Wednesday 11 March 2020

COVID-19 Coronavirus UK And World News Update 09/03-11/03

COVID-19 Coronavirus UK And World News Update 09/03-11/03

The UK now has reported a total of 456 positive cases of COVID-19, and we have 8 losses of life on home soil (plus 1 on the Diamond Princess).

18 of the UK's positive testing cases have recovered. 27,476 people have been tested.

Total cases assumed to be: England 387, Scotland 36, Wales 13 and Northern Ireland 18 (based on news reports).

Rep. Of Ireland have 34 cases.

The world has 124,968 cases and 4,585 losses of life. 67,050 people have already recovered.

At the WHO conference today, Dr Tedros said "In the past two weeks, the number of cases of COVID19 outside Flag of China has increased 13-fold & the number of affected countries has tripled".
"WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction"
"We have therefore made the assessment that COVID19 can be characterized as a pandemic"
"There’s been so much attention on one word. Let me give you some other words that matter much more, & that are much more actionable:
Public health.
Political leadership.
And most of all, People".

COVID-19 Coronavirus UK And World News Update 09/03-11/03

UK News

On television Tuesday morning Boris upset a huge portion of the population by mentioning the 'take it on the chin' approach for a second time. There is genuinely a MASSIVE debate here between business/economists and humanitarians/health workers. Letting everyone just catch COVID-19 will definitely speed up the epidemic and save trillions of $$$'s on the stock exchange, but it will easily kill around 3 times as many people. An article in The Lancet warned last week that world money is all built on such fragile loans and promises that countries will be faced with a choice. Save your economy, or save lives. Boris maintains the UK will keep a balanced mix.

On Monday Chris Whittey said that from today the UK will be screening everyone who finds themselves in hospital with a chest condition, not just those who are in Intensive Care.
He was really sensible actually, and advised that we don't yet have to make major changes to behaviour, but be aware that if we have a bad chest, we probably don't want to give it other people whatever it is, so use common sense. Everyone is asked to stay home if you are ill.
Within 10-14 days the UK will move to a situation where “everybody who has even minor respiratory tract infections or a fever should be self-isolating for seven days afterwards” - this is being held up by the world as an example of how to be realistic without causing panic. (It may be a little on the generous side time wise). Further measures are to be expected.

The Government are allowing local authorities to relax current delivery time restrictions to UK shops and supermarkets. They will be allowed to deliver any time of the day or night temporarily, in order to keep shelves stocked during the COVID-19 outbreak.

The General Medical Council have released updated guidance for medical professionals. It includes specific powers and allowances for COVID-19
"In an emergency the Secretary of State for Health can activate Section 18a of the Medical Act (1983) and ask us to grant temporary registration to certain groups of appropriate people, to supplement doctor numbers and provide cover in a range of roles." These include Doctors who have recently retired or relinquished position, registration is automatic and free. Volunteers are not needed unless an emergency is declared.

I hope you have paracetamol, because panic buying has not only cleared shelves, it's emptied some stores of items such as ibuprofen, paracetamol, Calpol and hand sanitiser. Well done to everyone who was greedy. A few stocks are still available for pharmacies, so we haven't run out entirely, but at massively hiked prices. Expect to pay more.

The 32nd Vietnamese COVID-19 patient should be one of the UK's. After attending a party in London with a Vietnamese person who became ill and tested positive upon their return home, she went her local London hospital with a dry cough. Even with her history she was told she wasn't going to be tested and should self-isolate. She took a chartered flight to Vietnam herself, and was tested there instead.

Health Minister Nadine Dorries has become the first UK parliamentarian to be diagnosed with COVID-19. She has met with hundreds of people over the past week and even attended a reception at No 10 with Boris Johnson.

According to Sky News at least one of the big 4 UK supermarkets has asked the government to suspend competition laws temporarily, so that in the event of stores closing or lack of supply, different supermarkets can work together to make sure customers still have access to what they need.

Ahead of the UK budget The Bank Of England started a very early day by cutting interest rates to the lowest in history - 0.25%. This is among a package of measures intended mainly to help shore up small and mid-sized business in the short term, and prevent job losses.

The UK budget itself offers several special provisions to help individuals and business survive Coronavirus financially, including:
1. A blank cheque for the NHS during the outbreak.
2. SSP and contributory Employment and Support Allowance from day 1
3. A sick note alternative by contacting 111
4. Over the next twelve months, nearly half of all business properties in England will not pay a penny of business rates
5. Allowing businesses and the self-employed to defer tax payments
6. A new Coronavirus Business Interruption Loan Scheme to support small and medium-sized enterprises.

