Showing posts with label SARS. Show all posts
Showing posts with label SARS. Show all posts

Stop the Spread Explained: Healthy people are the main spreaders, vulnerable people suffer the most.



Stop the Spread Explained - as best as I can manage as a lay person.

My attempt to explain in laymans terms what Stopping the Spread of an infectious disease is all about, when we have no vaccine and no preventative treatment - and yes, healthy fit people are the primary spreaders of the infection because they move about a lot more than chronically ill people do, and they do not present with as much symptoms, so they can spread and not be aware of it. Wearing masks takes this into account, It is a precautionary measure. . No blame here, this is just how this SARSCOV2 virus functions. And people with chronic disease and immune system compromised status are the ones who suffer the worst effects. That's a lot of people - in the UK it is 15 million people, in the USA it is 83 million people. A family, society or culture is very much defined by how it relates to and treats the most vulnerable within it.

Stop the spread, eliminate the virus from a population, be it a village, a town, a city, a region or a country is a whole raft of measures that are designed to stop the spread of infection when there is no vaccine - that means to get to a point where there is no more active virus in the population within the given zone or territory. It is not a pick n mix list, any country dedicated to eliminating the virus from the population must do all of it. The weakest link must be strengthened to ensure the whole program works most efficiently.

If the virus cannot find new human hosts, it cannot replicate.

Transmission of infection across the community ceases. It stops finding new human hosts.

Then the vulnerable are much better protected.

That is what we ought to be aiming for.

* Important repetitive note : this virus is primarily spread by healthy people who show no symptom and the people it harms the most are those who have chronic disease conditions that compromise their immune response. Other super spreaders are people with symptoms left to self treat at home, in shared living spaces, apartment complexes.

Tourists, Immigrants and Business people travelling on air travel, in cruise ships, on holidays and so on, were the primary vectors of this infectious viral disease.

In the UK the population with chronic conditions and immune compromised status numbers some 15 million people, and it is not just the elderly, over 70s or people in care homes (441,000). In the US that population is 83 million.

Across all developed states, the numbers of potentially vulnerable people are significant.

The vulnerable are much  larger part of our population than anyone has really acknowledged.

It is worth noting that a small percentage of healthy people with no known or unknown underlying conditions also suffer some of the worst effects. So there is a risk, a gamble so to speak, even if it is very tiny, for healthy people who are exposed to the virus.

But for the vulnerable that risk is much, much greater. It is not a gamble they need imposed upon them.

The task before us, therefore, is to protect the vulnerable population by stopping the virus in it's tracks.

It doesn't necessitate heavy lock down, even though some states have used that.

Usually the reason for heavy shut down is that the virus has been allowed to go further than it ought to have been allowed. Shut down is a response to uncontrolled transmission.

Learning from experience?

UK Government Economic and Political policy was to not panic, in order to 'protect the economy'. In essence to deliberately allow the viral infection to run through the population, which was touted as 'herd immunity' - an a-scientific 'theory'. That was the original position,

While that aspect of the policy was 'dropped' (they stopped mentioning it) , and then denied, (they claimed it was never part of their considerations - an outright lie)  the policy of allowing a slow spread has been  maintained, and as such it has amounted to a continuation of the same policy - let the people take it on the chin, the healthy will gain immunity, shut the vulnerable away for 12 weeks.

There is no scientific basis for this policy, and certainly no public health basis whatsoever.

Vietnam and New Zealand acted early, and assertively, they acted as soon as any cases emerged.

First known case in UK was confirmed on 31st January, a Chinese couple returning from China to Newcastle, it was announced January 31st.  They had been in country for at least a week before that confirmation. The Wuhan epidemic was in full flow, and the UK was still receiving travellers from China, with no health checks at an UK travel entry points.

At that stage Italy was also seeing confirmed cases, and the beginnings of an epidemic, with thousands of ski holiday travellers from UK returning from Italy over February, without adequate checking or quarantine at entry to the UK, there was more infection being imported into the UK.

The time to act assertively is always as soon as the first cases emerge that are confirmed. A point worth repeating. It is also true that assertive action to quell community transmission must be taken at all times. You cannot allow even a slow spread of an infectious disease when you have neither vaccine nor treatment.

That said even if the infection has hit 10, or 15 or 20 percent of a population, when there is no vaccine, the stop the spread or suppression of virus protocols still apply and can still be implemented, and if done well, the policy will work.

