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Like I suspect a number of scientists I've been quizzed by a variety of friends and family on COVID, and its gone up recently because (a) school is back and so people can feel change around them and (b) there is a change in stats in across countries in Europe.
Here do some Q&A on this.
Q: Has the virus gone away? There are very few deaths now.
A: Sadly no. The virus stop circulating in the population because we restricted how many people on average each person meets during lockdown. This worked, but the virus is still present in the population and can come back
A: Sadly no. The virus stop circulating in the population because we restricted how many people on average each person meets during lockdown. This worked, but the virus is still present in the population and can come back
Q: Has the virus got less deadly? Or hospital treatment better?
A: The virus has not obviously got less deadly inherently. Due to excellent clinical research across the world treatment has got better; we now know of a handful of drugs which do work and a number which dont >>
A: The virus has not obviously got less deadly inherently. Due to excellent clinical research across the world treatment has got better; we now know of a handful of drugs which do work and a number which dont >>
Although the treatments are better, it is nowhere close to a "cure" - perhaps 20% to 40% fewer people are dying in hospital than early on, but not enough to fundamental change the progress of the disease
Q: The cases have gone up to the same level as April of this year, and yet deaths have not risen. Surely something has changed?
A: Yes. The main thing that has changed is most countries have far more testing capacity and they offer tests to far broader range >>
A: Yes. The main thing that has changed is most countries have far more testing capacity and they offer tests to far broader range >>
The other thing is that younger people are being less careful (older people have remained careful) so the cases and transmission are happening more in the young, in particular in France and Spain
Q: Given that it looks like we have cases and few deaths that's ok right? Why not keep on like this?
A: Frustratingly epidemics have two modes: "growing" and "shrinking". It is basically near impossible to have something "just ticking along" at a steady relatively high rate.
A: Frustratingly epidemics have two modes: "growing" and "shrinking". It is basically near impossible to have something "just ticking along" at a steady relatively high rate.
Q: OK. Can't we just let the young people get it, and then they will all be immune
A: Although the rate is higher in the young it is still in the 1 in 1,000 or so (say in France) - there is plenty further it can get to and at some point it will likely go into the older population
A: Although the rate is higher in the young it is still in the 1 in 1,000 or so (say in France) - there is plenty further it can get to and at some point it will likely go into the older population
To make a segregation work to be confident that you just let rip in one part of the population without infecting another part you really have to have basically no contact - anywhere, any context, any shop, any school, any hospital and any family. It's basically unfeasible.
Q: What about just letting everyone have it at some controlled rate now? Isn't this what Sweden is doing?
A: Just letting the virus circulate will mean somewhere around 0.5% (perhaps a little lower) of people dying and many more people having a debilitating disease >>
A: Just letting the virus circulate will mean somewhere around 0.5% (perhaps a little lower) of people dying and many more people having a debilitating disease >>
If we did this at the virus' natural rate it would mean the health systems would have to become dedicated to palliative care for many months as well as just a large number of people dying. >>
Sweden's strategy is more nuanced than the headlines make out elsewhere. There was early on a higher acceptance of natural progression of the virus, but in many ways Sweden has ended up in a similar place to much of Europe - low viral transmission due to behavioural changes
Q: So - should I get worried about my friend in Madrid? Or Lyon? Or Sevilla? Other places in Europe?
A: If they are young, likely not. If they are old... then location matters. Spain has strong growth of cases and hospitalisation rates have climbed, in particular in Madrid >>
A: If they are young, likely not. If they are old... then location matters. Spain has strong growth of cases and hospitalisation rates have climbed, in particular in Madrid >>
France the cases have climbed but the hospitalisations have just nudged up. Belgium had a mini 2nd wave outbreak which they tamed by reintroducing local lockdowns and more mask wearing.
Q: Will schools going back increase transmission?
A: We don't know. What we do know is that schools going back is also a big shift in contact patterns post holidays - people moving around, more workplace visits, different visits by different people. It is not just about schools.
A: We don't know. What we do know is that schools going back is also a big shift in contact patterns post holidays - people moving around, more workplace visits, different visits by different people. It is not just about schools.
Q: Is there any risk to my children?
A: It is low, and it was low in the holidays when your children were somewhere else (likely ... having ice creams, visiting seaside cafes etc). Children need education and peers - they will be happier and safe in schools.
A: It is low, and it was low in the holidays when your children were somewhere else (likely ... having ice creams, visiting seaside cafes etc). Children need education and peers - they will be happier and safe in schools.
Q: Why are people so concerned about schools reopening?
A: Partly I think it is the unknown and genuine concern, I think unfounded, for risk to children. Partly it is the risk for the staff (though the evidence is thin that teaching staff are more at risk); however >>
A: Partly I think it is the unknown and genuine concern, I think unfounded, for risk to children. Partly it is the risk for the staff (though the evidence is thin that teaching staff are more at risk); however >>
The main concern though is that schools and universities going back means lots of potential new and more contact patterns - basically, teenagers + young adults going to pubs and clubs, adults going work place + pubs. More contacts, more at risky locations
Q: So we shouldn't go to pubs? Or clubs?