NHS England has only been carrying out 1500 tests a day - so it looked great until now, but it seems likely a backlog has formed. Testing will now be scaled up to 10,000 a day.
Expect a big jump in figures once this takes effect. We were about 3-4 days behind France by numbers until last week. You aren't scared - you know it's coming. More cases already exist, we just don't know who they are yet, and it's better to know. France has currently reported 1,784 cases and 33 deaths.

Public Health England has revealed it's own shiny new arcgis dashboard logging cases and which health authority they are in, along with a map. Bad news is it's always at least 24 hours out of date, but offers clear information for the public.
The UK's arcgis dashboardThe John's Hopkin's whole world arcgis dashboard

When to use a face mask

Rest Of The World

Until Monday I was being shouted at and called an idiot by Americans on Twitter, but on Tuesday our side of the globe woke up to incredible and very strong advice from the CDC for older people and those with chronic conditions to stay away and stay home when COVID-19 is in your community. This rapid turnaround probably means Trump has finally understood the difference between COVID-19 and flu, but begs the question, why so sudden? Did Donald Trump suddenly realise he's really high risk and all the power and money in the world won't change that?

US media reported that 2 of the 4 members of the Congress who are now under self-imposed quarantine had close contact with Donald Trump last week. White House Chief of Staff Mark Meadows is also under self-quarantine.

Japan still insist the Olympic Games will go ahead as planned.

My genuine sympathy to anyone who has spent the last 4 years training for any international sporting event that happens to be cancelled due to COVID-19.

Italian medical staff are having to make horrific decisions about which patients to save. They are over full to capacity with patients needing help breathing and have created Intensive Care wards in corridors and operating theatres, but are still unable to treat everyone. There is an amazing thread on Twitter from a Doctor in Italy describing conditions there. Heartbreaking in the extreme, they describe the arrival of patients as a tsunami, and the life and death choices they have to make. (Source link below)

Not good news with some new countries reporting cases, including Morocco and Democratic Republic of Congo. DRC medical infrastructure has been obliterated by Ebola, and they are currently celebrating the last case leaving hospital, but we are still in the countdown hoping no new cases appear. COVID-19 is not what they need right now.

Israel has ordered all visitors are quarantined. We are only a few weeks before Passover and Easter, which are traditionally incredibly busy times.

The USA is the only industrialised nation which has no national provision for paid sick leave.

After a big jump in cases on Monday, adding 376 for a total 1050 cases, Spain closed all schools in and around its capital Madrid.

An article in the New York Times has asked for the CDC to stop holding their tongue and speak out. With the developments overnight maybe this is about to happen. Currently the US has incredibly strict criteria for testing and insufficient test kits. The 11th richest country has until now maintained a policy of 'don't test, don't get numbers'. They aren't the only ones... The USA has now reported 1,051 cases and 31 losses of life.

Chinese President Xi Jinping is visiting the epicentre of the Chinese outbreak, Wuhan, for the first time today. I've seen several suggestions he'll send a body double, but I couldn't possibly comment.

Romania have closed their schools.

To prevent the risk of spreading Coronavirus, passengers at the Kigali Bus Park have to wash their hands before getting onto buses. They have these awesome little portable sinks on stands for people in the queue. Rwanda has recorded NO case of the epidemic yet - fingers crossed it continues.

Klaus Lederer, Mayor of Berlin, Germany has announced all large events have been cancelled until 19th April.

Japan has 1,335 COVID-19 cases in total, including 696 they unwillingly adopted from the Diamond Princess cruise liner. Unfortunately 12 domestic and 7 cruise line occupants have lost their lives, but much more encouragingly 443 patients have already recovered.

The Netherlands have been a bit quiet so far, but a sample of 301 employees at a hospital in Tilburg discovered 28 members of staff with Covid-19. The tests were all on employees who had mild airway complaints. Worryingly, the hospital staff have not been in risk areas and have not been in contact with COVID-19 positive patients. The Netherlands currently have 503 reported cases of COVID-19, after adding 121 today.

Taiwan is one of the biggest mask producers in the world, but has strictly rationed masks to 3 per person per week to maintain stocks. Macau has limited masks to 10 per person per 10 days.

A few days ago India limited exports of some drugs, but yesterday pharmaceutical suppliers petitioned the government to lift the ban and export to the world while excess stocks still exist. Thank you.

