The wretched virus has stolen our conversation, so I decided to run with it and post some new material here in ‘salon’ style.
1. Can you catch the coronavirus twice?
The answer is that we don’t know yet, according to the New Scientist.
Coronavirus is a broad spectrum virus that includes the flu and the common cold. With some viruses there is a short immunity period of a few months. With Covid 19 there have been anecdotal reports of a man and a woman in Japan and some reports from China. However, the tests may have been faulty.
- Early signs from small animal experiments are reassuring. A team from the Chinese Academy of Medical Sciences in Beijing exposed four rhesus macaques to the virus. A week later, all four were ill with covid-19-like symptoms and had high virus loads. Two weeks later, the macaques had recovered and were confirmed to have antibodies to the virus in their bloodstream.
The researchers then tried to reinfect two of them but failed, which suggests the animals were immune.
Some virologists are confident that infection confers lifetime immunity, but the truth is that we don’t know for sure.
2. Why finding the true source is important
There were 400 markets like that on in Wuhan. According to Donna Lu in the New Scientist Chinese scientists think some infected humans working at Wuhan’s Huanan Seafood Market in December may have caught the virus elsewhere. The South China Morning Post reports on Chinese government documents that suggested the earliest case of covid-19 may have been a 55-year-old person from Hubei province who seems to have contracted the virus on 17 November, much earlier than the first that was noticed on 8 December.
- A study of six children who contracted the covid-19 virus identified a girl who developed symptoms on 2 January (NEJM, doi.org/ggpxpr). She and her family live in Yangxin, more than 150 kilometres from Wuhan. None of them had travelled outside the county for a month before she became ill, and the researchers weren’t able to identify how she became infected.
They say that the virus probably came from bats, but not directly. Rather it was amplified in larger animals and may have jumped to humans more than once. Unfortunately most samples from the Huanan Seafood Market have been destroyed.
Richard Kock at the Royal Veterinary College in London says:
identifying the source of the outbreak is crucial, given that three coronaviruses – the SARS, MERS and covid-19 viruses – have all emerged since 2002. “In evolutionary terms, that’s in microseconds,” he says. “The risk of these things happening has enormously accelerated. We have to get a grip on that.”
Knowing more about the event that led to the covid-19 virus spreading to humans could help us figure out how to stop it from happening again…
There are more where that one came from, and the next one may be worse.
The Chinese were actually on virus watch. Next time they may handle it better.
BTW scientists are certain the virus is not a human construct which escaped from the lab.
3. The importance of messaging
Anne Leadbeater told Linda Mottram last week Get the messaging right or trust is lost and people won’t act. It’s actually pretty simple:
- you tell people what you know, you share with them what you don’t know, you explain what you are doing and then you tell them what you need them to do.
Let’s take that slowly
1. you tell people what you know,
2. you share with them what you don’t know,
3. you explain what you are doing and
4. then you tell them what you need them to do.
Clearly and unequivocally.
4. Bill Bowtell is cranky
Bowtell is an adjunct professor at the Kirby Institute for infection and immunity at the University of New South Wales. He was the architect of Australia’s world-leading response to the AIDS epidemic several decades ago. More recently, he worked for 15 years with the Global Fund to Fight AIDS, Tuberculosis and Malaria. He knows a bit about the insidious way diseases spread.
That was from Mike Seccombe’s article in The Saturday Paper published on 21 March – What Morrison did wrong on coronavirus. It’s worth the sub to read the whole thing.
Nick Eversham and Graham Readfearn have done an overview of what happened. This chart comes from the university of Melbourne:
Bowtell’s big point is that Scott Morrison and Greg Hunt should have acted on January 23. When Mike Seccombe contacted him, Bowtell let fly:
- “Let’s cut to the chase,” he fires down the phone line, before even being asked a question. “They were warned 12 weeks ago by WHO [the World Health Organization] and others what was coming. They did not accumulate test kits. They did not accumulate the necessary emergency equipment. They did not undertake a public education campaign. They gave no money to science, no money to research, no money to the International Vaccine Institute, no money to WHO. They diligently did not do anything useful.”
We put in place some travel bans, especially people coming from China, but mostly too late, and ignoring the US and Europe too long.
- “We were out there thumping our chests and putting people on Christmas Island, but we should have at the same time been saying, ‘Okay, what are the scenarios from here? Can we order some ICU machines? What else will we need?’
“And we should have been paying more heed to what was happening elsewhere in the world.”
Meanwhile we should have followed:
- China, South Korea, Japan, Taiwan, Hong Kong – that responded early and decisively and have succeeded in flattening the curve of infections, if not stopping the spread of Covid-19 almost completely. We should have been emulating them, says Bowtell, but instead Australia’s response to the plague has been more akin to Europe and America.
Then on February 27 Morrison, Hunt and the deputy chief medical officer, Paul Kelly, held a media conference to announce the government was activating a coronavirus emergency response plan.
- Between them the three men said the word “plan” 32 times, but in reality it was more like a blueprint for bureaucratic consultation. There were no concrete actions mentioned. None of the three men uttered the words hygiene, handwashing or social distancing.
That was when it was still OK to go to the footy, have Chinese meals etc.
