This suggests the Chinese are really good at keeping people alive with this disease’ Might NHS Scotland be doing the same?”

  1. “The role of modelling burst into the open last Monday, when the UK government switched its strategy on the virus. Gone was the idea to allow it to pass through the population in a managed way (and build up ‘herd immunity’), and in came complete suppression. It soon became clear why.

    A shocking new analysis from disease modellers at Imperial College suggested that 250,000 people would die under the old strategy. Some have reported the U-turn as a triumph for the modelling team, but that’s not the full story. Buried in the report was the admission that only “in the last few days” did the modellers update an assumption about the demand for intensive care beds. The demand had been assumed, based on pneumonia data, to be half the actual level observed elsewhere. Earlier versions of the Imperial College model, with the errant assumption, had been informing the UK and US government policy on the virus for “weeks”.

    The Health Secretary Matt Hancock, who days before had boasted that the abandoned strategy was built on “the bedrock of the science”, must have felt the earth shake.

    Richard Horton, a doctor and the editor of medical journal The Lancet, is one of many experts who is angry and looking for answers. The ‘new data’ was not new. Research from Chinese scientists in late January established the percentage of coronavirus patients needing intensive care. “We have lost valuable time,” Horton wrote in The Guardian. “There will be deaths that were preventable. The system failed. I don’t know why.””

    The above is an extract from a piece in Open Democracy. Allysson Pollock, a professor in public health, could have told Richard Horton one reason why the system failed. It is “the lack of public health input and the decimation of the speciality and expertise in communicable disease control prior to and after the Health & Social Care Act 2012. There appears to be no public health evidence from experienced physicians in communicable disease control and their teams.

    Last week the New England Complex Systems Institute presented a critique of the Ferguson paper (Imperial College) which the government used to justify its volte face – on the basis of its truly apocalyptic figures. The NECSI academics’ critique highlighted the deep flaws in the modelling in the Imperial paper, and crucially how the model failed to take account of the impact of contact tracing and testing, isolation, and quarantine. These are classic public health measures. The government’s evidence includes an important paper by Keeling et al on the impact of contact tracing on disease containment. This shows how, if basic public health measures are implemented, the transmission of the disease can be markedly reduced and the disease contained, without the draconian measures we are currently being subject to.

    It is not too late to do this and it must happen especially in areas within Scotland and the North East where the number of cases are still low.

    Blanket school closures across the whole country do not make sense. They should be proportionate to the situation in each local area with appropriate risk assessment and to the effectiveness of contact tracing, cordon sanitaire, etc, on containment. For example, Gateshead, Sunderland, and Northumberland have very few cases, so vigorous contact tracing of cases could be done. During the H1N1 flu epidemic only some schools were closed and then for short periods depending on the local information and risk assessment.

    This useful map shows the distribution of cases and deaths in different parts of the UK for COVID-19 and also the opportunity for rapid and intensive contact tracing and local intervention and risk assessment depending on the number of cases.

    Children appear to not be at high risk of COVID-19 infection and there is no strong evidence to suggest they are vectors; indeed, the Chinese evidence suggests the contrary. Those interviewed could recall no cases of child to adult transmission.

    It seems our government and its task force has failed to read and above all to learn from and apply the meticulous lessons of the China WHO report.

    “Much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China. These are the only measures that are currently proven to interrupt or minimize transmission chains in humans. Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts, and an exceptionally high degree of population understanding and acceptance of these measures.” [My emphasis]

    “China has a policy of meticulous case and contact identification for COVID-19. For example, in Wuhan more than 1800 teams of epidemiologists, with a minimum of 5 people/team, are tracing tens of thousands of contacts a day. Contact follow up is painstaking, with a high percentage of identified close contacts completing medical observation. Between 1% and 5% of contacts were subsequently laboratory confirmed cases of COVID-19, depending on location.” [My emphasis]”

    With new appointments to advise the Scottish government, it looks as if the Scottish government has, belatedly, grasped the folly of following UK government policy on covid19. If it has we have, I think much to thank Professor Pollock for.
    https://www.allysonpollock.com/?p=2901

    Liked by 1 person

      1. Just checked for UK figures at 2316 hours. Updated figures finally appeared: given for up to 9am on 25 March.

        Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.