Daily numbers, graphs, analysis thread 3

[Barracker]

Welcome to thread 3 of the daily updates.

Resource links:
Worldometer UK page
Financial Times Daily updates and graphs
HSJ Coronavirus updates
Johns Hopkins Coronavirus Resource Centre
NHS England stats, including breakdown by Hospital Trust
Covidly.com to filter graphs using selected data filters
ONS statistics for CV related deaths outside hospitals, released weekly each Tuesday

Thank you to all contributors for their factual, data driven, and civil discussions.

While I'm on a roll, I'll spam the thread with the latest graphs from the brilliant John Burn-Murdoch.

The "Not turning the corner yet" one:

The "trajectory definitely worse than Italy now" one:

Japan is so low.

Ah thanks, Baracker I like a key

Yeah it looks like we were ahead of Italy for awhile, then we were tracking them and now we're back ahead of them.

India have started to have more cases recently too. Do we think we will see an explosion in cases there soon?

I can't begin to imagine how horrific the pandemic will be in developing countries, where people cannot 'lockdown' in a home easily, nor isolate from poorly family members in a different room, where never mind advice to try to use a different bathroom, there isn't even a family bathroom in the first place, and handwashing facilities are scarce and hygiene is tremendously difficult. Where noone can stock up a couple of week's food using Sainsbury's home deliveries and food is often served from a communal bowl. There's nothing much other than overcrowded public transport available to get anywhere far, and hardly any hospitals within reach for many people. Too few beds or ventilators or medication.

Let alone facilities to take care of the dead.

It's beyond imagination.

It is going to be terrible. Your last line to me is a big issue, sadly. As that could bring its own problems.

In some developing countries, conditions under an epidemic might not be much better than in mediaeval times of plague in Europe

• unless we have the will and the resources to send a lot of aid

Japan has under 3,000 confirmed cases
They seem to have managed to stop the spread v early on
They have far fewer visitors than most places, so maybe they can keep out the virus

I saw this the other day - World Bank approves $1 billion emergency funds for India to tackle coronavirus

List of funding here Livemint

Other things may have impacted Japan.

Wearing masks from the the start. No hugging like Italian greeting etc.
Also possibly under reporting due to the Olympics

Lymphopenia/Lymphocytopenia is a clinical feature of HLH, as is Splenomegaly

The end conclusion of that paper is interesting -

We speculated four potential mechanisms leading to lymphocyte deficiency. (1) The virus might directly infect lymphocytes, resulting in lymphocyte death. Lymphocytes express the coronavirus receptor ACE2 and may be a direct target of viruses.5 (2) The virus might directly destroy lymphatic organs. Acute lymphocyte decline might be related to lymphocytic dysfunction, and the direct damage of novel coronavirus virus to organs such as thymus and spleen cannot be ruled out. This hypothesis needs to be confirmed by pathological dissection in the future. (3) Inflammatory cytokines continued to be disordered, perhaps leading to lymphocyte apoptosis. Basic researches confirmed that tumour necrosis factor (TNF)α, interleukin (IL)-6, and other pro-inflammatory cytokines could induce lymphocyte deficiency.6 (4) Inhibition of lymphocytes by metabolic molecules produced by metabolic disorders, such as hyperlactic acidemia. The severe type of COVID-19 patients had elevated blood lactic acid levels, which might suppress the proliferation of lymphocytes.7 Multiple mechanisms mentioned above or beyond might work together to cause lymphopenia, and further research is needed.

Section (3) sounds like a description of EBV-sHLH

wwwnc.cdc.gov/eid/article/6/6/00-0608-f2

4 Lactic acidosis has been linked with HLH in adults and inborn errors of metabolism are linked to HLH in babies.

ashpublications.org/blood/article/134/Supplement_1/4879/428567/Type-B-Lactic-Acidosis-in-Adults-with

www.researchgate.net/publication/304536617_An_Unusual_Case_of_LCHAD_Deficiency_Presenting_With_a_Clinical_Picture_of_Hemophagocytic_Lymphohistiocytosis_Secondary_HLH_or_Coincidence

Other Zoonotic diseases (including SARS-CoV) have kicked off sHLH: www.europeanreview.org/wp/wp-content/uploads/1324-1337.pdf

The "trajectory definitely worse than Italy now" one

Oh crikey 😢

As someone who has occasionally unpredictable immune reactions, this is motivating me to be even more careful.

