Everyone in the UK - please share this widely, this and other posts that explain what is happening in the UK. We have to act, and act promptly. Every day of delay makes things worse.
First if you are in the UK you may be unaware of what the WHO themselves say as it is not normally reported here in the UK since it conflicts with what our scientists say.
There is so little understanding of this in the UK. Few seem to know about it in the general public.
The WHO are the world experts on this topic and are responsible for overseeing the eradication of polio, also eradicating malaria from many countries and near eradicaton of smallpox, also in stopping many outbreaks of Ebola and they respond to 200 or more epidemics every year. These people are absolute experts on this topic. Meanwhile the UK experts base their experience for dealing with COVID19 mainly on flu.
The WHO are to be respected and listened to.
Dr Tedros, director general of the WHO said on monday in his “test test test” speech that we all have a duty to stop this virus not just for our own countries but also for the other countries with weaker health care systems that it could spread to.
He is especially concerned about what happens if it spreads to countries with people weakened by AIDS or with malnourished children or refugee camps - and any country that doesn’t stop it becomes a source for it spreading more easily to those countries. The WHO is acting to reinforce their health systems to cope and unlike Europe most of those countries have been preparing with the greatest urgency for this disease for weeks now. Still, they will struggle to contain this disease if it gets to them in large numbers, for instance, from the UK.
This is the video of the WHO press briefing on 16th March with my summary of opening remarks and official transcript
It may be a good one to share to raise awareness of what the WHO themselves say.
The good news is that China contained it and many other countries are already containing it. We can too. We can stop it,and must..
The UK however have abandoned the approach of the WHO.
They have started to do tests again but they have not yet come around to say they are going to try to find all the mild cases, contain them and trace all the contacts and isolate those, as the WHO say has to be done.
Please don’t be scared by this. You can protect yourself and your loved ones, and protect others too by breaking chains of transmission that pass through you. The government are not yet explaining this to us properly.
Then, if we act together we can get our government to change its direction and save lives. A government is made up of MPs and the MPs for the large part care deeply for their constituents. They need to be made aware what is going on. They are objecting already, but they are not well informed about the background of the WHO.
Here is one MP showing how feelings are strong already about the risk for our health workers and old people with this policy:
https://twitter.com/BBCPolitics/status/1240255298423717889Here Boris Johnson responds that he is acting on the best scientific advice. I think he may well be unaware of what the WHO are saying - politicians are not expert on science, often are not especially scientifically literate. Boris Johnson has a degree in the classics, ancient literature and classical philosophy and he then went on to be a journalist.
He is relying here on his chief medical adviser who never talks about what the WHO recommend in his briefings to the general public and probably doesn’t mention this to Boris Johnson either.
Of course Boris Johnson, and Dr Whitty too for that matter, want to slow iti down. If they though they could stop it this would be their top priority.
Yet the WHO say it can be stopped and this is where it gets strange.
Even politicians here are unaware of what is going on. For instance Jeremy Corbyn would surely criticise Boris Johnson on this point if he knew about it, but he doesn't mention it.
It is the same for many experts too - and it sounds like it is the same in the Netherlands who are following the UK's lead here. These experts don't seem to be aware of what the WHO say. Or they are discarding it because it doesn't fit their paradigms for flu (more at the end of this post)
Out of basic scientific integrity, they should make it clear that what they say differs from what the WHO say. They should say something like:
“In every press briefing the WHO say that this disease can be stopped and that it is not a queston of wether we can any more but if we will. Also there was a joint WHO-China report with an international team of 13 experts lead by Bruce Aylward and 12 Chinese experts and they also concluded that itcan be stopped after studying it on the ground in China including a day and a half in Wuhan.
However I believe the WHO are incorrect and the expert report is incorrect when they say it can be stopped for x y z and …”
That then would be scientific integrity. Then our PM would then assess for himself whether to follow the advice of his chief medical officer or of the WHO in full awareness that they are giving different advice. Also we as a country would know what is going on and all this would be explained on the TV news and in the media.
It is okay to disagree but if they have good reasons to do so, they should tell us all upfront why they are doing this.
Not just that, they should say in detail what they think is wrong with the WHO's analysis and advice, and why.
They should also explain clearly to the British Public that in the opinion of the WHO this course of action endangers people not just in the UK but also in countries with weaker health care that we may infect with our outbreak. They should explain to us why it is they are continuing with this plan faced with this warning from the WHO.
