This is the news that they are not really sharing on the mainstream TV. China is containing this outbreak. This is in one of the other provinces, not Wuhan. Meanwhile China as a whole has reported only 329 new cases yesterday, 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 one, that the course of this disease is under our control.

Text summarizes the evidence which helped the international research team of international experts on infectious diseases to confirm that the Chinese findings were valid.

Independent confirmation:

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

WHY THIS IS NOT A PANDEMIC

Here I am using the word pandemic as the WHO themselves use it. From yesterday’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 was influenza we will probably have called this as 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.

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 he says there, influenza is much more infectious. It spreads communally. It spreads through children. It has non symptomatic spreaders - about 1 in 3 is a non symptomatic spreader, 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.

This is one of my articles to try and counter the COVID19 infodemic 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?

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 is lots of independent evidence to to 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 patients fell from a peak of 500/day in lateJanuary to average 50/day since mid-February (page 7 of the report)

He 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 that went down from 0.47% prevalence of the virus all the way down to 0.02%.

Within the fever clinics in Guangdong, the percentageof 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 team of experts (12 from China and 13 from outside China) agreed that China had significantly reduced the numbers 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 infection in China has also played a significant role in protecting the global communityand creating a stronger first line of defense against international spread. Containing this outbreak, however, has come at great cost and sacrifice by China and its people, in both human and materialterm

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 covering up this one.

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 WHO. For details see my:

YES THE REST OF THE WORLD CAN DO WHAT CHINA DID - THEY ARLEADY ARE

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 did they then say “Okay they did it but we can’t”.

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

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

India, 3, all recovered.

Singapore has a big cluster of 96 (last count) and that is just about contained.

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

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, they 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 VIOLATION OF HUMAN RIGHTS?

Well first, the Wuhan lockdown is only possible because the population of 11 million 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 they can harm others by their actions.

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 save lives. Italy is enforcing quarantine around some small provincial towns in Northern Italy in this way. It is using police plus the military to supplement police (not that they are going to shoot anyone, just acting as police to stop them - 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

. 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 was an outbreak it would have a doubling time. Usually COVID19 numbers double every 3 days or so if you don't do anything to stop it (or 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. This is definitely slowing down - and 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.

See also

If you quarantine 90% (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 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?

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 if this goes in jumps - we saw that with the contact tracing for Singapore. You may get one person infect 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.

Italy are not only tracing contacts within Italy. They 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 wherever the are around the world.

This is why it really doesn’t matter if 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 end up with, say, 3000 Italian cases, but the nwith good care nearly all will recover, 80% or 2400 will only get mild symptoms on average. 15% develop severe symptoms, in that example 450, and maybe 0.7% die but it could be more because European populations have more elderly people than 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 to find all the ones that are currently infected but not yet detectable. Then with so many contacts to trace there are bound to be a few hundred slip through the net so you would continue to get many more, but less per day, for several weeks after that (if it is already well contained).

WHAT IS GOING TO HAPPEN IN SOUTH KOREA?

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 find another cluster and 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 day by day break down of the main outbreaks or does graphs of them. If you know of one please say in a comment. Wikipedia is often unreliable but this 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?

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. But you can still contain it.

Iran, perhaps surprisingly, is also well able to deal with it 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 was 7 in 1000 it would mean it likely has several thousand milder cases to be detected.

Iran have

Issues Iran is facing:

Why Iran hasn't imposed quarantine areas

Sadly the WHO team have 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

In most other countries this virus is rapidly contained.

As of writing this 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 Phillipines 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 he 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

More about this in yesterday’s WHO press conference.

See also my