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.
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
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