After another day that felt like a month crammed into 24 hours, where are we at with #covid19? My colleague @sciencecohen and I tried to present the big picture here. A quick thread below sciencemag.org/news/2020/02/c…
@sciencecohen Call it a “pandemic” as many scientists do now. Call it “epidemics in different parts of the world” as @WHO does. The fact is: We know of several places where #SARSCoV2 is spreading rapidly and all the signs point to it spreading in some other places that we don’t know of yet.
@sciencecohen @WHO Iran is particularly worrying: regional hub, sanctions, distrust of government, pilgrimage sites, neighbouring countries with shattered health care systems. It could add up to a perfect storm. But spread in Italy and South Korea is worrying as well.
@sciencecohen @WHO But the point is not one particular place, but the basic fact that the virus is spreading in different places. As @chris0dye told me: “It looks to me like this virus really has escaped from China and is being transmitted quite widely.”
@sciencecohen @WHO @chris0dye If that is the case then stopping people at the border or suspending flights will soon become pointless. A few more cases won’t make a difference if you have spread within your country anyway. And you are paying a hefty price for it.
@sciencecohen @WHO @chris0dye Ramping down those measures won’t happen tomorrow. But it will very likely happen. And when it does it will come as a shock to many people. Communication on this should have started already.
@sciencecohen @WHO @chris0dye Delay has many advantages: Time to prepare people, train health care workers, develop countermeasures. As @mlipsitch told me: „If I had a choice of getting [COVID-19] today or getting it 6 months from now, I would definitely prefer to get it 6 months from now.“
@sciencecohen @WHO @chris0dye @mlipsitch Trying to slow the sprad locally has another advantage: It flattens the epidemic curve. Case numbers climb more slowly, the peak is lower. It spreads out the epidemic, reducing peak demand on the health care system. And overall it leads to less infections.
@sciencecohen @WHO @chris0dye @mlipsitch An analysis by @chris0dye and others concluded that suspending public transport, closing entertainment venues, and banning public gatherings were the most effective mitigation interventions in China. That can be done. (latest version of paper here: medrxiv.org/content/10.110…)
@sciencecohen @WHO @chris0dye @mlipsitch Then there are the bigger ones: locking down entire cities, cordons sanitaires, etc. Is that warranted? Is it ethical? I‘m missing a debate on this. Accepting it, will have long-term implications that are barely being taken into account so far.
@sciencecohen @WHO @chris0dye @mlipsitch .@LawrenceGostin says, measures in China were "astounding, unprecedented, and medieval”. He says he is particularly concerned about the physical and mental well-being of people in Hubei who are housebound, under intensive surveillance, and facing shortages of health services.
@sciencecohen @WHO @chris0dye @mlipsitch @LawrenceGostin How much of China’s recipe other countries want to adopt needs to be discussed. And it needs to be discussed now. And better data is needed to evaluate some measures like closing schools. “We just don’t know what role kids play” says @mlipsitch.
@sciencecohen @WHO @chris0dye @mlipsitch @LawrenceGostin As always, tons of caveats. None of this is set in stone. What role will seasonality play? What else will we find out? What interventions will come? We don’t know. But as far as I can tell, that’s where we are at now.
@sciencecohen @WHO @chris0dye @mlipsitch @LawrenceGostin Excuse any spelling mistakes. It’s late (and I need a copy editor for my tweets). Make sure you seek out other sources of information too to get a rounded picture. It’s becoming hard to track everything. And read this thread by @sciencecohen too:
