COVID Update 21 April 2020 By John Buchanan

COVID Update 21 April 2020
By John Buchanan

Postscript 22 April: How to build and deploy coronavirus testing at unprecedented scale
Countries will have to do it to end their lockdowns safely
(The Economist) So far, every country that has reduced covid-19 infection to low levels has relied to some degree on “social distancing”—that is, either encouraging or forcing people to stay at home, and to keep well apart if they find that they have to go out—to prevent the virus from spreading. On top of this many are in any case fearful to go out, lest they catch the illness. Without a vaccine or therapeutic drugs, neither of which is guaranteed, countries therefore face a future of bouncing in and out of lockdown every few months, with infection rates ebbing and flowing in response. The result will be mounting death tolls, depressed economies and confidence-sapping uncertainty. This can, however, be partly ameliorated by extensive testing for the virus. Testing enables the government to keep tabs on the disease, reveals which social-distancing measures work, and, if those testing positive remain at home, instils confidence in the public that it is safe to go out.

1. The numbers continue to grow, in terms of cases and deaths worldwide but there are many jurisdictions where deaths and cases are in decline. Germany is beginning its exit from lockdown, accompanied by massive focussed testing, while South Korea is almost in a state of normalcy. The Taiwan model, also very successful, is that if 50% of the population reduces their social contacts by 50%, some form of normalcy can be achieved. All three of those jurisdictions were ready to conduct large scale testing, tracing, and isolation programs by the end of January. The province of Alberta had also developed a test in January but it seems that so far this ability (about 15,000 tests per day) has not been used in tests of the general population which could identify the percentage infection of the population. Sweden remains the sole developed country which has not had a lockdown.

2. America leads the world in cases and deaths although Chinese reporting is dubious but in any event the real story lies in the per capita numbers. Here Belgium leads with over 500 deaths per millions of population followed by Spain at 446, Italy at 399, France at 310. The USA is at 126 so far, rising rapidly, Germany at 56, Canada at 45. Ontario is finally starting to test in quantity and cases rising accordingly. Sweden which has remained broadly open is at 156 deaths per million and ranks low on the testing ladder with about 8000 tests per m, compared to Germany at over 20,000, Norway, Switzerland, Portugal, Israel, Italy and Austria all in excess of 20,000 per day. Some tests are far more valuable than others, those which are followed up with vigilant contact tracing, isolation, etc…such as in South Korea, Germany and Taiwan. The UAE leads the world with 78,000 and 4 deaths per million. The New York Times lists the reasons why Sweden has suffered relatively few deaths despite largely remaining open (but practising social distancing) as including:
“Sweden has one of the world’s best-run health-care systems that at no stage saw a shortage of medical equipment or hospital capacity. More than half of Swedish households are single-person, making social distancing easier. With universal access to fast Internet, more people work from home there than anywhere else in Europe.”

3. The rush to have ventilators is now over as ICU use has been far less than the worst case, (and intubation seems more a death sentence than a treatment), but there is a new worldwide competition to acquire testing capacity, machines, swabs and reagents. The reliability of many of the Chinese tests including the antibody test is seriously open to question. Meanwhile other essential treatments for cancer, heart disease etc. are still being held back at an unknown cost in overall population health. A review of mortality data in 11 countries shows about a 40% increase in overall deaths over the past month relative to last year.

4. There is little evidence that the governments of the USA, Canada, France, UK, Spain and Italy are anywhere close to the level of sophisticated massive testing detection tracing and isolation required to accompany a successful reopening. They basically need to staff and equip a large detective agency, and have the population agree to be traced at all times in public. Obviously there are civil liberties issues but the main obstacle now is supply of materials and training of personnel. Hotspots need to be quickly identified and shut down. Harvard researchers have stated that 500,000 tests a day are needed in the US for the phase 1 reopening proposed by Trump. The actual capacity is about 150,000 per day. Some American states are opening up in part anyways, effectively being guinea pigs for the rest of us! Harvard says 5 million tests per day are needed by June and 20 million tests per day for a full reopening. Presently, virtually no asymptomatic testing is happening in large developed countries outside Germany.

5. The UK response has been widely criticized and a Boris Johnson speech of early February found where he states that there may be commercial advantages to staying open while the rest of the world locks down during a pandemic. Clearly the UK was extremely ill prepared on all supply fronts and continues to struggle with testing, with per capita testing less than half of many developed countries. After his close brush with death, Boris is apparently very reluctant to rush a re-opening. Meanwhile Brexit negotiations have restarted and the government has stated that the December 31 deadline for a deal will not be extended. On both fronts the British leaders are muddling through (code for ignoring reality rather than acting on it) and the population will suffer accordingly.

6. Opinion polls worldwide show that the population is afraid of reopening and prefers a continued lockdown. As Lord Sumption wrote some weeks ago, “The real problem is that when human societies lose their freedom, it’s not usually because tyrants have taken it away. It’s usually because people willingly surrender their freedom in return for protection against some external threat. And the threat is usually a real threat but usually exaggerated. That’s what I fear we are seeing now. The pressure on politicians has come from the public. They want action. They don’t pause to ask whether the action will work. They don’t ask themselves whether the cost will be worth paying. They want action anyway. And anyone who has studied history will recognise here the classic symptoms of collective hysteria.”
Various leaders worldwide have moved to take advantage of the fear and panic to grant themselves draconian powers. In Lebanon for example the cabal of corrupt aging politicos has imposed a nightly curfew, imposed severe restrictions on access to private bank accounts and is preparing the “haircut” of the population. The revolution started last fall has ended for now. China just arrested 15 leading democratic politicians from Hong Kong. Hungary gave its President powers worthy of a dictator!
7. Donald Trump continues to veer from one extreme to the next. A dustup with Andrew Cuomo seems to have ended, and the Donald now claims to be taking the lead on testing after having said it is a matter for each individual state.

8. There is continuing great uncertainty as to the level of infection so far and the actual death rate, i.e., the severity of this virus and the extent to which immunity has already built up in the population. Only massive testing can give us the answers. Nor do we know if there is antibody immunity and for how long, whether one can get the virus on multiple occasions.

9. What was a ventilator crisis has now become a testing crisis. The good news is that this issue is now front and center in the public discourse in the US, other countries and various states are moving forward on various forms of reopening with or without proper testing, and the Canadian population seems in no mood to rush back to “normalcy”. In other words, we will likely be able to let others stick out their necks and then take advantage of their acquired wisdom.
NB The data base used for this paper is Worldometer coronavirus