1.0 The Vital Importance of Testing
Examining the responses of nations and their success in combating the Wuhan Virus one trend is very clear; greater testing leads to improved containment and lower death rates. However, as with all statistical analysis without accurate data the conclusions will forever be questionable. The feedback that I have received from AI modelling groups such as Calyps is the quality of the data in the EU and globally, to put it politely, is frighteningly inconsistent. Some of this is government manipulation, but a large part is poorly designed data gathering systems. These shortfalls will have to change in the future. Surely, it should be part of the WHO’s remit to set consistent reporting standards for epidemics?
There are four very clear advantages that come from testing in the current epidemic:
- Maximising the number of health workers on the front line in hospitals, GP surgeries and care homes.
- Identifying who can go back to work once they have the antibodies.
- Developing a test area to provide the front line with warning that an epidemic has arrived in a region through water testing.
- Devising an effective strategy that balances the death rate with the destruction of the economy.
Whilst on the topic of large scale testing, there is a question concerning China that still stands. How has it managed to contain its secondary outbreak centres outside of Wuhan? Did they test on a scale we are unaware of? What are we all missing as to how they are now emerging from the pandemic and seemingly going back to work? The simple answer may be Chinese collective self-discipline, combined with a memory of SARs that caused individuals and companies to act before their government even admitted that there was a problem. But, more of that in a future Murrination.
2.0 The Testing Deficit
The graph below shows how far behind the curve Britain, the US and France are today. They will have to triple their testing rates to catch up with the leaders. However, even at current peak rates of 10,000 per million the sampling of 0.1% of the population will never contain the pandemic. The reality is nations should be looking to test their whole population in month one and then at a lesser percentage each month there afterward . Consequently, testing capabilities must increase by two hundred and fifty times current peak levels of 10,000 per million. That is a mammoth task and one the management consulting groups of the big accounting firms are just not up to with their iterative thinking process. Rather, this is a task for miracle makers in the mould of Lord Beaverbrook who ramped up aircraft construction and repair in time for the Battle of Britain. Sadly, as per my previous article about the need for wartime thinking, this recognition of the need for right brained maverick achievers in key roles has not yet manifested within the top levels of governments.
Meanwhile back in the UK the rate of the testing program per day is slowly increasing. This is coupled with promises of 100,000 tests per day by the end of April. But, as discussed above, this still will not be enough for the whole population. This number will have to keep growing to 2m per day to meet my target proposed above.
3.0 Area Testing - Future early warning
For countries like South Africa and its high-risk townships, a new yet simple area testing method shows great promise. Microbiologists at the research institute KWR conducted a series of RNA-analyses at municipal wastewater treatment plants (WWTP) in the Netherlands. The analyses showed the presence of RNA gene fragments of the COVID-19 virus within incoming sewage water. According to KWR, such screening could be used to signal new outbreaks in advance and play an important role in combating the pandemic. This approach is supported by a study released by Chinese microbiologists in 2005 that showed SARS-CoV RNA had been detected in the sewage water of Chinese hospitals where SARS patients were treated.This early warning technique has the potential to both track the current outbreak and give warning of either new strains or new epidemics in the future. The more localised the testing, the greater the ability to sound the alarm at an early stage and thus contain an outbreak.
4.0 What is the Real Death Rate from The Pandemic?
Effective testing rates increasing in the days ahead will maximise the number of NHS and health workers being at work and should start to get those with the antibodies back into the workplace. However, this will not be enough to save the economy which is currently losing hundreds of jobs per death as of last week. Without large scale random testing of the public we simply do not have accurate information to ascertain the real death rates. The problem is highlighted below with Germany performing more tests than the UK, effectively lowering the formers reported death rate.
However, even in Germany people have not been tested at random, but rather when they have symptoms. This means there could be many more people who have been exposed, developed immunity and never shown any symptoms. This number is critical because if it is high,which it likely is , the death rate could be diluted down to 0.65% in Germany. If the demographics of the deaths are considered to be mainly focused on the old and weak, the concept of excess deaths comes into play. This reduces the number of effective deaths from the pandemic in the developed world for this strain.
The countries with low testing rates and thus restricted numbers of available tests, such and Britain and the US, will not be able to execute a meaningful, representable sampling of their population for at least a month. Rather, they will have to rely on Germany to create the first clear study to produce an excess death rate.
5.0 A Strategy to Escape Lock down.
As I discussed in THE NEW WUHAN REALITY-1: GOVERNMENT STRATEGIES , the greatest threat to national survival is not the Wuhan Virus but the economic depression the containment strategy creates. The question has to be is a death rate of sub 0.5% (worst case 1%) worth sending the world into depression for, with all its hardship and the geopolitical risks that will inevitably follow?