The basic suppression of virus infection protocol is this :

A. From the very first cases, Government must give the citizens accurate clear direct information on the virus, how it is transmitted, and be transparent and honest in all communications - the first suggestion is that all mass events, public transport etc be curtailed - these are super spreader events. The UK government failed on that policy as Cheltenham Racing weekend was allowed to happen and a number of Football matches were allowed to go ahead.

People are asked to stay home for 8-12 weeks.

The State must support the citizens income for that period, and it must be fairly distributed, so that they can bear the burden.

All that money will be channelled into the local economies, which eases the stress on the economy at the local level. It is not wasted money. It is an investment in the health and welfare of the people.

B. Social distancing principles are put in place, to slow the spread, to give time for contact tracing etc, to work.

The Government must always be ensuring that people are very well informed as to why - you do not want to order people, you want to give them exact, detailed evidence based information. so that they are engaged in the process.

C. It is obvious that all social care and medical facilities must be fully equipped with PPE and other technical and logistical support for dealing with infectious disease, and have the ability to maintain standard services for the people who need their attention and care.

In China and Vietnam they created isolation treatment hospitals fever hospitals,  for treatment of people at the earliest possible stage of symptoms, to keep those ill people who were shedding viral away from the community. This stopped the spread and reduced cases escalating to severe or critical.

This must be enabled in both public and private care and health care settings. This means that they must be set up away from main hospitals. There can be no cutting corners in either environment.

D. The same applies to all institutional residential settings. If prisoners become infected,they must be removed from general population and treated in isolation.

E. We do not need health care 'heroes' - we need health care properly supported, well trained, not over stretched or over worked. UK has failed on all these areas.

(East Asian states had SARS and MERS in recent memory so their populations were alert to the methods having gone through them previously. )

Here is the basic process:

1. A case turns up at hospital or GP surgery, saying "I have fever, cough etc since yesterday." The earlier they report better. This is not a 'flu to be treated at home.

2. That person is tested (not just for SARSVOC2 Virus, but also for Flu and other Fever inducing diseases) and if found positive, with any infectious disease, is placed into treatment away from main hospital services in a Fever Hospital.

Government covers their income for the duration of their stay, average 2 weeks.

The Chinese and others have learned that Fever Hospitals are an effective way to treat cases of a specific virus or pathogen away from existing services so that escalation of cases are reduced, and so that cases can get the earliest and best possible treatment available. This reduces case fatality rates and protects main hospital ICU units. Those main hospital units can be expanded, and staff trained, more readily than entirely new ICU Hospitals can be built and staffed.

3. The person is questioned on his or her movements going back a week (standard incubation time, during which he or she might have been shedding viral particles that could infect other people) to draw a list of potential infectees - the list will be every person that the case spent more than 15 minutes with, in close contact, with attention paid to any public transport or crowded areas.

4. Contact tracing teams go out and visit each of those contacts, to check for symptoms, give advice and inform them of a 2 week quarantine - if they have symptoms, they go to Fever Hospital, with a contact trace carried out of their case. If no symptoms they are advised to stay on quarantine, and get in touch if any symptoms emerge - Government covers their weekly income for the 2 weeks of quarantine.

5. Repeat this for all cases and what you are doing is slowly but surely isolating all active infections, keeping an eye on potential new cases and finding out where people who have had the virus and had no symptoms are. And yes, teams of well trained people, who are good communicators must be assembled for this task to cover a large outbreak. I repeat that if Government is doing it's job, the communications of what is needed will be clear to all citizens, and they will have confidence in the teams of contact tracers, and will engage.

6. This is essential on closing down on the active virus. Chase every case, all contacts until no new cases emerge.

It is labour intensive, and smart phone tech can help make it a bit easier, but it cannot replace the human contact point - for example if an outbreak of cases occurs in your town, or neighbourhood, everyone is notified, by text or map, and people go into extra tight shut down, with hyper awareness of what to do if they get symptoms, vulnerable people get isolation treatment to protect them from being infected, people can provide help in shopping etc..

7. This helps being more precise in action, it can work without a major shut down if people wear masks, follow the protocols and are well disciplined - in the UK people are well disciplined, but the media have hyped the few who were not..

Contact tracing and mass testing makes the virus visible. 

That's the point. If we know where it is, then we can close it down
.
Obviously quarantine is essential at the borders of any territory, for all incoming travel, to maintain a virus free zone.

At their own expense, if foreign travellers or business, and if nationals returning, then the state funds it - use hotels close to entry points. This must be mandatory as the risk in not doing it is to great.

It is a process that has been tried and tested, it was developed during 1917-18 Flu Pandemic (even though they had no testing, or phones they applied the other human labour aspects and it worked well in limiting spread where it wass applied) and then refined during SARS in 2002-3, and MERS in 2012, Ebola  in 2013 -16.

It is an essential process for when an infectious pathogen is active and there is no vaccine or preventative treatment, and it has lethal outcomes for a significant part of a population.

In the case of this virus, it is spread rapidly by health fit people who show no obvious signs and for this reason shut downs are designed to slow the spread - and then you need the protocol above to STOP the spread. If you shut down, and do not follow the other protocols, there will be a drop off of infection rate, and as soon as you open up again, it will take off.

If we do not stop the spread, and eradicate the virus within a population it will continue to be passed around and that will expose those who are vulnerable because it's movement is invisible.

I wrote this song as an upbeat political protest song comparing New Zealand and others with USA and UK. There is room for more than hope in this crisis because we see proof positive of the stop the spread protocols.




this track is available as a free download as a .wav file (High res) on Soundcloud (above)

 or on Reverbnation as an ,mp3 file.


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Useful links

Short paper: Did we Eradicate SARS? Lessons Learned and the Way Forward

https://biomedgrid.com/pdf/AJBSR.MS.ID.001017.pdf

Guardian Article: "I’m an epidemiologist. When I heard about Britain’s ‘herd immunity’ coronavirus plan, I thought it was satire"

https://www.theguardian.com/commentisfree/2020/mar/15/epidemiologist-britain-herd-immunity-coronavirus-covid-19

Lancet paper on: Can we contain the COVID-19 outbreak with the same measures as for SARS?

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30129-8/fulltext

Wiki Page : Eradication of Infectious Diseases

https://en.wikipedia.org/wiki/Eradication_of_infectious_diseases

NHS England : Corona Virus - Expert Interview - What is contact tracing?

https://publichealthmatters.blog.gov.uk/2020/02/13/expert-interview-what-is-contact-tracing

Time Article : What We Can Learn From Singapore, Taiwan and Hong Kong About Handling Coronavirus

https://www.time.com/5802293/coronavirus-covid19-singapore-hong-kong-taiwan/

PR news article : Korean Government Communications during Corona Virus Epidemic

https://www.prnewsonline.com/South+Korea-coronavirus-communication

Vietnam's story - How Vietnam is winning its 'war' on coronavirus

https://www.dw.com/en/how-vietnam-is-winning-its-war-on-coronavirus/a-52929967

New Zealand:  New Zealand has ‘effectively eliminated’ coronavirus. Here’s what they did right

https://www.nationalgeographic.com/travel/2020/04/what-new-zealand-did-right-in-battling-coronavirus/


Fever Hospitals in Wuhan

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30744-3/fulltext

Fever Hospitals

https://www.scmp.com/news/china/society/article/3078397/china-style-makeshift-hospitals-could-help-coronavirus-hit


Kindest regards

Corneilius

"Do what you love, it is your gift to universe."

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The argument for Stopping the Spread of Infection, as opposed to Slowing it down.


#StopTheSpread #SpreadTheLove

The lock down, keep your distance, no large crowds, stay at home, isolate the elderly and the vulnerable for 12 weeks and wash your hands approach is best described as the top down approach.  Government Advice.

It is imposed or suggested from above.

It is an umbrella policy. 

It is a very broad brush.

It has no detail.

It is partly an order,  and partly an advice, issued by the UK Government.

The policy is to slow the spread of the infection.

As things stand there is no policy in place to stop the spread of the infection.

Two entirely different policy choices, with profoundly different outcomes.

The UK Government's claim is that this slowing of the spread is necessary in order to prevent a potential overwhelm of the NHS as it stands.

Their claim is that by isolating the elderly and those in care settings we can allow the infection to spread among the general population of 'fit' people and thus protect the vulnerable and the NHS.

Sounds good.

What does slow the spread of infection really mean?

It means to allow the spread of the infection, albeit more slowly.

How is that possible?

When we all  carry on as normal, what do we need to do to make the infection spread more slowly than if we deliberately exposed ourselves to the viral infection by continuing with our everyday interactions.

Masks, physical distance, hand hygiene, limits on indoors gatherings, work from home is what is on offer.