And then explain to us why they think this is not a concern.
I live in the UK and nobody is doing any of this in the UK. There are letters from experts and politicians outraged by what is happening but though mentioned, they are basically dismissed.
There seems to be almost no awareness that the WHO are even saying this.
I don't think any of our politicians know this either. Nobody is challenging Boris Johnson on this basis or even mentioning it, on the BBC, even the Guardian usually very critical of the government, the experts on twitter etc.
The experts in the UK are doing projections which they create with simple adaptations of models they previously developed for influenzau. They change none of the assumptions in the models about how influenza is transmitted and expect them to work for this very different disease that is not a version of flu but a coronavirus and is alos different in how it transmits from SARS too.
Their models are only validated against influenza outbreaks and not against data for COVID19. It doesn't necessarily follow that actions that help suppress an influenza outbreak will also be optimal for COVID19 without testing a model. A model is just a hypothesis and should not be used for prediction until it is validated against the data you are modeling.
They should explain this too to the general public too and then tell us why we should believe their conclusions from their theoretical models based on flu over the practical experience and the direct research in China and the findings of the experts in the big report co-lead by Bruce Aylward, an epidemologist who was a lead of the global polio eradication campaign for many years.
This, for instance, is the model that has been headline news in the UK recently which they say has lead to the UK government modifying some of its ideas - but still nowhere near the WHO approach and nowhere near contain.
You may have seen this graph reproduced from their paper which leads them to predict a second surge if we don’t let it spread a bit now:
They say in the paper itself that they basic structure is as previously published and they say nothing about modifying the spread dynamics to model for COVID19 instead of influenza:
We modified an individual-based simulation model developed to support pandemic influenza planning to explore scenarios for COVID-19 in GB. The basic structure of the model remains as previously published. In brief,individuals reside in areas defined by high-resolution population density data. Contacts with other individuals in the population are made within the household, at school, in the workplace and in the wider community.
Paper Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand
Popular exposition here:
3 charts that helped change coronavirus policy in the UK and US
There the main difference is that flu spreads easily in the community amongst large groups of people, in schools, and has symptomless spreaders, about a third of us are which makes contact tracing impossible.
Meanwhile COVID19 almost only spreads through prolonged or very close contact e.g. families visiting each other or in hospitals, prisons, old people's homes and some religous situations. These people know each other, or the organizers of the events know them all.
This is why COVID19 spreads mainly through easily traceable close contacts - a method that wouldn't work for flu.
You can see this especially strikingly for Singapore.
There may be a very small amount of community spread in the genuine sense such as is the norm for flu - but it must be very small because tracing the first 266 patients in Singapore they didn’t find any.
All the cases traced back all the way to China.
These were some of the early cases in Singapore:
What we know about the locally transmitted coronavirus cases in Singapore
If there was large scale local spreading in Singapore, and this was causing serious illness or killing people, they would have reported to the clinics or hospitals and we should have come across some of those cases by now.
However all the cases at least through to the first 266 can be traced all the way back to China. Here is just a small part of their big chart.
Explore it here:
You couldn’t do that with flu. If any of those people had passed it on to someone in a bus, coach, plane, train, waiting in a queue or something, it would be impossible to do this contact tracing.
But it’s mainly things like people in the same family, maids etc. Also notice that most of the cases are end points in this graph, which means they don’t infect anyone. This virus spreads by just a few people of the many already infected spreading the virus to many. Then just one or two of those spread to more,\ and so on.
Also we know this graph is complete, apart possibly from symptomless non spreaders, because they test everyone in Singapore for COVID19 that presents with fever or respiratory symptoms in a population of over 5 million and these are the only cases they found.
COVID19 in Singapore shows there can't be a hidden population of symptomless superspreaders
Hong Kong and China have also done a fair bit of testing in fever clinics too, and so has South Korea.
Even for South Korea most of their nearly 8000 cases are from a few well defined huge clusters.
This is what makes it so different from flu.
When I say these distinguished academics are not validating or checking their model - I mean they have not checked it against this detailed data. They can’t have or they would have mentioned in the paper the need to modify it radically, so that the infections in the model happen largely through easily identifiable close contacts.