I have previously highlighted three options for government strategies:
Up until now this has been the standard response to the relatively limited Ebola, SARs and MERs outbreaks. All of these could be contained because the transmission characteristics meant infectiousness was signalled by temperature. It has worked on relatively small outbreaks, but once past the firewall of a limited outbreak its chances of success are too very limited. This has led to concerns over secondary waves of the pandemic hitting countries executing this strategy, i.e. China and the EU nations.
This would be the ideal route. First, lockdown a country at the onset of outbreak. After the outbreak subsides, expose critical members of the workforce to the virus intentionally in waves that do not saturate the ICU system (to maximise survivability). The limitation on this strategy is the number of ICU beds and oxygen enrichment facilities per 100,000 of population. Britain has 6.6 per 100,000 and is poorly equipped compared to an Italy that has been swamped with double that number. Germany and America have the highest number, but is that enough? Assuming that 10% of all infected need critical care, that means that even America with 35 beds per 100,000 could only infect and protect 0.35% of their population every two weeks. Following this, in 52 weeks only 9.10 % of the US population could have been put through such a program. This is not sufficient to keep the economy alive. Thus it is clear that, although desirable, phased exposure would not save the nation's economic integrity.
Mass accelerated herd exposure (No Suppression)
The whole population is exposed to the virus rapidly. Whilst the death rate generated will be the worst scenario possible in terms of loss, it may be much lower if the iceberg of the untested immune population is taken into account. Most of all, this would give the highest chance of economic survivability compared to the almost guaranteed failure of a containment strategy. There are key areas that should be observed to maintain social integrity. These include the isolation of the most vulnerable, such as the old and the sick with low immune systems. This would reduce the death toll and leave more critical care for the young and healthy, to more swiftly return to the workforce. However, this strategy is what amounts to a wartime decision of what is in the greater good and the knowing infliction of casualties. The challenge is that a peacetime public would never agree to this course action during the key early stages, even if they were fully informed. Hence, the need for a balanced national information management scheme, such as those used in Britain in WW2 to keep the public both informed and onside with the national course of action. The political challenge is that even if the death rate was 0.8% (less if excess deaths are considered) it would take 60% of the population to become immune, which is 36 million, of which 0.8% of 36 million (i.e 290,000) would die. However, recognising that there are some 550,000 normal deaths per year the excess deaths may be much smaller than we appreciate.
In Britain, Boris was initially executing the herd/no suppression strategy and placing economy first. Then, the Imperial College study revealed the scale of potential deaths from the no suppression scenario. As the Government had not taken the appropriate steps to look after the vulnerable they were exposed for seeming as if they did not care. Belatedly, they executed the protect the old and vulnerable program. However, as mentioned in THE WUHAN REALITY - 7: THE IMPORTANCE OF EFFECTIVE EARLY WARNING AND AI-URGENT HELP NEEDED, I believe the care homes have been left to fend for themselves with dire consequences. Next, quite logically the UK Government focussed on raising the horizontal line of surge critical capacity with an inspiring program of ventilators and huge hospitals. An example of this is the ground-breaking Nightingale hospital built in the EXCEL Centre. With all that being done, the government can honestly say they have optimised all of the variables above as much as possible.
Having noted this, the fact remains; if we continue to be locked down the economy will wither and die. As a consequence, I believe the Government will soon be forced to implement a combination of the phased exposure model until herd Immunity is reached(starting with the young and less venerable). Thus we should see the lock down being gradually lifted in phases (possibly by region) to continue to shift the curve to the right-hand side. If this strategy is followed, it will logically start with essential workers and then move through phases to nonessential workers whilst maintaining strict social distancing measures, restrictions on gatherings and shared transport. This will require strict behavioural discipline from the population along the lines of an Asian society. A not insignificant challenge for Western and particularly British society with its strong individualistic streak. All that being said we must be prepared for a second wave of the epidemic in the autumn, which if it follows the pattern of the Spanish flue could be even more severe.
What is critical for this strategy to be successful is that the government demonstrates bold and clear leadership from the PM down. They must brief the nation with a clear and honest strategy of what they are doing and why. With the population mobilised and behind the government, I believe that Britain could get back to work faster than any other EU nation. There will, very sadly, be loss and mourning. My heart goes out to those who have lost and who will lose loved ones. However, I suspect these losses will be lower over time than if we let our national economy crumble around us.
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