This is the news that they are not really sharing on mainstream TV: China is containing this outbreak. The screenshot shows figures for one of the other provinces, Henan province, right next to the worst affected province Hubei. Meanwhile China as a whole reported only 329 new cases on thursday, the lowest number for over a month. This would not happen for a pandemic, so it is not a pandemic yet.

The WHO say that if we act promptly it will never be a pandemic. The course of this disease is under our control.

skip to: Why this is not a pandemic

The Text (above) summarizes the evidence which helped an international research team of international experts on infectious diseases to confirm that the Chinese findings were valid. Independent confirmation: Hospitals with many empty beds

CT scanners in fever clinics idle

Not enough patients for clinical trials

In survey of 320,000 visitors to fever clinics — infections fell from 0.47% to 0.02%

If you explore around the regions in China, a fair number are nearly all recovered. This means they can't have had many new cases recently; you can explore this here:

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Do share this with your friends if you find it useful, as they may be panicking too

See also video here where I talk through this article.

WHY THIS IS NOT A PANDEMIC

skip to: How do we know that the Chinese data is accurate?

Here I am using the word ‘pandemic’ as the WHO themselves use it. From Friday ’s press conference:

A pandemic is is a unique situation in which we believe that all citizens on the planet will likely be exposed to a virus within a defined period of time. If this were influenza we would probably have called this a pandemic by now—but what we've seen with this virus is that with containment measures and a robust Public Health response, the course of this epidemic, or these multiple epidemics, can be significantly altered It is unhelpful to declare a pandemic when you're still trying to contain a disease. See Dr Mike Ryan's answer to a question from Forbes magazine at 23:20 into the press conference on friday More about this with my unofficial transcript of the whole press conference: COVID19 - Together we're powerful. Containment starts with you. Our greatest enemy is not the virus. It's fear, rumors and stigma. Our greatest assets are facts, reason and solidarity. Dr Tedros - WHO press conference

To give a bit more background to what Dr. Mike Ryan says there, influenza is much more infectious for several reasons.

Flu spreads communally. Flu spreads through children. Roughly 1 in 3 of those who get flu are a non symptomatic spreaders, who never show any symptoms. All that makes it just about impossible to use this method to contain flu, and that is why you can declare an influenza pandemic at an early stage.

However COVID19 has none of these characteristics as we will see. It spreads typically through households and close or prolonged contact, and typically the contacts know each other. Unlike flu, other forms of transmission are rare to nonexistent and are not driving the spread. This is why case finding and contact tracing has proven to be so effective in stopping COVID19.

This is one of my articles In which I try to counter the COVID19 infodemic news as well as the bias of the mainstream media that they just don't share good news on COVID19, or rarely do.

If you find this helpful, do share this post with others to help counteract the infodemic. Thanks!

HOW DO WE KNOW THAT THE CHINESE DATA IS ACCURATE?

skip to: Yes, the rest of the world can do what China did; they already are

There was a big report earlier this week on how China is on the point of containing this outbreak.

The report itself is here:

He shared this striking graph of the numbers of cases by symptom onset:

The way it has tapered off here shows clearly that it is being contained. The graph for the rest of China is especially striking—of course there are far more people outside of Hubei Province than inside it, yet it has far fewer cases.

This is Bruce Aylward sharing that same graph.

There are lots of independent evidence which confirm this.

Several sources of data support this conclusion, including the steep decline in fever clinic visits, the opening up of treatment beds as cured patients are discharged, and the challenges to recruiting new patients for clinical trials.

E.g., as they traveled around China they saw hospitals set up to treat COVID19 with empty beds and fever clinics with the CT scanners well underused—and they mention this in the report:

Note: At a major hospital in Wuhan, fever clinic patient numbers fell from a peak of 500/day in late January to an average of 50/day since mid-February (page 7 of the report)

Aylward also mentions someone who was doing a clinical trial who said he just couldn't get enough patients for his trial in Wuhan, the worst hit area, and it would therefore go on a bit longer.