Friday March 13 saw the government start to get a bit serious, but that weekend was a train wreck in communication, as Dr Murphy shook hands with everyone at the ABC’s Insiders, and Scotty first said he would, then said he wouldn’t go to the footy.
You can see why Bowtell was worried by March 21.
The article says the Australia has a strong health system, but it has been getting weaker since 2013 (when Tony Abbott was elected):
- OECD data shows us well down the list on the number of hospital beds: 3.8 per 1000 population. That is about the same as Norway, a little ahead of Italy and Spain, but way behind Japan and Korea, which have nearly four times as many. Even China has more.
Between 2012-13 and 2016-17, according to the Australian Institute of Health and Welfare (AIHW), funding for public hospitals rose by an inflation-adjusted 1.8 per cent on average each year, while private hospital funding went up 2.9 per cent.
That’s while Australia’s population grew at more than 1.5 per cent annually and the number of Australians over 65 increased at roughly twice the rate of the working-age people. Public hospitalisations are increasing three times as fast as extra beds are appearing.
We are doing as little as we can get away with in most public expenditure areas, and I believe Morrison and company have carried the same philosophy into countering the virus.
5. Where is the modelling?
On Thursday I heard Bill Bowtell interviewed. He was pleased that the curve seemed to be flattening at last, but said that we were not maximising our potential to come out of the clampdown. He would like to have a crack at developing some alternatives, if he could see what they were basing their policies on.
During the same afternoon Greg Hunt said that the modelling had been released weeks ago, and printed on the front page of the paper of the journalist who was asking.
The next day Phillip Coorey in the AFR seems to have found it:
According to modelling Morrison released on March 15, the six-month strategy does include forecasts of up to 4 million people contracting the virus by October, the vast majority of whom will be sick but emerge OK and immune on the other side.
By flattening the curve, the serious cases should be able to access the hospital beds.
Either way, by October 1, there will still be people out of work, a lot of businesses will never re-emerge, and there will still be a risk of people falling ill.
That can’t be right, as 4 million works out to over 22,000 new cases per day. There is no way the medical system could cope.
Today the AFR said that new cases in Qld, NSW and Victoria were all at between 4 and 5%. Hunt said yesterday, that the current trend was good, but not yet good enough, with Morrison emphasising that government actions had prevented about 3,000 cases.
I’m cynical enough to think that the current communication policy will allow the government to claim success, whatever happens. The latest is that modelling will be released next week, but I hope it is more helpful than modelling that recently came out of the ANU which suggested that the number of deaths would be somewhere between 2,500 and 50,000.
If you agree with Bowtell’s assessment of our response, then it points to negligence having caused thousands of avoidable cases and even deaths.
6. Claims about testing
Hunt has recently been boasting that Australia has been testing more than every other country, having tested 1000 in every 100,000 of the population.
In straight language, that is 1% and not enough to support his claim that we have a really good handle on the disease. It implies that Iceland, where everyone was tested, and Germany, which has exceeded 1% and are currently aiming at 500,000 per week, are not countries.
Germany is attempting to test contacts; to date in Australia you mostly had to have two risk indicators to be eligible for a test.
Queensland authorities have said that some contact tracing has involved finding 300 people.
We will need much enhanced testing, tracing, and isolating regimes if life is going to go back to anything like normal. Even then, oldies will have to be isolated until a vaccine is found.
Morrison keeps saying he has to worry about the economy. Raina MacIntyre’s focus is clearly on the health system, as in the recent Four Corners:
- We’re going to have healthcare workers facing the brunt of this in the health system, and they’re going to be forced to work either without PPE, or with inadequate PPE. They’re going to be infected, they’re going to die. Like they are in Italy and like they’re getting infected in the United States. It would take a generation to replace healthcare workers, they’re not like, you know, drugs and vaccines that we can just crank up the production and get some more. We can’t afford to take a soft approach or a gently gently approach because we have to ensure that our healthcare workers are not in that situation as they are in Italy or Spain. In Spain doctors are weeping, because they have to take the ventilator out of patients to give it to other people who are younger, you know, because those patients are too old and they’re getting infected. They’re treating their own colleagues. They’re seeing their own colleagues dying, we really should be doing everything we can to make sure we don’t get to that point.
She has said that our medical A team are at risk. It takes generations to build that kind of team, apart from compassion for the individuals.
Yet frankly the dilemma does not seem to weigh so heavily on our leaders shoulders. We could trust them more if they told us what they know, what they don’t know, and exactly what they are trying to achieve.
Vietnam has shown that you can fight COVID-19 despite being a third-world country.
One reason is that not being particularly democratic, and they still own much of the health infrastructure, hence can make decisions easily, which do seem to be accepted by the population. Phillip Adams discussion with Satyajit Das was gold, but he made the point that important societal infrastructure should be in government hands, and that the Chinese had this advantage.
BTW there has been a disinformation campaign suggesting that Chinese figures are fake. Dr Murphy said he thought the Chinese were being transparent, but then he said that the only stats he trusted were ours. The ABC typically dropped the first bit. Richard Mcgregor from the Lowy institute said the Chinese figures were like their GDP figures. Produced with astonishing rapidity, but then only revised later a point or two and reliable in showing the trend. He said there is no way Xi’s minders would have allowed him to visit Wuhan if they were covering up large number of deaths in the area.