Kai Kupferschmidt @kakape
For me and for everyone I know who has been following #covid19, the last few days have felt like a profound shift in the epidemic. We are clearly entering a new phase. And since I've had some time to digest recent news, here is a short thread about that „window of opportunity“
Why do I believe that? First in general: there is the way the virus has spread on the #Princessdiamond, in hospitals, in prisons. #SARSCoV2 is very infectious, patients seem to spread it for a long time and cases are hard to detect. It is simply very hard to contain such a virus.
Iran: Until three days ago, Iran had not reported a single #COVID19 case. Now we are at 28 cases, incl. 5 deaths. The number of deaths and also the cases of travellers from Iran testing positive suggests this is the tip of an iceberg. We will soon see how large that iceberg is.
South Korea: The country has now confirmed 433 #COVID19 cases. Most of these are related to a hospital outbreak and to meetings of a religious group. The sheer number is going to make it hard to contain this. Are we looking at a second China? Hopefully not, but it’s possible.
Singapore with its gold-standard surveillance, has at least 7 #COVID19 cases that have not been traced to a known transmission chain. Japan has a similar problem. Italy has local transmission incl. 2 deaths, which suggests those numbers will go up significantly.
And these are just the things we know. We can only guess what we don’t know. This MRC analysis suggests that 2/3 of all #COVID19 cases exported from China have been missed t.co/HXYOVYiK1o
From the summary: "we estimated that about two thirds of COVID-19 cases exported from mainland China have remained undetected worldwide, potentially resulting in multiple chains of as yet undetected human-to-human transmission outside mainland China"
None of this is a shock. Most researchers always expected it would get to this point. The question is: What happens now? I’m not a public health expert, I’m not an epidemiologist. I’m a journalist. That means I think a lot about communication and that has to enter a new phase too
The massive efforts in China have bought us time. But we should be using that time to prepare and that includes preparing the world by communicating what is happening, what is likely to happen and what the response might look like. That is the “window of opportunity” we have now.
Helen Branswell @helenbranswell
- This thread should be read as a companion to *@kakape*'s terrific analysis of where things stand with the #COVID19 outbreak. If you aren't following Kai, you aren't following coronavirus news properly. Here's his very insightful thread. Next, my thoughts. [RTB ~ as posted above]
- As *@kakape* wrote, *@WHO*'s strategy — building on China's strategy — has been to strive to drive #COVID19 out of humans. Stop its spread in China, tamp out all the sparks that flew out from China, consign this virus to the history books with its close cousin, SARS.
- This strategy has roots in the 2000s, when 1) SARS was stopped & 2) mathematical models said a threatening H5N1 bird flu pandemic could be snuffed out at source with antiviral drugs & quarantine, etc. I never believed those models but thankfully, H5N1 didn't take off.
- As the number of #COVID19 cases has far surpassed the SARS total, as it has become v/ clear the new virus transmits with far greater ease than its cousin, the possibility that this one could be contained/eliminated has seemed more & more remote.
- Still, very seasoned infectious diseases & public health experts — people I've learned tons from over the years —have as recently as Thursday-Friday told me they thought #COVID19 could be stopped. I don't know if they believe it. I'm certain they think the world has to try.
- I very much hope they are right. But:
The #COVID19 containment strategy rests both on China being able to put out the forest fire AND every country hit by sparks — exported cases — also being able to stamp out those sparks.
- Other countries have to be able to identify incoming #COVID19 cases, isolate them, monitor contacts, isolate the ones who get sick. Stop the virus from spreading locally. Stopping the virus in China, if it can be done, isn't enough. That's especially evident this weekend.
- Models have already told us this in theory but the #COVID19 outbreaks in Iran & Italy show graphically that we haven't seen all the sparks that have flown off the conflagration in China. We don't know how far this virus has spread or what will be the next Italy, Iran.
- Iran exported a case before it knew #COVID19 was in Iran. An infected Cdn traveler was home for days before Iran declared its first cases. But for the fact that an ER doc decided to test a woman who had traveled, but not to China, the Cdn traveler wouldn't have hit the radar.
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On Friday morning, Italy had 0 diagnosed #COVID19 cases. Today it has at least 32 & 2 deaths. Which means it has had cases for a while. Which means there are more.
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All this to say that regardless of whether China can stop #COVID19 within its borders — a very tall order, despite its extraordinary efforts — there are new fronts in this battle. A few of them have hit our radar in the past few days. They surely aren't the only ones.
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This map is a bit misleading because we don't know if the Iranian outbreak was set off by someone who had been to China. Sounds like the Italian one, yes. But it gives you a sense of how much #Covid19 is skipping around.
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At some point, public health officials at @WHO & elsewhere will likely stop talking about containment & start talking about "mitigation:" What can be done to lessen the blow, how do we take care of our families, our communities?
It's important to be thinking of this now.
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A last thought: Several scientists I have spoken to recently, people who know how advanced Chinese scientific capacity is, have told me they think China must by now have done studies to estimate the percentage of mild #COVID19 cases that have missed detection.
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That is a critical piece of information & could change our view of #COVID19 substantially. It's not a nice disease, but it's probably not as bad as it currently looks.
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Think of an iceberg. With #COVID19, it's easy to see the deaths/serious cases. But people with mild illness don't go to hospital/don't get tested. Studies have to be done to find them. We need a clearer picture. If the data exist, share. If they don't, generate them.