Coronavirus Saturday 28 March

People should isolate themselves and if possible stay at home and work from home. In three weeks we shall have much more information about the Coronavirus. It is much better to be safe than sorry. 

However, there are a lot of interesting scraps of information already that I am trying to make sense of. One of my main reasons for blogging is to clarify my mind.

The most concerning news at the moment is from Italy but what is happening there and why?

In Italy 969 died yesterday with (not necessarily of) the Coronavirus.  Normally, on average, 1750 people die in Italy per day. 

The latest figures from Bergamo show that total mortality there almost quadrupled in March 2020, from 200 to 300 people per month to around 900 people. It is unclear what proportion of this was due to Covid19.

In total, 9,134 people in Italy have now died with Covid-19. Around one in seven are under the age of 70.

A number of people have said that the high number of deaths in Lombardy is a crisis caused by lack of facilities for geriatric care. The ageing population does not help. 

Northern Italy also has the worst air quality in Europe, which has led to an increased number of respiratory diseases and deaths in the past.

Two professors of medicine at Stanford, Dr. Eran Bendavid and Dr. Jay Bhattacharya, say that the lethality of Covid19 is overestimated by several orders of magnitude and probably even in Italy is only at 0.01% to 0.06% and thus below that of influenza. The reason for this overestimate is the greatly underestimated number of people already infected (without symptoms).

Between 50% and 75% of the fully tested Italian community of Vo were symptom-free and test-positive.

Preliminary findings by researchers at Oxford suggest fewer than one in a thousand of those infected with Covid-19 become ill enough to need hospital treatment, according to Sunetra Gupta, professor of theoretical epidemiology, and the vast majority develop very mild symptoms or none at all. Some consider these findings are suspect as they mean a much higher number of test positive, asymptomatic cases than in Vo. 

John Lee, a recently retired professor of pathology and a former consultant, argues in a must-read article in the Spectator that the particular way in which Covid-19 cases are registered leads to an overestimation of the risk posed by Covid19 compared to normal flu and cold cases.

A Facebook friend of mine posted the article and a doctor made this interesting comment:

"I have read the article and it corresponds exactly to what I have been thinking and saying. We do not have the evidence to be firm about the "science" and it is my experience that much of what passes for hard medical science these days is very far removed from it, especially in epidemiology, a discipline seeking a cause since the '70s. I have been a doctor for 45 years and a senior clinician for well over 30 of those.

"This panic is driven by scaremongering journalists and cowardly and or misinformed politicians. Not for the first time, Donald Trump seems to be making the most sense, whether you like him or loathe him."

Dr. Carsten Scheller, Professor of Virology at the University of Würzburg, says that Covid19 is comparable with flu and has so far led to fewer deaths. Professor Scheller suspects that the worrying graphs showing exponential curves have more to do with the increasing number of tests than with an unusual spread of the virus itself.

It's worth repeating what Professor John Ioannidis wrote on March 17, that Covid-19 

“might be a one-in-a-century evidence fiasco” 

and the fatality rate could be anywhere between one in 100 (1%) and one in 2,000 cases (0.05%). 1% is much less than some figures I see bandied around on Facebook of 5% or even 10%.

An interesting article in today's Daily Telegraph discusses Sweden which has no lockdown.

'"Sweden cannot take draconian measures that have a limited impact on the epidemic but knock out the functions of society," stated its public health secretary Johan Carlson last week, saying out loud what so many are thinking: That the horse has already bolted, a vaccine is probably 18 months away, the coming weeks and months will inevitably overwhelm national health systems, but that far more lives and livelihoods will be destroyed as a result of shutting entire industries than lives lost to this virus.

'This a disease, now all-but over in the country it hit first, that has killed 25,237 people worldwide over three months.'

I suspect that Sweden might be about to change her policy as deaths start suddenly to mount.

Still more important than how many in the end will die of the virus is the effect it is having on hospitals and doctors in Lombardy and Spain and may have throughout the world.

How do we avoid this? China solved the problem in Wuhan by a very draconian lockdown indeed. On the other hand, Japan and South Korea have millions of Chinese tourists and no lockdown, but these countries have not yet experienced a Covid19 crisis. 

Is it because they wear mouth masks, which limit the spread of the virus by infected people?