Gareth Vaughan on the Imperial College London paper, what the PM's chief science advisor says, angry Italian mayors, the EU's battle for relevancy and Hong Kong's second wave

Gareth Vaughan on the Imperial College London paper, what the PM's chief science advisor says, angry Italian mayors, the EU's battle for relevancy and Hong Kong's second wave

New Zealand is heading into a four week lock-down as we try to slow the spread of COVID-19 (novel coronavirus). This is an unprecedented and uncertain situation for most of us. Health is paramount at a time like this. And the economic and financial impact is going to be immense.

Regular readers will be familiar with our Top 5 column. Typically this runs once a week on Friday, usually with guest contributors either covering a theme of their choice or a range of issues. Typically this involves links to five items from around the internet and the author's comments on them. Or perhaps the author discussing five different issues, or five aspects of the same issue. (You can see all previous Top 5s here).

On Monday prime minister Jacinda Ardern announced New Zealand would move to Alert Level 4 at 11.59pm Wednesday, where we will remain for at least four weeks. This is the most severe alert level and should effectively put most New Zealanders in lock-down in their homes. During these unusual times we will be publishing more regular Top 5s starting today.

The idea is to draw readers' attention to interesting, topical, important, amusing and entertaining articles, videos etc related to the COVID-19 pandemic, and offer a place for readers' to comment on developments and add their own links, experiences and thoughts in the comment thread.

It's just two months today since I included an Al Jazeera coronavirus explainer on developing events in China in a Top 5. At that time it all seemed a long way away. Events have certainly moved quickly since then.

1) An influential Imperial College London paper.

This 20-page paper from the Imperial College's COVID-19 Response Team has proven influential, including with our own government. The paper certainly gets to the point quickly, saying the public health threat COVID-19 represents is the most serious seen in a respiratory virus since the 1918 H1N1 influenza pandemic.

The last time the world responded to a global emerging disease epidemic of the scale of the current COVID-19 pandemic with no access to vaccines was the 1918-19 H1N1 influenza pandemic. In that pandemic, some communities, notably in the United States (US), responded with a variety of nonpharmaceutical interventions (NPIs) - measures intended to reduce transmission by reducing contact rates in the general population. Examples of the measures adopted during this time included closing schools, churches, bars and other social venues. Cities in which these interventions were implemented early in the epidemic were successful at reducing case numbers while the interventions remained in place and experienced lower mortality overall. However, transmission rebounded once controls were lifted.

Whilst our understanding of infectious diseases and their prevention is now very different compared to in 1918, most of the countries across the world face the same challenge today with COVID-19, a virus with comparable lethality to H1N1 influenza in 1918. Two fundamental strategies are possible :

(a) Suppression. Here the aim is to reduce the reproduction number (the average number of secondary cases each case generates), R, to below 1 and hence to reduce case numbers to low levels or (as for SARS or Ebola) eliminate human-to-human transmission. The main challenge of this approach is that NPIs (and drugs, if available) need to be maintained – at least intermittently - for as long as the virus is circulating in the human population, or until a vaccine becomes available. In the case of COVID-19, it will be at least a 12-18 months before a vaccine is available . Furthermore, there is no guarantee that initial vaccines will have high efficacy.

(b) Mitigation. Here the aim is to use NPIs (and vaccines or drugs, if available) not to interrupt transmission completely, but to reduce the health impact of an epidemic, akin to the strategy adopted by some US cities in 1918, and by the world more generally in the 1957, 1968 and 2009 influenza pandemics. In the 2009 pandemic, for instance, early supplies of vaccine were targeted at individuals with pre-existing medical conditions which put them at risk of more severe disease. In this scenario, population immunity builds up through the epidemic, leading to an eventual rapid decline in case numbers and transmission dropping to low levels.

The paper suggests we are in for a disruptive time and lengthy battle. Social distancing and home isolation are recommended, and uncertainty is also flagged.

Overall, our results suggest that population-wide social distancing applied to the population as a whole would have the largest impact; and in combination with other interventions – notably home isolation of cases and school and university closure – has the potential to suppress transmission below the threshold of R=1 required to rapidly reduce case incidence. A minimum policy for effective suppression is therefore population-wide social distancing combined with home isolation of cases and school and university closure.

