Public Health

The WHO talk about contact tracing in every press briefing. They constantly stress that contact tracing iis the key to suppressing COVID-19 and then stopping it. They say that contact tracing will not just delay the peak, but suppress it and crush it right down to no new cases a day. For some reason some countries are not paying any attention to this advice. I wonder if part of it is that not many realize what it involves, and why it is so effective for this disease? It does not mean tracking random people that you walk past in supermarkets or in the street. It is about close or prolonged…

Many governments, the UK included, focus their policy on physical distancing - which is the most obvious eye catching thing that filled the news about Wuhan. Contact tracing often gets far less attention - yet it is the absolute key to stopping this virus. It is also relatively easy to do. It doesn't need health workers. Other countries are using civil servants, community organizations and volunteers. Contact tracing is the key to winning. Physical distancing is buying time, like defensive tactics in a game of football. Having bought time in this way we can go into the attack, crush this…

In the UK those who think they have COVID-19, including confirmed cases, isolate at home for 7 days after onset of symptoms. Matt Hancock, the health secretary, was confirmed to have COVID-19 a week ago. He has just come out of isolation after 7 days. See: Matt Hancock leaves week-long isolation period under UK's 'outlier' rules This is radically different from the WHO isolation period. According to the WHO he is still infectious and could contribute to the spread of the disease. He should only leave isolation this early if he has two negative PCR tests 24 hours apart. The WHO advice is…

Experts are weighing in on Matt Hancock’s proposal of “immunity passports ” in the UK. They say antibody tests will NOT prove you are immune to the disease. We don't know enough about this disease yet to say. From our experience with other diseases, it is possible that those with antibodies can be infected a second time (with the same strain of virus), and die of the disease. Such certificates would give a false sense of security, especially for the general public who might think they are totally safe from reinfection when they are not (or at least, not known yet to be safe). They could…

This is a conversation I had recently via text with someone who suffers from depression about the situation about COVID-19 in the UK. I hope my answers will help others with depression face this situation. The main message is, don't give up - we can and will deal with this - pressurize our government to act and protect yourself and others by making sure you don't get it yourself. On a personal level, this is how to protect yourself, and also the people around you who might get it from you - you can break those chains of transmission at least and prevent it spreading through you into your…

The idea that COVID-19 can’t be stopped and has to go in waves is based on the idea that it transmits like flu. But COVID-19 is not flu. COVID-19 can be stopped; it can be contained. Any second wave can be stopped too. You can totally crush COVID19. China, South Korea have shown how. Spain and Italy are doing it now too. The WHO say this with every press briefing but the media almost never report this. To do this you test, isolate and care for cases, trace contacts and quarantine the contacts. If you stop 75% of the transmisions you change a transmission that goes 100 cases → 200 cases…

Many countries are showing that the strategy of China, Singapore and South Korea also works in Europe - to aggressively find cases, isolate them, trace contacts and isolate them. They now need to keep this up. Italy is now down to a 4% increase per day - that’s a doubling time of 17 days. It’s down from a doubling time of just 5 days a fortnight ago. Italy looks to be well past its exponential rise, and even over the stage of a linear increase too. The cases per day are decreasing significantly. Doubling time of 17 days = [log(2)/log(1+4/100)] Doubling time of 5 days = [log(2)/log(1+13/…

I am glad to read that the former health secretary Jeremy Hunt is asking our government to follow the WHO recommendations on COVID19. Not just mass testing, also quarantine and contact tracing, all on an unprecedented scale. His op ed is here: Mass testing is the fastest route back to normal life We can do this. The cobas 8800 by Roche Diagnostics can test 2,500 samples a day. 400 of those machines would test a million samples a day. Text on image: We need to ramp up production of these like we ramped up production of spitfires in WWII 400 of these machines can test 1 million samples for…

The UK’s policy is based on a model such as is used in pandemic simulations. The (simulated) influenza in this model is an upper respiratory tract infection, and is airborne which means you can get it just by breathing the air of someone who is near you. Their simulated disease also has a large population of people who don't show any symptoms and have half the infectivity of those who do have symptoms. These assumptions are not based on real world data for COVID-19 but rather on data for influenza. Influenza and COVID19 are unrelated diseases. Both are respiratory tract infections,but…

Good news - one small Italian town, Vo Euganeo, has completely stopped its outbreak by rigorously testing everyone in the community including those who were asymptomatic. To do that they disregarded a directive from their government to only test those who had symptoms. Even China didn’t do that, or Singapore. They only tested those with fever or respiratory disease symptoms. Vo Euganeo is in Veneto which has had consistently lower case numbers than the other provinces and has had the most rigorous approach to case finding. With their first test they found that 3 percent tested positive (that…