Then he mentioned a big survey of over 320,000 people whose numbers went down from 0.47% prevalence in virus screenings to 0.02%.

Within the fever clinics in Guangdong, the percentage of samples that tested positive for the COVID-19 virus has decreased over time from a peak of 0.47% positive on 30 January to 0.02% on 16 February. Overall in Guangdong, 0.14% of approximately 320,000 fever clinic screenings were positive for COVID-19 (page 9 of the report)

All 25 of the 25 member team of experts (12 from China and 13 from outside China) agreed that China had significantly reduced the numbers of infected and saved probably hundreds of thousands of people from infection in China—which because of the way the world is connected saved the rest of the world from having many more outbreaks than it is having today.

Based on a comparison of crude attack rates across provinces, the Joint Mission estimates that this truly all-of-Government and all-of-society approach that has been taken in China has averted, or at least delayed, hundreds of thousands of COVID-19 cases in the country. By extension, the reduction that has been achieved in the force of COVID-19 infections in China has also played a significant role in protecting the global community and in creating a stronger first line of defense against international spread. Containing this outbreak, however, has come at great cost and sacrifice to China and its people, in both human and material terms.

China did cover up the SARS outbreak for several weeks, which significantly contributed to the issues. They learnt from that, however, and there is clear evidence that they are not engaging in a covering up if this outbreak.

Lie Wenliang wasn’t really a “whistleblower” — he only spotted the unusual pattern the day before the Chinese automatic system flagged it as an unusual cluster. At that point you couldn’t call it a new virus yet, as it could still be a statistical fluctuation. As soon as it was clear it was a new virus, the Chinese immediately notified the WHO. For details see my:

YES, THE REST OF THE WORLD CAN DO WHAT CHINA DID; THEY ALREADY ARE

skip to: Isn’t that because Singapore has a travel ban with China?

Then you get people saying:

“Okay but we can’t do this in the rest of the world.”

How defeatest is that? First, that China can’t have succeeded. Then, faced with clear scientific evidence that China has done what they say they have, others then say: “Okay, they did, it but we can’t”.

Meanwhile, many countries are showing we can do the same thing as China has, by acting, by doing it themselves.

For smaller clusters e.g., in Vietnam, there are 16 cases, all recovered:

India, 3, all recovered.

Singapore has a big cluster of 96 (by last count as if this writing), and that is just about contained:

ISN’T THAT BECAUSE SINGAPORE HAS A TRAVEL BAN WITH CHINA?

skip to: How can you do a Wuhan-type lockdown outside china; isn’t it a violation of human rights?

People often say “Oh, but Singapore has a travel ban with China; we need to solve this by banning travel from any country where it is spreading.”

But what about India? It only has a travel ban on foreign nationals. Aircrew who travel to China are exempt as are overseas nationals with Indian citizenship: “Overseas citizens of India” — they can travel freely from China to India. Yet India has only 3 cases.

International Travel Document News

Also Singapore has similar rules. It doesn’t apply to residents of Singapore, or travelers with a long term pass with final destination Singapore.

If they have been in Hubei province in the last 14 days they are quarantined on entry in Singapore, otherwise those covered by those exemptions can travel freely back and forth between Singapore and China.

International Travel Document News

So, not really.

The WHO advise against travel bans: In their experience of dealing with 200 outbreaks a year, bans don’t work. One way or another the virus finds its way through a travel ban, and if you have it in place, it gets into your country in other ways that you are not monitoring (e.g., people who lie about their travel history or cross borders without passing through border control), which makes it harder to control the outbreak.

Of course travel bans are appropriate, if you have a region in lock down—nobody can fly out of Wuhan airport.

HOW CAN YOU DO A WUHAN-TYPE LOCKDOWN OUTSIDE CHINA; ISN’T IT A VIOLATION OF HUMAN RIGHTS?

skip to: Outbreaks start with steep slopes - example of Singapore

Well first, the Wuhan lockdown is only possible because the population of 11 million people co-operate. Even China couldn’t contain 11 million people against their wishes. Indeed they have a strong sense of solidarity in Wuhan. Most of the population have to be behind you to do this.