A: Beer gardens / outside seem fine. Inside - keep the windows open, wash everything obsessively and get back outside. Personally I think it's just best not to go to clubs.
A: Beer gardens / outside seem fine. Inside - keep the windows open, wash everything obsessively and get back outside. Personally I think it's just best not to go to clubs.
Q: This is not going to work well when it is raining
A: Agreed
A: Agreed
Q: So - is there a plan?
A: Broadly yes, though one does have to piece it together. The main plan in most European countries, UK included, is have enough control of viral transmission until there is a good enough vaccine for the at risk (elderly) population.
A: Broadly yes, though one does have to piece it together. The main plan in most European countries, UK included, is have enough control of viral transmission until there is a good enough vaccine for the at risk (elderly) population.
The development of vaccines have gone far far faster than anyone expected (I have been on a Phase II/III trial for the Oxford vaccine since the summer); more vaccines are being made and at a faster rate than ever expected.
There are now consistent noises of readouts for the vaccine results later this autumn (some partly politically driven in a slightly depressing way) but some vaccines probably will have reasonable data then. BUT >>
even if the vaccines are "good enough" they still have to be made at scale and distributed. This means we've got to navigate at least the autumn and start of winter *without* a vaccine, and might have to do it until spring/early summer 2021.
Q: That sounds depressing. Can we do this?
A: We don't know but a number of countries have consistently kept transmission pretty low - South Korea, Germany and Japan are 3 examples. Two things seem to be important >>
A: We don't know but a number of countries have consistently kept transmission pretty low - South Korea, Germany and Japan are 3 examples. Two things seem to be important >>
1. Testing. One needs to be able to test a lot and test quickly.
2. Contact tracing, in particular back to sites of high risk infection.
Most European countries have now some mixture of both of these. We need these working at the highest level to keep the infection under control
2. Contact tracing, in particular back to sites of high risk infection.
Most European countries have now some mixture of both of these. We need these working at the highest level to keep the infection under control
Q: If Germany, Japan and South Korea can do it, why can't all countries?
A: They probably all can - it is just really far hard to operationalise and organise. Tweeting these things - easy. Doing them - far far harder.
A: They probably all can - it is just really far hard to operationalise and organise. Tweeting these things - easy. Doing them - far far harder.
Q: Is UK / France / Spain / Italy / Germany doing this?
A: Nearly all countries have the same fundamental components in their strategy. Operationalising it is complex and improving in most places. The country I know best is the UK: testing depth has come on hugely since May >>
A: Nearly all countries have the same fundamental components in their strategy. Operationalising it is complex and improving in most places. The country I know best is the UK: testing depth has come on hugely since May >>
Track and Trace in the UK had a far bumpier summer but seems to be working at some level - still plenty of improvements that can be made. The French testing has improved alot, and track and trace is good.
The Spanish situation is made more complex to track because it is organised mainly region by region. I have to admit I find it hard to track the details, and I think even good Spanish journalists find it hard to keep track.
Q: Are there anything more we can - should - be doing?
A: A surprising thing at first glance is testing sewage to spot specific outbreaks early. This seems to work and more places are using it. This helps find outbreaks quicker. >>
A: A surprising thing at first glance is testing sewage to spot specific outbreaks early. This seems to work and more places are using it. This helps find outbreaks quicker. >>
The other thing is to take testing to the next level: More capacity, different technologies (so less single supply chain risk) and more portable formats. And from spit rather than swabs.
(Here I have to *yawn* point out that I am a long established consultant to Oxford Nanopore which makes one of the new, more portable, tests - LamPORE)
Q: So should I be worried?
A: Probably worry a little less than you are now. Organised, motivated and clever people are worried about it in most governments / health organisations in Europe and they are being held to scrutiny by organised and clever people in the press.
A: Probably worry a little less than you are now. Organised, motivated and clever people are worried about it in most governments / health organisations in Europe and they are being held to scrutiny by organised and clever people in the press.
Right now, I worry at the moment about my colleagues in Madrid, and I hope Madrid can find a path through this. I'm so impressed by the people who work in the different public health, clinical research + COVID facing research - they work their socks off everyday in my experience
Stepping back, we understand what is going on at far far better level than in March and April. Sadly we can't snap our fingers and make the virus go away, but we do understand far more of the moving parts.
Q: What can I do?
A: Follow health advice: ask for a test if you get the slightest hint of symptom; don't go to a high risk area (pub, club, karoke bar) unless you have to; wear a mask in all medium risks (shops, public transport etc); love yourself and your family
A: Follow health advice: ask for a test if you get the slightest hint of symptom; don't go to a high risk area (pub, club, karoke bar) unless you have to; wear a mask in all medium risks (shops, public transport etc); love yourself and your family