To avoid a rebound in transmission, these policies will need to be maintained until large stocks of vaccine are available to immunise the population – which could be 18 months or more. Adaptive hospital surveillance-based triggers for switching on and off population-wide social distancing and school closure offer greater robustness to uncertainty than fixed duration interventions and can be adapted for regional use (e.g. at the state level in the US). Given local epidemics are not perfectly synchronised, local policies are also more efficient and can achieve comparable levels of suppression to national policies while being in force for a slightly smaller proportion of the time. However, we estimate that for a national GB policy, social distancing would need to be in force for at least 2/3 of the time (for R0=2.4, see Table 4) until a vaccine was available.

However, there are very large uncertainties around the transmission of this virus, the likely effectiveness of different policies and the extent to which the population spontaneously adopts risk reducing behaviours. This means it is difficult to be definitive about the likely initial duration of measures which will be required, except that it will be several months. Future decisions on when and for how long to relax policies will need to be informed by ongoing surveillance.

2) Interview with the Prime Minister's chief science advisor, Juliet Gerrard.

I caught this RNZ (Radio NZ) interview with Gerrard while driving home on Auckland's quiet streets on Monday evening. It's worth a listen to get a feel for the thinking and work going on behind the scenes here. Interestingly Denmark is being watched closely, where Gerrard is encouraged by recent developments. And Gerrard explains why signs of community transmission are being watched closely, and why we're having a lock-down for a four week term.

3) Angry Italian mayors.

To date more people - over 6,000 - have died in Italy from COVID-19 than in any other country. (Global statistics are here). The video shared in the tweet below shows the frustration, anger and efforts some Italian mayors are going to as they strive to get the message across.

4) European Union struggles for relevance in fight against coronavirus.

Across the world countries and continents are debating the best way(s) to tackle coronavirus. Leaders are under pressure everywhere. In Brazil, for example, President Jair Bolsonaro is reportedly losing the battle of public opinion. In the US President Donald Trump's attempts to stem the crisis are rarely out of the news. And in Europe the European Union is struggling for relevance, Der Spiegel reports.

In short, as the pandemic takes hold in Europe, the decades-old union is showing its weaknesses. While the EU managed to survive Brexit and the euro crisis, the corona crisis may yet prove to be an insurmountable challenge.

Instead of trying to come up with joint solutions, the Continent is becoming balkanized and is reverting to national solutions. Instead of helping each other out, EU countries are hoarding face masks like panicked Europeans are hoarding toilet paper. The early decisions made by some EU member states to refrain from exporting medical equipment to Italy – the EU country that has thus far been hit hardest by the pandemic – has even overshadowed the lack of European solidarity displayed by Hungarian Prime Minister Viktor Orbán in the refugee crisis.

Europeans are even divided on the question as to how to combat the virus. Whereas Germany is eager to prevent as many people as possible from encountering the virus and becoming infected, the Netherlands wants to see as many healthy people as possible fight off COVID-19, thus becoming immune. The signal is clear: When things get serious, every member state still looks out for itself first – even 60 years after the founding of the community. The question now is whether the European commissioner can do anything about it.

5) Hong Kong's second wave.

Hong Kong-based Bloomberg journalist Tracy Alloway has been tweeting a stream of informative tweets since early on in the coronavirus crisis. This one today shows a concerning increase in infections from imported cases.

And here's a taste of the Bloomberg story Alloway's highlighting.

In the last week, hundreds have rushed back to Hong Kong, in part to avoid the March 19 government deadline that subjects all international arrivals to a 14-day self-quarantine. The influx has more than doubled the number of cases in Hong Kong to 356, a shocking spike after the local government had mostly contained the spread of Covid-19 for the past two months.

In response to the surge, Hong Kong Chief Executive Carrie Lam issued a 14-day ban on foreign non-residents and moved to restrict alcohol sales at bars, restaurants and nightclubs. Fighting back tears, she slammed the growing numbers of people who have been caught breaking quarantine.

“To anyone who intends to breach the quarantine orders, anyone who still wants to go out and meet up with friends, can you not be restrained for some more time so Hong Kong can win this battle?” she said.

6) And finally, have you been wondering what all those highly paid sports stars are doing to fill their time now they can't play? Here's a taster from the famous Barcelona football team.

We welcome your help to improve our coverage of this issue. Any examples or experiences to relate? Any links to other news, data or research to shed more light on this? Any insight or views on what might happen next or what should happen next? Any errors to correct?