What is not available is the resource base for rapid suppression of localised surges and outbreaks - expert effective local contact tracing,  economic support for quarantine, economic and medical support for isolation treatment, local real time data and information so that locally people can see where outbreaks are happening and take action to reduce contact or exposure to infection and then stop the spread of the infection.

What is on offer guarantees that the infection WILL spread, just slowly.

That is what slow spread means. There is a problem - slow spread cannot be controlled, it will always lead to exponential growth at some stage.

The Government ignored calls by responsible health professionals an epidemiologists to properly resource the NHS and the 15,570 care homes across the UK with PPE.

The UK Government ignored calls to make other provisions in advance, calls that were made from early January when the genome of the new virus was sequenced, and the virus given it's name (SARSCOV2). The disease was named COVID-19 (Corona Virus Disease 2019).

Because of that failure to respond to rational warnings,  the NHS frontline staff have been placed in harms way,  they are forced to deal with a multitude of cases of infection without the appropriate protection kit, and other essential supplies amidst staff and bed shortages, and they are suffering the impact of the governments choice, and we can see clearly now that the claim that they are protecting the NHS was and is obviously false.

They knew it was false the day they announced the policy to slow the spread of the infection.

Slowing the spread means infections have already hit care homes, and the entire population within care homes, carers and the cared for alike, are now at serious risk because they do not have the PPE kit and other situational practices to prevent infection spread.

Therefore the claim to be protecting the elderly and the people in care homes was a non-starter, it is demonstrably not the case.

What does slowing the infection spread mean for the 5,000,000 people in the UK with known  chronic compromised immune system conditions?

It means they are guaranteed to be imprisoned, in isolation or in shielding, for as long as the spread is allowed to progress, however slowly.  It means masses of early, painful, horrific deaths within that cohort -  a conservative estimate would be 1% of that population would be 50,000 deaths.

Slowly, over a period of a many months, or more up to a tear - what does that mean?

How many deaths a month is acceptable?

Why not adopt a stop the spread policy?

https://bylinetimes.com/2020/04/01/the-coronavirus-crisis-eight-week-suppression-strategy-could-stop-covid-19-in-its-tracks-says-ex-who-director/

"We know we can get this under control,” says Dr Anthony Costello, a former Director at the World Health Organisation (WHO), where he headed up maternal, child and adolescent health. “The problem is that Europe has been too slow to act compared with Asia; and America is now facing a huge crisis.”

Costello, who is Professor of Global Health at University College London where he previously headed up the UCL Institute for Global Health, spoke to me via telephone from Yorkshire, where he is currently isolating from his family members, many of whom are experiencing symptoms of the novel Coronavirus.

Having worked at the WHO from 2015 to 2018 before returning to UCL, Costello pulls no punches about the failures that, he says, have allowed the virus to rampage across Western countries.

He is also concerned about tepid Government messaging. “It’s not enough to just have modellers, virologists and behavioural scientists.

You need people who can translate this into action. Social scientists. Public health experts experienced in community mobilisation.

Right now, we are locked into this strange idea that the Prime Minister or President makes a speech and suddenly the entire country changes its mind. That’s just a fantasy.

Throughout my career, I’ve seen that just giving people a few of the right messages won’t necessarily change behaviour. We need a more serious, decentralised approach and to share data with local communities.”


He refers to some of China’s mass communications measures.

“The Chinese managed to suppress the virus in provinces outside Wuhan without the same sort of total lockdown by operating quickly.

They had a TV station giving out information on the virus round-the-clock on a 24-hour basis.

We had policing of supermarkets and pharmacies.

But most importantly we had a comprehensive mass testing and contact tracing programme. And proper protection for frontline health workers. And that’s how this was brought under control within seven weeks.”


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636331/ - a paper outlining how the SARS epidemic was stopped in it's tracks.

Which is to say take the proven steps to eradicate the virus from within the population in any given area, from a village to towns, to cities and entire territories.

Because we have no vaccine we have no time to waste.

There is no lee-way, no room for any margin of error. Every error will cost lives, will cause avoidable horrible deaths.

So here is the protocol to stop the spread of infection.

A) Officially declare a legal shut down, and pay all non-essential workers to stay at home, by providing a Universal Basic Income for the duration of 3 months itwho  would take to stop the spread, and eradicate the virus from the population.

To make this easier to bear, if UBI is not acceptable then consider a pause rents, mortgages, major bill payments and roll out temporary income support for the duration of the program to stop the spread of the infection.