Then—actually, even in countries with the strongest human rights laws, it is still permitted to restrict someone’s liberty, if he or she can harm others by his or her actions. The UK, for instance, gave itself the powers to enforce self isolation on10 February 2020.

The strengthened powers, effective immediately, will ensure that NHS staff dealing with possible cases can be confident the necessary powers are in place to keep individuals in isolation where public health professionals believe there is a reasonable risk an individual may have the virus. This is in line with measures taken in other countries. Health Secretary announces strengthened legal powers to bolster public health protections against coronavirus

Quarantines can be enforced and policed in any country, if it is necessary to do this for the safety of the public—if by doing so you can save lives. Italy is enforcing quarantine around some small provincial towns in its Northern territory, in this way. It is using police plus the military to supplement the police (not that they are going to shoot anyone, but they just are acting as police to stop violators; the military are often called in for emergency action, e.g., for earthquakes etc).

Italy has locked down 11 towns with more than 50,000 people in them in this way.

Explore the red zone locked down regions here: MAP: The parts of Italy worst hit by coronavirus outbreak

OUTBREAKS START WITH STEEP SLOPES - EXAMPLE OF SINGAPORE

skip to: What is going to happen with Italy?

. The COVID19 disease outbreaks always start off with steep slopes unless you act very quickly to stop it.

After you contain it, it slows down and then stops. There is a delay of up to 14 days between putting in the containment measures and the disease slowing down. If it is a big outbreak, it can take many weeks to stop completely.

This is the curve for Singapore:

If it is an uncontrolled outbreak, it will have a doubling time. Usually COVID19 numbers double every 3 days or so, if you don't do anything to stop it (or there would be some other doubling period, but for COVID-19, it tends to double about every 3 days)

Look at the point when there were 50 cases discovered: It still hasn’t doubled to 100, sixteen days later; so this is definitely slowing down—and there are a couple of days with no new cases.

New COVID-19 cases in Singapore, including 12-year-old student from Raffles Institution: MOH

This shows how it worked in Singapore—how all the cases so far are connected together by these clusters.

Then you can zoom in on any of the cases:

Explore it here:

That is the contact tracing which is the key to stopping it.

If you trace everyone, and then quarantine all the people in all the chains of infection, then it is over. Everyone is in quarantine.

Also see:

If you quarantine 90% infected persons (and you will always miss a few), then you have still reduced the number that will be infected. E.g., suppose naturally it doubles every 3 days, and you have 10 people who would naturally infect 20 more—then if you find 90% of those, they will only infect 2 more, and then it stops. Find 75%, and they infect 5 more, and then those infect 2 more—and then it stops.

Everyone (each nation or community) can do this; the faster you act, then the sooner you stop it and the less high the curve gets.

WHAT IS GOING TO HAPPEN WITH ITALY?

skip to: What is going to happen in South Korea

Italy’s curve is going up very fast at present.

2020 coronavirus outbreak in Italy - Wikipedia

However, they have quickly put in strict containment measures.

The data is from these official daily reports.

It’s not surprising that this progresses in jumps: We saw that with the contact tracing for Singapore. You may get one person who infects a dozen or more others in one event, then those people may only show symptoms days or weeks later.

But if you patiently and methodicaly keep up the contact tracing whenever someone is infected, eventually this stops (the “jumping” pattern).

Italy is not only tracing contacts within Italy. The Italians are tracing contacts through to other countries. Take the two cases in Mexico, say. They are not only tracing all their contacts in Mexico. They are tracing all the contacts of the person who infected them in Italy—or wherever the original contract-point areas for the cases happen to have been around the world.

This is why it really doesn’t matter whether you have travel bans or not, so long as you have co-operation of countries in contact tracing.