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Its the following waves of infection that worries long can we continue to live in lock down for? The effects might (will?) take years to recover from.

We really don't have a lot of choices unless we want to see a whole lot of people die quite suddenly. The death toll in Italy so far is 2 yrs of fatal road crashes and increasing. Maybe there is insufficient capacity in our health system and we cant increase it fast enough. We can find $16B in a hurry but not $50M for mental health...

I understand there was quite some prosperity in the 1920's following the Spanish Flu. Given that prosperity is what we have been/what we are all about, should we just let is run its course?

Yes. If we don't go into lockdown for about 5 years, it would appear that the virus will leap up and get whoever it is going to get, regardless of what else we do. So there is an argument for the herd to keep running and devil take the hindmost. It may be true that the virus will settle into it's place, and kill a certain percentage of us as we live our lives. As road deaths do. As mental illness does. As drug stuff does. As quite a bit of our recreational activities do. As our work activities do. Just another one on the list. Those who are fatalists or believe in an afterlife of some sort will have no trouble in living with it. If we find something to kill the virus, then well and good, but how long will we put up with grade 4 before we refuse to put up with it?

We do have choices, but our government has likely just made a really bad one. Chances of 300-400 deaths here (=annual road toll) are very low. Will they ban cars? I doubt it. Let’s say we hit 5,000 deaths (=annual smoking deaths)...will they ban smoking? Of course not. When people wake up after this is over and look at all the financial carnage, countless suicides, etc, maybe they will think differently. Then again, maybe not. We’re just not that smart.

Err no if you let this rip through the general population unchecked then 6% of the population is going to die. It also depends on your definition of "recovered" because 20 to 30% reduction in your lungs ability is never recovered in my book. Do the math its not pretty.

You raise a valid point.

Unfortunately, under the present system; largely controlled by banksters, its every man for himself. And corporate welfare for those who are in charge of the politicians.

The only way to stop this is to let banks fail, and nationalise them so that he wider population have the final say rather than some facely overseas banker. Most people are sick of privatising profits and socialising losse's; which is the current system.

The measures are a sign the banksters model is crumbling, and history will tell you empires dont last for ever and normally less than 200 years. We are definitely closer to the end of the banksters rein than the start.

What you refer to is really reserve capacity. That is the capacity that is required in a crisis, but otherwise not normally required. The primary issue here is that with a publicly (tax payer) funded health system, it will always be restrained by resources. Simply put there will never be enough money to provide full coverage for every possible contingency. The cost of maintaining a reserve capacity would be high, but would it be worth it? Hard choices - who lives, who dies!

Once NZ is Covid-19 free we can get back to business (schools and all business open). All incoming passengers should be in forced isolation and 100% Covid-19 testing so NZ remains virus free. This remains in place until a vaccine becomes available.

My understanding a vaccine is 12-18months away?

it will be quicker than that, they are already running the tests way ahead of normal process and i expect the FDA to allow it to be used before proper approval once the SHF in the USA

Longer than that, as my estimate.. there'll be another typo error variants.. which not carry the same behaviour as the previous bug, hence why those closer of SARS or MERS drugs, which already been tested for this Covid, not that effective - yet, this freakin' bug actually similar main characteristics to previous both RNA class viruses.

Yeah its easy to see China getting the infection numbers under control and think "we can eradicate this". The problem is China managed to reduce their infection rate during a time when the outbreaks in other countires were limited. It will be more difficult to contain the spread when outbreaks are occuring across the globe.

The Warehouse is an essential service , what a load of bullocks, maybe online?

The guy said on the press conference today that the Warehouse is not an essential service. After rising over 32% today on the back of that article this morning claiming essential service, WHS shares are now in trading halt after the press conference. They should face charges for market manipulation.

That was extremely messy - and then the PM more recently said we wouldn't be able to shop at our local Warehouse. I'm not sure about whether or not they should be able to keep physical stores open - but for certain, I think we need that Group to keep its overseas supply chains in place. They are a huge importers of goods (including the Noel Leeming change, I believe).

The only other big importer groups we have that are fully maintaining their import supply chains are Progressive Enterprises and Foodstuffs. What if one or both of their supply chains have interruptions, particularly for household (non-food) goods (i.e., thread, tape, paper, pencils, light bulbs, socks, tights, towels, kitchenware, etc.). And what if your computer or television goes bust?

I think having three major import supply chains is better than two.