What can happen is that they have no place for it to fit into their models. However, instead of concluding that their model needs a radical revision to model this new virus, they wait for more “good” data that fits their paradigm. This isnot “good science” but it is a natural thing for humans to do.
This virus also often spreads via places like hospitals, or care homes. Places where people are in contact for a long time. It just doesn’t seem to happen that someone coughs on you a few times in an underground train and then you have the disease.
I need to be careful here. This is not saying it is okay to go around coughing on people if you have COVID19 or that it is okay to let others cough on you or that it is okay to skip quarantine.
There may well be a small risk of community spread. Even if the risk is small, doing such things would be likee playing russian roulette with someone’s life or your own.
But the risk is very small for this disease, unlike for a flu outbreak. So small that you’re containment measures only need a small element of social distancing, for instance certain kinds of large groups. South Korea and Singapore, also China outside of Hubei province didn’t need to do any lock downs.
The sensible advice here is that if someone was indeed a covid 19 case they must quarantine for the period of sick ness + 14 days.
If they are in a household - then those others if they are contacts would self isolate from each other and the suspect case for 14 days and then if they didn’t have it they are virus free.
But the UK government tells them to continue living with their household and isolate all of them together from the rest of the world for 14 days. But at the end of that time they are still infectious and many of the household would likely already be infected too (as they are not isolating from each other) - and forcing them all to stay at home for the duration and not leave at all is creating the prolonged contact which seems to be what this virus needs to spread. So this seems likekly if anything to increase the amount of spread. Many of the household members would not be infected until the end of that period. So now the first case is over their symptoms but still infectious. The other members may be infected now but presymptomatic. At that point the entire household can now leave their house and do what they like and pass it on to others.
This seems almost calculated to increase the infection rate faster than normal - and indeed the deaths are doubling every 2 days, one of the fastest doubling times for deaths. I think it is entirely possible that our government’s instructions are acting to increase rather than decrease the rate of spread of this virus.
This is why a model of transmission for flu is not at all obviously suitable for this disease. It has to take account of its unusual transmission dynamics where the transmission is to people that the case already knows or to an event where typically they know each other.
This also makes the hospitals, prisons, old peoples homes etc top priority to protect because they are the places where people spend a lot of time in prolonged contact.
It might well be droplets on surfaces or coughs, but however it is that it happens - it can be brief but very close contact, or it may be very prolonged repeated contact with the virus.
One reason might be that it might require a high viral load because this virus has an affinity for the lower respiratory tract and not much of an affinityu for the upper respiratory tract so it has trouble entering the body originally.
Then the other thing that may be different from flu (I don’t know enough about flu) is that a case remains infectious for a very long time after they have got over their symptoms.
They are not talking about 14 days isolation to see if you have it.
If you do have it, and it is genuinely COVID19, then after it has run its course and you are completely symptomless, you are asked by WHO to continue to stay in quarantine for an additional 14 days after that in case you infect somone else.
You are also infectious for 1–2 days before you show symptoms (if you trace all contacts then that’s why they isolate even when they have no symptoms once they are known to be contacts with a COVID19 case - if you got them to isolate only once they have symptoms then it is too late).
I haven’t given the cite here - I should then you can check it for yourself along with other readers. It is that big report from China lead by Bruce Aylward.
Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)
On a personal level your risk if you go out and about in the community, from this data is very low, and then by the hand hygiene, respiratory etiquette and not touching your face you can reduce it to the point you can be confident you didn’t get this virus.
You are far more likely to get it from someone visting including a relative. You can catch it in just one day, you don’t have to wait for weeks to get it. The German cases were acquired quickly and an early example in China was of one family that visited another family in Wuhan for a day and I think they all got it.
But you might not get it for some time.
Personally in the UK I think the only way I am likely to get it, given that I am careful if I go to the shops etc, wash my hands, don’t touch my face, is if I, say, break an ankle and need to go to see a doctor or hospital. Our government is not giving any thought to stopping spread through hospitals for cases that are admitted for accidents such as broken ankles and I’d worry I would come away from the hospital with COVID19
Similarly if I have to see a dentist.
I will just have to be careful not to break any ankles and avoid sweet things!
But those are the two things they should focuson most of all.
I think ours is the only government that seems to be actively encouraging community spread through doctors and care homes, again by this false analogy with flu and not requiring adequate protection even for known COVID-19 cases
I go into the details here:
For both these reasons I wouldn’t be surprised if our governments policies cause it to take of more rapidly in the UK than anywhere else.
