As we approach the end of what has felt like a pivotal week on #COVID19, here's an attempt to summarize where things stand.
It's a mixed picture - reasons for hopefulness and concern. Probably more of the latter, for now.
It's a mixed picture - reasons for hopefulness and concern. Probably more of the latter, for now.
China is no longer the main driver of global spread. More cases are emerging outside China than inside it.
And as @WHO's sitrep shows, most new cases outside China are either local transmission (green) or sourced to a non-China country (purple).
who.int/docs/default-s…
And as @WHO's sitrep shows, most new cases outside China are either local transmission (green) or sourced to a non-China country (purple).
who.int/docs/default-s…
This is now in so many countries, and transmitting locally, that fully extinguishing or containing it is unlikely. That means the ballgame globally is instead about mitigation: limiting the speed and burden of local transmission, rather than expecting to fully end it.
There is reason for hopefulness on that front. Since so many people in my mentions these days are screaming "we're all gonna die", let's start there.
You're *not* all gonna die. We are not in Kent Brockman territory.
You're *not* all gonna die. We are not in Kent Brockman territory.
We have now seen the disease play out across several different countries, w/ several different containment approaches. Where transmission has been held in check (Singapore) or dramatically reduced (China), the common thread is use of disciplined, rigorous public health measures.
China did this very heavy-handedly: they shut down huge swathes of their economy and locked down half a billion people. There are massive ethical and practical problems that would prevent replicating this elsewhere. China's ability to do this is unique.
But despite the numerous valid ethical objections to their approach, have to acknowledge that as an outbreak control measure, it delivered.
The flipside of this is that it was hugely, hugely disruptive - economically, socially, huge impact on other health risks, etc.
The flipside of this is that it was hugely, hugely disruptive - economically, socially, huge impact on other health risks, etc.
Perhaps more instructive is the case of Singapore. One of the first countries to be seeded outside of China, it has managed to keep its outbreak in check. It is spreading, but not aggressively.
Unlike China, Singapore is not locking down its whole citizenry; but it is conducting tight surveillance, sophisticated contact tracing, and vigorously enforced quarantine measures at individual level. Applying an incredibly disciplined approach. bbc.com/news/world-asi…
So China and Singapore strongly suggest that consistent, disciplined application of public health principles can do much to curtail the spread of this virus. That in turn can limit the burden the disease poses to health systems, and in turn keep mortality down. A virtuous cycle.
However, that is not easy. Rigorous measures depend on a compliant public. And the disease is unforgiving; breakdowns can compound quickly into much greater crisis. It's a very fine line between keeping spread in check, and an out-of-control situation like Wuhan in late January.
So the good news is: China and Singapore show that there are paths to successful mitigation of explosive transmission.
Now the concerning news: many countries will have extreme difficulty replicating this.
Now the concerning news: many countries will have extreme difficulty replicating this.
Global mitigation relies on every country that is experiencing cases being able to apply the level of rigor, unity of effort, and discipline that China and Singapore have.
That's....unlikely. As the outbreak in Iran shows.
That's....unlikely. As the outbreak in Iran shows.
So what we're up against is that this virus will "hold up the mirror" to the health security readiness of every country it reaches. Many will not like what they see.
The greatest risks will be in the developing world, where health systems and surveillance are weakest. Nigeria just announced its first confirmed case today. Few under-developed countries have the kind of robust public health capacity and resources that Singapore has.
This is a picture of outbreak readiness around the world. No one is in great shape (including the US), but Africa and the rest of the developing world are in particularly bad shape. ghsindex.org
And there is a risk, in those countries, that mortality could be considerably higher than in China. About 5% of cases are critical, and require sophisticated equipment and expertise (esp ventilators) to treat. Fewer critical cases will survive in poor countries than did in China.
We are in for a long hard slog. Little likelihood of vaccine availability at scale for 18+ months. Our best hope is to apply rigorous public health controls and protect frontline personnel across as many countries as possible to keep transmission down while we await a vaccine.
In the meantime, the disease will continue spreading and reaching new countries. Those that have difficulty mitigating it will continue to pose risks of re-seeding outbreaks even in countries that have proved more successful. The human toll in the poorest places may be large.
What does this mean for the US, and how might we expect the US government and health system to deal with the level of rigor and discipline this will require?
More on that tomorrow.
More on that tomorrow.