Expect the Italy numbers to increase by several hundred more, even thousands. Maybe we will end up with, say, 3000 Italian cases, but the with good care, nearly all will recover—80% or 2,400 will only get mild symptoms on average. 15% develop severe symptoms, meaning in that example 450 cases, and maybe 0.7% die, but it could be more, because European populations have more elderly people than do those in China.

Italy actually has 21 deaths already, the number you’d expect from a population of 3,000 infected cases from the Chinese experience. Either the death rate is higher because of the elderly population, or else it has many more undiscovered mild cases. It is probably a bit of both.

The mild cases seem a likely explanation and could explain the unconnected clusters, that they were joined together by mild cases that have now recovered and likely won’t be found until we can do serology (blood serum) tests to find the antibodies.

Anyway - so if that’s so, then a few thousand Italian cases would be no surprise, and they may turn up in the cities that are now under lockdown.

So please don’t be scared if the Italy cases soar to say, 5000 or even 10,000 before it stops. That would be only 35 to 70 deaths (or maybe more for the aging population).

If well-contained, it will probably stop rising quite so fast within a few days—but up to 14 days for us to find all the cases that are currently infected but not yet detectable. Then, with so many contacts to trace, there are bound to be a few hundred which slip through the net, so you would continue to get many more cases, but less per day—for several weeks after that (if it is already well contained).

WHAT IS GOING TO HAPPEN IN SOUTH KOREA?

skip to: What about Iran?

The situation is similar for South Korea and Iran. South Korea is very high tech and wealthy, similar to Japan. It has all the resources needed to contain this.

It is only 9 days since the start of the new outbreak; remember it takes 14 days for all the infections to develop symptoms and then you need to trace their contacts, too.

It may not seem likely from this graph, but if it is contained, then we won’t notice it for a few days yet. It may be leveling off, but maybe they will find another cluster—and then it jumps again; it is only a few days since it started: plenty of time for large clusters to emerge that were infected a few days ago.

2020 coronavirus outbreak in South Korea

I am using Wikipedia, here, because I can’t find any other site, yet, that does a day-by-day break down of the main outbreaks, or does graphs of them. If you know of one, please say so in a comment. Wikipedia is often unreliable, but that varies by topic. Pages that have lots of eyes on them and many editors tend to be the most accurate.

In my experience, Wikipedia has summarized its sources on this topic reasonably well.

WHAT ABOUT IRAN?

skip to: Rapidly contained in most countries

Here it is for Iran:

2020 coronavirus outbreak in Iran - Wikipedia

This again is a similar situation. If you catch it very early, you stop it in its tracks—but if you catch it a few days or a week later, as in these countries, it escalates rapidly—however, you can still contain it.

Iran, perhaps surprisingly, is also well able to deal with the virus, according to the WHO.

Iran has a lot of previous experience with epidemics. It has nearly eliminated malaria (most of the malaria cases are visitors, now) and polio, only one recent case. It is very experienced in dealing with earthquakes and natural disasters and has a high level of health care. Indeed its health care is so good that it is a country for medical tourism from India, Pakistan and parts of Europe—a $1.8 billion dollar industry for Iran in 2017–8. It also exports high tech medical gear such as scanners, (including innovative new designs) to the rest of the world.

Given that it has good health care, those 54 deaths are rather high. If that were 7 in 1000, it would mean it likely has several thousand milder cases to be detected.

Iran has:

Banned the use of shisha water pipes in Qom; these are often smoked communally and passed person to person

Closed schools and universities in affected areas and cancelled sports matches, gallery openings and film premieres

Decreed Main Friday prayers will not be held in these areas

Advised people to avoid unnecessary gatherings and asked Citizens not to travel to Qom, but no decreed outright closure of religious sites—especially at the Hazrat Masumeh shrine, seen as a source of recovery and healing (so cannot be shut down)

Issues Iran is facing:

Iran is finding it hard to buy necessary medical supplies because of the sanctions—even though the sanctions have an exemption for humanitarian goods banks are unwilling to risk breaking US rules and facing sanctions themselves for assisting purchases of medical supplies by Iran; however, the WHO has managed to send Iran some medical test kits and supplies, as donations.