A model of spread designed for flu would not be expected to work unmodified for COVID19.
Their model also doesn’t include any attempt to predict the effect of contact tracing, isolation and aggressive case finding.
This is the model that they are using to predict that the cases will surge in China maybe 8 weeks from now. But this is not flu.
This is the real data from the world:
COVID19 is a new disease and could resurge. However there is little evidence yet that it will surge up again.
China has stopped it just about completely, and has had days with no native Chinese cases. They are restarting their economy, opening restaurants, restarting travel even in Hubei province.
There has been no second wave yet. The Chinese are prepared for one if it happens. They have kept bed space, ventiliators etc to be able to stop it as they stopped the first one.
During the first wave, most provinces outside of Hubei had only a few hundred cases.
China can now detect a new COVID-19 case within 3 days of symptoms starting because of they way the public there now go to fever clinics to be tested as soon as they have a fever and because of a huge testing capacity.
So China is not going to have a second wave like the first one even if it does resurge. The rest of the world could do this too. We can stop it, from the experience of China this is clearely something that can be done with this virus. Then we can monitor with extensive testing of anyone with flu symptoms to see if there is a second wave. With testing in place, we can stop any such second wave as well before it happens.
Dr Bruce Aylward talks about the Chinese response and compares it to the UK response here:
https://youtu.be/vsV_PJ3txn8?t=465So, if we do as the Chinese did, and as Singapore and South Korea are doing, we don't have to just flatten the curve. Those projections with a second wave don't take account of the unusual way that COVID19 spreads and the way that it can be stoppped by contact tracing unlike flu. They can’t model what happens in the real world with COVID-19 until they add modeling of contact tracing.
So we can handle this if needs be. But so far there is no evidence that COVID19 will resurge like this.
Also COVID-19 could transfer to humans again from its original reservoir, perhaps in pangolins (not discovered yet). But if so, again, the Chinese will spot it within days now they know how to detect it, and handle the second wave in the same way they handled the first wave in provinces outside of Hubei province.
WILL. THE UK GOVERNMENT’S ADVICE ACTUALLY MAKE THINGS WORSE, AND SPEED UP INFECTION?
All of our governments advice seems to be based on measures they know from experience help with flu rather than the new measures developed in China, Singapore, South Korea, Italy etc that work with COVID19.
For instance they are asking people with mild symptoms to self isolate at home for 7 days if they are on their own, but if they isolate with a family that they should all stay at home for 14 days.
This is a recipe for infecting everyone in the family with COVID19. Close contact with a family all cooped up for 14 days in winter is the perfect situation to infect as many as possible - unless they know how to self isolate the one with the symptoms. Going out in the community is much less risk if they do social distancing than staying in the house and infecting others in the house. Then at the end of those 14 days, if it is COVID19, they are still infectious, for up to 14 days after they have completely recovered. Some of the others in the house may have only just got COVID19 at that point and not yet showing symptoms. And at that point they can all go out and start infecting others again. It may be good advice for flu but how is this good advice for COVID19?
Then there is the way they are doing almost nothing to protect care homes, hospitals, surgeries, and dentists from patients who may have undetected mild cases of COVID19. Or prisons. These are not their center of attention and they have even downgraded the level of protective equipment recommended to doctors working with known COVID 19 positive patients.
See my
This is not a theoretical study, it is real life with real people’s lives at stake. These places have been involved in spreading and amplifying COVID19.
I am sure eventually they will notice their measures are not working - but they need to get up to speed fast and change their ideas rapidly. It needs to be evidence based, based on evidence for COVID19 rather than influenza.
There are signs of this already. Look at the deaths from COVID19 in the UK doubling every 2 days. Usually it is every 3–4 days. Their measures may be making things worse.
With a doubling time of 2 days it would continue
200, 400, 800, 1600, 3200, 6400, 12800.
We could have 12,800 deaths by two weeks from now, at this rate, increasing 64 fold every fortnight.
NOTE I AM NOT SAYING THIS WILL HAPPEN
There is no way we go as far as that.
But exponentials increase very fast. The UK strategy is not evidence based on experience with COVID19 and we have no previous experience of anyone else to show that it works. It may be making things worse as I said.
If we don’t stop this approach RIGHT NOW, it will soon be in a situation as difficult as Italy and if we do nothing for another 10 days it can easily begin to get as bad as WUHAN or worse.