That money will not be wasted, it will  be going back into the local economy.

Support all essential workers - food production, distribution and retail, public transport, utility, health, police, fire brigades, NHS, military and civil service by ensuring they have full PPE and training adequate to their roles, and provide them and their employers with exact and accurate information on the virus, the infection, the disease and the protocols demanded by the situation.

Clear communications that  treat the citizens as rational adults.

B) Roll out fully resourced contact tracing - Trace all the contacts of every case that presents, and meet each and everyone  of those contacts with a team who can gently and firmly assess and test every one of those contacts to see if they

1) have the virus - send for treatment in isolation wards to avoid treatment at home which leads to more spread

2) have the antibody - have survived the infection, are presumed immune

3) have not yet been infected - people who could become infected - they must be protected from contracting the infection and also quarantined for two weeks to see if symptoms emerge.

Use school buildings that are empty as co-ordination centers locally. Distribute testing and organise local contact tracing through these as well.

C) Treat symptomatic people from the contact list and all who present with symptoms in isolation hospitals, rather than leaving them at home, where they can spread the infection, and where the patients condition can escalate without support to deal with that.

(This was observed in Wuhan before the contact tracing and new build isolation hospitals kicked in - in the end they had 1800 teams of 5 people each meeting all the contacts, contact tracing is resource heavy in that it needs lots of people working at it, nonetheless it works really well, and then mobile phone tech was integrated into that to monitor symptoms and spread. Potentially hundreds of thousands of jobs which puts more cash back into the local economy and build community cohesion at the same time.)

D) Quarantine all asymptomatic contacts, and as soon as they show symptoms, move them to treatment hospitals to prevent or reduce escalation to severe or critical  - this also means less pressure on the available intensive care units and general hospital admissions.

E) Everyone who is quarantined is supported financially and monitored for signs of symptoms so that earliest treatment can be given, to reduce escalation of symptoms into severe or critical.

If the Government had taken this route, back in February, or even in Early March, a method which is proven already in 5 largely urbanised states, China, Taiwan, Hong Kong, Singapore and South Korea and is being deployed successfully in others as I write, we would be closer to stopping the spread and then eradicating the infection spread within the UK population.

We know that it would take 8-12 weeks to stop the spread across a large populous state.

Those states that have applied this protocol are experiencing imported cases, that is to say the infection is being carried in by travellers from outside those States are bringing the virus back into those virus free territories.

F) Quarantine all incoming travellers, via Air, Land or Sea, for two weeks, and monitor them strictly.

If the Government were to move immediately to stopping the spread with an eye to eradication, we could clear the infection within three months.

https://bylinetimes.com/2020/04/01/the-coronavirus-crisis-eight-week-suppression-strategy-could-stop-covid-19-in-its-tracks-says-ex-who-director/

We have the resources, we have the people, we have the desire - but do the Government share this vision?

The aim is to find all infection routes and to chase them down to where everyone infected is known and observed, and no new infections are starting - when the virus runs out of new hosts, it vanishes in that population. Quarantine must be fully implemented upon all incoming  and returning domestic and international air, sea and land travel. Even from Northern Ireland.

We need both the shut down and the bottom out approach.

Instead the UK Government policy is encouraging the slow spread of infection, and pretty much guaranteeing importing extra new infections by way of air, sea and land travellers arriving from other countries where there are serious infection outbreaks, because, as of today, 17 April 2020 is no testing or quarantining of those arrivals.

This is insane.

Let me repeat - within the UK we could, given the fullest resourcing, eradicate the virus in 3 months.

Then a fully funded quarantine must be in place for all incoming or returning travellers to maintain that eradicated status, until a vaccine is available or we have implemented the stop and eradicate policy across the Earths states and communities...

Allowing the slow spread will play out over many,  many more months, possibly years...

In economic terms the difference is between losing three months of GDP or losing a years GDP plus the other costs as various systems reach collapse or stress beyond repair due to continued shut down, re-opening and further waves of infection outbreaks generating a cyclic pattern that persists because there is no vaccine.

It's not just about me, or you my dear reader, it is about all of us.

This situation is about all of humanity as one human family, one society of many cultures and languages, it is about unity across diversity.


Kindest regards

Corneilius

"Do what you love, it's Your Gift to Universe"

Thank you for reading this blog. All we need to do is be really honest, responsive to the evidence we find,and ready to reassess when new evidence emerges. The rest is easy.