Why Iran hasn't imposed quarantine areas

Sadly, the WHO team has not yet been able to get to Iran for technical advice, but hope to get there tomorrow with the help of the UAE. It is a problem of travel permission, flights and getting the equipment there.

RAPIDLY CONTAINED IN MOST COUNTRIES

skip to: Major recommendations for countries with reported cases of COVID-19 or outbreaks

In most other countries this virus is rapidly contained.

As of this writing:

-There are 16 countries with only one case.

-There are 15 countries with at most 10 cases, and 16 countries with more than ten and less than 100 cases.

-There are only 5 countries with over 100 cases, and the Diamond Princess.

-35 countries have only imported cases, and only 16 countries have some cases of local transmission. (See the latest Situation report: 39 from Novel Coronavirus (2019-nCoV) situation reports)—

-There are 9 countries with no new cases for more than two weeks:

Belgium, Cambodia, India, Nepal, Phillipines, the Russian Federation, Sri Lanka and Vietnam.

Indeed nearly all of the cases in those nine countries have recovered—apart from the Philippines, where there is one case still under treatment and one that died.

2020 Coronavirus Outbreak in The Philippines - Wikipedia

This doesn’t mean that these countries are immune from reinfection. Finland and Sweden reported no new cases for 2 weeks, but then, unfortunately, they both reported new cases—but it shows, for sure, that it is not spreading, yet, like a pandemic.

Those numbers are from the press conference on Thursday, and I have just double checked that none of those countries had new cases in the past couple of days, apart from the two which Bruce Aylward mentioned, Finland and Sweden:

This would not happen at this stage in an uncontained pandemic.

We can stop this, if we continue to apply rigorous control measures as we are doing so far.

As for the first case in Africa, the head of the Nigerian CDC is one of the world’s experts on containing COVID19 and infectious diseases; he was one of the 13 international experts who have just got back to their various countries after studying COVID19 on the ground in China, including in Wuhan.

See:

MAJOR RECOMMENDATIONS FOR COUNTRIES WITH REPORTED CASES OR OUTBREAKS OF COVID-19

skip to: Top

The report recommends

Immediately activate national Response Management at the highest level for an All-of-government and all-of-society approach Prioritize exhaustive case finding, isolation, contact tracing and quarantine of close contacts Educate the public on the seriousness of COVID19 and their role in preventing its spread Immediately test all patients in the country with atypical pneumonia or upper respiratory illnesses, and add testing for COVID-19 to surveillance systems for influenza-like-illness and to Sentinel systems for hospitalized severe acute respiratory infections (SARI)

Quoting from the report, in more detail the reccomendations for countries with imported cases and/or outbreaks of COVID-19 are:

Immediately activate the highest level of national Response Management protocols to ensure the all-of-government and all-of-society approach needed to contain COVID-19 with non-pharmaceutical public health measures; Prioritize active, exhaustive case finding and immediate testingand isolation, painstaking contact tracing and rigorous quarantine of close contacts; Fully educate the general public on the seriousness of COVID-19 and their role in preventing its spread; Immediately expand surveillance to detect COVID-19 transmission chains, by testing all patients with atypical pneumonias, conducting screening in some patients with upper respiratory illnesses and/or recent COVID-19 exposure, and adding testing for the COVID-19 virus to existing surveillance systems (e.g. systems for influenza-like-illness and SARI);and Conduct multi-sector scenario planning and simulations for the deployment of even more stringent measures to interrupttransmission chains as needed (e.g. the suspension of large-scale gatherings and the closure of schools and workplaces).

More about this in yesterday’s WHO press conference:

See also my:

skip to: Top

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Seven tips for dealing with doomsday fears

If you are scared: Seven tips for dealing with doomsday fears which also talks about health professionals and how they can help.

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