My mum too, who is living with me

@Barracker thanks so much for this really informative thread. I’m living in a developing country and it’s terrifying. We only have a few reported cases but we know it’s coming. The capacity to test is very limited as is the PPE. On a good day people die here from preventative infections diseases. I would add to your list the fact that most people survive on a combination of day labour and subsistence farming. There is a very real chance lockdowns will mean starvation. If we look at India and South Africa lockdowns are being enforced by more and more draconian measures including beatings and rubber bullets. There needs to be emergency aid and roll out of PPE. But I think while the US and Europe are trying to tackle there own epidemics people will be very slow to respond.

Italy finally looks to be on a more downwards trajectory.

Does anyone else fill in the daily COVID app to track cases? Usually they just ask- have you been tested and do you feel ok or ill. Very simple. Yesterday they added an additional question of do you take blood pressure medication. Could be a factor.

So France reported 1053 deaths yesterday. Of that 441 died in hospital, the remainder is still the catch up for care home deaths. So far there are 7560 total deaths in France of which 2028 are care home deaths and «other establishments», it’s unclear if that includes people who died in their own homes.

28143 people are hospitalised, 6838 are serious critical.

Interesting and new article, written by the Syracuse University Department of Chemistry and published 6 days ago.

papers.ssrn.com/sol3/Papers.cfm?abstract_id=3561958

Key data is a graph of latitude versus deaths per 1000 cases reported.

Conclusion: ''COVID-19 morbidity and mortality are correlated with vitamin D deficiency......... Indeed, the raw data from the World Health Organization show that barely 1% of the reported deaths worldwide occurred in individuals south of the Tropic of Cancer''

Peak death rate is very clearly between the 40th and 50th parallel north latitudes. Note that the following regions lie in this geographical region: London, New York, Lombardy and Madrid.

Notable decrease in Norway, Sweden and Denmark latitudes: ''Scandinavian nations have some of the lowest vitamin-D deficiency rates on Earth ............attributed mainly to dietary supplementation, with both fish liver oils and vitamin-D-fortified milk.''

Indonesia and Philippines seem to show higher than expected death rates perhaps due to higher rates of vitamin D deficiency and limited testing in high population densities.

Overall year-round sunny nations seem generally to have lower death rates, perhaps due to a combination of sunlight exposure and vitamin D levels and also the viral instability above 28 degrees C combined with ultra violet rays.

Gosh that's interesting

If one good thing comes out of this it might be better general monitoring of vit d status in the population.

NeurotrashWarrier I agree.

Check out these articles/abstracts published in the last three years:

clinmedjournals.org/articles/jide/journal-of-infectious-diseases-and-epidemiology-jide-3-030.php?jid=jide

www.ncbi.nlm.nih.gov/pubmed/30675873

Key conclusions:

''Vitamin D supplementation was safe, and it protected against ARIs overall. Very deficient individuals ................... experienced the benefit.''

(ARI = acute respiratory infections)

Lots of people have been saying, yes of course, a large % of the UK population will be vit D deficient after a long, cold, dark winter. But even the NHS is not recommending vit D supplements for boosting the immune system - it only state that it is necessary for healthy teeth and bones!

One person wrote to me, ''My uncle recommended I take vit D supplements in January! He's a respiratory consultant............................''

That's interesting then I read this

www.bbc.co.uk/news/uk-52172035

for people wh0 have no outside space

Does anyone know what the stats are on the ages of those currently in ICU? I keep seeing people say "my friend works in X hospital and there are X number of people in their 20s, 30s and 40s on ventilators".

LWJ70, thanks.