I didn't realise that the 1918 Spanish Flu was also an H1N1, as the 2009 Swine Flu was. Perhaps we dodged a bullet 10 years ago....But look how long the Spanish and Swine Flu were about for - 18 months. That could be a long time to be at Level 4 !

The 2009 flu pandemic or swine flu was an influenza pandemic that lasted from January 2009 to August 2010, and the second of the two pandemics involving H1N1 influenza virus (the first being the 1918–1920 Spanish flu pandemic)

And at the risk of repetition:
" COVID-19 is not influenza, although it behaves in some ways like influenza. It is, instead, more accurately called a highly contagious viral pneumonia. No one has built up immunity to it. "

Yeah, read up on it a few weeks ago. Some US scientist managed to dig up a sample from some massive grave in Canada bavk in the 80’s. Did a bunch of tests messing with it’s genome though and found that it was nowhere near as virulent with minor genetic changes though so not all h1n1 strains are equal.

What if Covid-19 in some form or other stays with humans forever like the flu ? May be our annual flu shots will be modified. I posited that a few days back here. Toady an aritlce in NZ Herals suggests precisely that.
Here is the link :

Let's put it in catastrophe perspective; how long world recover after WWI, WWII? - How could? in this day an age, where long ago we already put man on the moon, since then all those amazing technological achievement in all fronts. Now, we're witnessing world wide countries in musical chair of lock down, we can say, let's leave the bug out. Bring all of the world young generations with all herd immunity, purge the elderly in which by past natural history.. is not to be preserved anyway, against natural ageing pathway. Now, I do liked your enthusiasm. Specially reading a piece from journalistic media, with strong sponsorship funding from country that first ID this bug.

It appears the most difficult aspect of declaring a quarantine is actually enforcing it. Hopefully we have learned from other countries and have plenty of people ready to go.

Hope people don't get the wrong idea and buy more toilet paper rolls to practise their kicking skills.

When I passed through Asia many years ago the place was filthy. It nearly killed me. Nothings changed.

The race is on for the Vaccine & effective medications, 20s promising so far being develop for both, the closer deductions of Malaria & HIV combinations/derivatives drugs/medication treatment, so far below threshold to bring up patient closer to normal survival mode from the mortality percentage verdict. So? we knew this is going to be a long ride, re-visits, second third waves etc. As per Earth global rotation, seasonal changes, the turn of day/night, different of time zone - yet, the most difficult one to contain is that: human endeavour for business, profit making.. which encourages movement of $ funds/transactions from place A to B to C etc. - in the case of most country in this world, it is clear the their funds movement shall be accompanied by their people movement (look not being negative here, tourist pay? for a visit, student pay? for months of study). Off course post 2020, most of the countries on this planet shall add the visiting requirement into their immigration paperwork: health declaration status of Covids (sorry, I put that in plural for a reason), you guys ain't see nothing yet how this RNA replicate under the scopes, how the strain transmitted and how adaptable they're with different host protein, sure human body is clever to overcome it. But I'm talking about certain spectrum of patients age demographics worldwide, which will succumbs eventually by this bug nasty visits when their respective country healthcare was just simply unable to cope, unable to attend it in time left to:..survive, recover, damage or death. - I knew it's hard now to fathom by both property bear/bull on this site.. wealth vs health vs well being - We're into 4 weeks of self contemplating, do be kind at one another. Life in this world is full of intertwined inter dependency. Being greed, arrogant, not kind merely due to wealth? won't bring you that happiness closure.

Maybe we save the planet by saving ourselves!

It looks as though we are about to witness an enormous real-life experiment in the US. Money v Lives. I, along with many others will watch with a certain morbid fascination as this unfolds. Clearly, the death toll will rise sharply as restrictions are eased, so which will eventually win? The poor and uninsured will presumably die in much greater numbers as the public hospitals become overwhelmed. Will private hospitals have armed guards outside to repel those who cannot pay?

How many deaths will it take to provoke large-scale disorder? I despise Trump, but he is not alone in this. Big Business is urging him on as are many Republicans and they will all have blood on their hands.

" Will private hospitals have armed guards outside to repel those who cannot pay?"

Will the free market be allowed to prevail, so those private hospitals crank up the prices for services to limit demand to the point they hover at 99% bed occupancy? Will they hold auctions for setting the price of the next bed/batch of drugs to become available?

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