On Tuesday President Trump had a message for any Americans who were worried "It will go away, just stay calm. Be calm. It's really working out. And a lot of good things are going to happen."
(Errrrrmmm.... what? ) Current USA case count 1,016 with 31 losses of life.

The Mayor of New York City says he has no plans to cancel St. Patrick’s Day Parade, which usually attracts over 2m visitors. Dublin and many other parades in Ireland have already been cancelled.

Angela Merkel has warned the German people “When the virus is out there, the population has no immunity and no therapy exists, then 60 to 70% of the population will be infected....The process has to be focused on not overburdening the health system by slowing the virus’s spread. It’s about winning time.”
Germany has a population of over 82m and currently has reported 1,908 cases of COVID-19.

How to remove a mask

The Whole World

Since the beginning of the outbreak, WHO Operations, Supply and Logistics have "shipped more than 584,000 surgical masks, 47,000 N95 masks, 620,000 gloves, 72,000 gowns and 11,000 goggles to 57 countries.”
"Global demand for critical items continues to outpace global supply availability”.

Apple have updated their support pages to say that you can use a 70 percent isopropyl alcohol wipe or Clorox Disinfecting Wipe to clean your phone or laptop - but you do have to be careful. Don't sue me, read the full instructions yourself.

If you want to watch the COVID-19 genome mutate and move around the world in close to real-time, then a website called NextStrain dot org is tracking it's evolution as it travels.

Italy have published a report on 155 patients who succumbed on 6th March.
When patients first arrived at hospital their symptoms were:
-  Fever 86%
-  Dyspnoea (difficulty breathing) 82%
-  Cough 50%
-  Diarrhea and hemoptysis (coughing blood) 5%
Their findings are that if you only have a fever, you do not need to be hospitalised. Anyone with symptoms should not attend for medical care, instead ring for advice and instructions.
At least 136 of the patients had pre-existing medical conditions. 48 were women. All were over 50. The average age was 81.4.

Where hospital staff are overwhelmed, other hospital departments are being reassigned. Staff are all working in whatever capacity they can with COVID-19 patients, so some bizarre drugs are trialling from some random departments and specialities. There's nothing like a disaster to repurpose obscure solutions. Current favourites include remdesivir, originally developed to treat Ebola, HIV drug ritonavir, HIV combination drug Kaletra, Hepatitis drugs and Quinine-based anti-malarials.

A 103 year old Grandma in China has recovered from COVID-19 in less than a week. She is the second oldest patient to recover, after a 100 year old man was discharged yesterday. She was treated using platelets taken from the blood of recovered patients, something Chinese medics are currently trialling.

The WHO have held a telephone meeting with Facebook, who have offered to help combat disinformation in several ways:
-proactive strategy to ensure vital messages on coronavirus get to people in need
-unlimited ads offer for WHO campaigns
-removing harmful content & limiting misinformation
-banning ads & sales listings of masks to ensure access for those in need the most.

South Korea continue to show how it should be done. They have published updated mortality rates, which are still currently the lowest in the world, but bear in mind they have yet to have an outcome for thousands of people:
< 30: 0%
30-39: 0.1%
40-49: 0.1%
50-59: 0.4%
60-69: 1.3%
70-79: 4.1%
80+: 6.5%
Overall: 0.7%
86% of deaths were in patients aged 60 or over. South Korea has a very young population. Only around 14.4% are over age 65

Percentages of populations over age 65 (going by recently reported figures):
UK- 18%
Italy - 23%
USA - 23%
China - 9.5%

In an article for Science Mag, molecular evolutionary biologist at the University of Edinburgh Andrew Rambaut says "Over the length of its 30,000-base-pair genome, SARS-CoV-2 accumulates an average of about one to two mutations per month. It’s about two to four times slower than the flu,”. Vaccines, once completed, should be effective. We currently have to make a new flu vaccine every 12 months or so because of these teeny tiny mutations adding up.

Tempted to make your own hand sanitiser? Let me repeat the message that ordinary soap is perfect against coronavirus. The structure of COVID-19 is really unstable, like blocks held together just with fats. Dissolve the fats, the blocks fall apart and the virus is destroyed.

If you know anyone who is feeling smug that no-one they love fits into the 'high risk' category, remind them that right now Italian doctors are having to guess which patients have the best chance of life, and give them treatment while others die - and that's the whole hospital. Your personal chances of dying from Coronavirus might be tiny, and you might not have any loved ones in the at risk categories, but if you get appendicitis, fall down the stairs or your child gets hit by a car, when your health service is a mess, so are you.

Sources: - Italian ICU Doctor

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