Saturday I was very relieved because our daughter arrived home. She had been on a language study trip for a week. In Italy. Naturally I have been watching events there rather more closely than I might otherwise have done. And it is disturbing in several ways, particularly as the Italian government response to the covid-19 virus was pretty good. Luckily daughter was not in the infected region and they weren't traveling back with Flybe. Even when the schools were closed the language school she was at stayed open. And when Easyjet started cancelling flights from Italy for lack of demand, hers wasn't affected. They did a few visits of course to the tower at Pisa and to Florence, and judging by her account and the pictures those tourist sites were far less busy than normal. That's was all before the latest announcement that the whole of the country is now in lock-down.
The statistics on the virus are tricky to interpret. Partly that's because of the 2 week or so incubation period which you ought to account for in comparing numbers of cases with mortality and hospitalisation figures. Statistics from Italy and China over mortality rates and hospitalisations are also notably different. Two potential real reasons for that I can identify - demographics and differing strains of the virus. Demographics because the virus affects over 65's rather more severely than younger cohorts, so rates will appear higher in places with a higher average age. If it should be because Italy has a different more aggressive strain that really troubling. It implies it can mutate very rapidly and that is big trouble. The other possibility is that someone is 'managing' their official figures.
Something that is quite clear from Italy is that the symptoms are severe in a significant portion of the cases. The mortality rates seem to be a touch below 3% and many people , especially younger ones, get mild symptoms and do recover. But about 10% need intensive care. And that is where the immediate stain comes - on the demands on the health system. I don't know how prepared Jersey is in terms of intensive care capacity (facilities and staff), face masks etc. I do know other places have been caught flat footed. The State of Washington had to issue emergency instructions because they were about to run out of face masks in hospitals , and had been scrounging stuff from vets and even builders supplies to give to patients. Staff were instructed not to use them!
To my mind the response of the States of Jersey , like that of the UK and US governments, has been appallingly lax and ill informed. Washing hands properly and working from home, if you are one of those non essential people who works at a desk, is fine. But it is inadequate. The latest comment I have seen from the Chief Minister was claiming testing at the ports wouldn't meet their requirements. Possibly so if their requirements are unrealistic. You won't stop the virus reaching us by testing like that. There are at least two well documented instances of the virus being passed on by someone who is asymptomatic. But testing everyone entering would shift the odds and also buy some time. Certainly the pressure on the hospital here would be lessened if we get past the seasonal flu period and have more time to arrange adequate intensive care capacity. And yes it is possible to do it. Mongolia last week banned flights from high risk countries, Germany is testing at some borders, including road passengers. By comparison Jersey has limited access points so should find testing a doddle. Israel is expected to go further and require all entering the county to go into quarantine initially. Probably a step too far for us at this stage.
China and Italy have responded swiftly and strongly. If the official figures from China are right they are getting on top of the virus spread. Italy despite their efforts has not, yet. I find it revealing to see those places that have taken strong action are those that have a tendency of putting citizens interests before those of business. Places like the UK, USA and Jersey where the first reaction typically is to think of the economy are way less prepared, and have done little beyond issue the predictable trite 'don't panic', 'wash your hands', 'we are prepared'.
That brings me to a point where I think the comments from the Chief Minister are most misguided. He was quoted saying that if the economy did suffer we have reserves and funds to deal with it. Yes there are reserves and funds, but no it wont be effective if this is a pandemic developing. There are two main reasons for this. First, unless the funds are heavily skewed in the allocation to US treasuries and gold or well hedged with some short or inverse positions the values are dropping rapidly and will continue as economies everywhere slow down. Second as economies falter and people get ill, the government costs rise -sick pay, unemployment benefits, while tax revenues tend to fall. If you think the government are going to use those reserves to prop up the economy rather than bailing out its cashflow, you are a bigger optimist than me!
Finally I want to point out something alluded to above. The choke points that can be used to test people entering. In that scenario they are an advantage. But in another scenario it is a problem. Imagine just for a moment that the crews of the ferries to Jersey are quarantined for two week because they have the virus...
UPDATE . Call from school this morning that all those on the trip have to self isolate. The info comes from update UK advice, but isn't retrospective there. Jersey officials have decided to apply retrospectively.
https://www.vox.com/2020/3/2/21161067/coronavirus-covid19-china
ReplyDeleteThis is a good link on lessons from China by a WHO expert.
"The faster you can find the cases, isolate the cases, and track their close contacts, the more successful you’re going to be. Another big takeaway is that even when you have substantial transmission with a lot of clusters — because people are looking at the situation in some countries now and going, “Oh, gosh, what can be done?” — what China demonstrates is if you settle down, roll up your sleeves, and begin that systematic work of case finding and contact tracing, you definitely can change the shape of the outbreak, take the heat out of it, and prevent a lot of people from getting sick and a lot of the most vulnerable from dying."
"In China, they have set up a giant network of fever hospitals. In some areas, a team can go to you and swab you and have an answer for you in four to seven hours. But you’ve got to be set up — speed is everything."
Here the swaps go to the UK and there is a 3 day turnaround!
No one here seems to be taking on any of those lessons!
Thanks for the link Tony. It good to see some reliable on the ground evidence that the Chinese have got on top of new cases.
ReplyDeleteI agree about speed and tracing contacts being vital.
I note "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]." and "They bought a heap of ventilators to keep people alive. They made sure they had a lot of high-flow oxygen, CT-scanning capacity, lab capacity. So beds, ventilators, oxygen, CTs, and labs. And they had problems with all of those supplies at different points. "