I know the government is introducing many major measures but are they the right ones.
Here is a bullet list:
The governments increase in testing to 25,000 a day is a welcome step in the right direction. But there is far more they have to do.
Also for specific vulnerable populations:
So far they are not doing any of these things, and every day counts.
They are doing many other radical things that would work for flu but for the most part are untested for COVID-19
Details here:
We don’t really know the number of cases infected now until they do rapid and extensive testing. But if the cases are doubling only every 3 days instead of every 2 days, then that would be a ten fold increase every ten days. 1000 cases become 10,000 ten days later, then 100,000 then within a month, 1 million, more than ten times worse than the total cases for Wuhan.
We crossed 1000 cases on the 14th of march. That makes it the 24th when we may hit 10,000 cases and 3rd of April when we may hit 100,000 cases. If the government’s actions are actually accelerating spread due to using the wrong paradigm of flu instead of COVID19 it may even happen faster.
PARADIGM SHIFTS AND TRAINED INCAPACITY - WHY DON’T THE UK EXPERTS SEEM TO SEE ANY OF THIS?
I think myself it is an example of a paradigm shift as in Thomas Kuhn's "The Structure of Scientific Revolution".
Paradigm shift - Wikipedia
They are using the flu paradigm and everything else is checked according to how it fits that paradigm and they are discarding information and advice that doesn't fit it.
This can often seem puzzling to non experts because you are not invested in the old paradigm. You can't see things the way they do with their decades of experience working in great details with all the intricacies of transmission mechanisms of flu.
I think it is also related to Thorstein Veblen's idea of "trained incapacity". He has a rather unflattering analogy with chickens:
By trained incapacity he meant that state of affairs where one's very abilities can function as blindnesses. If we had conditioned chickens to interpret the sound of a bell as a food-signal, and if we now rang the bell to assemble them for punishment, their traiing would work against them. With their past education to guide them, they would respond in a way that would defeat their own interests.
Thorstein Veblen - Wikipedia
We are not talking about chickens and a simple conditioned response here of course. Our experts are erudite, highly educated, and very intelligent .
However paradigm shifts can be tricky for even the most intelligent. I have a special interest in the history of Maths.
Back in Sumerian times then they put a mouth picture over a number, meaning “part” to turn e.g. the number 5 into 1/5
So the Sumerians could notate any number, e.g. 5 and a single part as a result of any number of divisions e.g. 1/5.
However they had no way to notate, say, 3/5.
For instance they couldn’t notate 3/4. Instead they had to notate it as
For centuries an entire civilization of people with the same genes as us, as intelligent as us, never invented the idea of a ratio.
You can do the same calculations with these methods, but they become increasingly hard to do, with many more stepsas the calculations get more complicated.
Ratios would have made many calculations they had to do so much simpler for them, but the idea never occurred to them. Not even their equivalent of our best scientists or mathematicians were able to think of this idea. Put Albert Einstein back into Sumerian times, raised as an orphan there, and he wouldn’t think of it either.
That’s an example of a paradigm shift.
There are many others in maths. There was huge resistance in the middle ages to the introduction of negative numbers in equations.
Before negative numbers were accepted by mathematicians - then they had many different forms for the quadratic or the cubic. You always had to rearrange the equaation to make sure all the coefficients are positive. As they went through the steps to solve the quadratic, they had to keep everything positive because they didn’t think negative numbers were valid numbers. This lead to many different techniques you had to learn to solve a quadratic and even more so for the cubic with this clumsy notation.
It took until the fifteenth century for negative numbers to take off in Europe.
As late as 1758 the British mathematician Francis Maseres wrote that negative numbers
"... darken the very whole doctrines of the equations and make dark of the things which are in their nature excessively obvious and simple" .
Now we learn about negative numbers as children. Back then it was an advanced subject for their equivalent of university level maths with the experts arguing about whether it was valid to use them or not.
I hope this helps you have more sympathy for these experts. They are not stupid, or arrogant or unethical. Just facing a paradigm shift, and their vast experience of influenza has caused a “trained incapacity” that makes it really tough for them to change this paradigm. So they are discarding the evidence against their ideas over and over.
Their own erudition is the thing that is causing them problems.
They will come around eventually. But we don’t have time for this; we must stop it now.