Scenarios for ending lockdown and how this will impact on those with CLL

[AussieNeil]

In encouraging news for the world, New Zealand and Australia have done so well bringing the spread of the SARS-Cov-2, coronavirus under control, with very few cases now being detected, (less than 100 new cases in Australia in the past week), both countries are now working out how to best relax the stringent controls implemented to achieve this and restart their economies. Likewise some USA states are going through the same process. medpagetoday.com/infectious... We will be taking the risk of finding out the best scenario for bringing this pandemic under control so that the world can safely get back to living as usual.

Unfortunately, our CLL community will remain vulnerable until the communities where we live have established herd immunity - which requires about 60% of the community to have immunity to SARS-Cov-2. We don't know yet if that can be achieved, either by people recovering from infection or an effective vaccine - anticipated to be around a year or more away. We know that the actual infection rate is considerably higher than initially anticipated, due to the considerable percentage of people who do not develop symptoms. Less certain is whether these people infect others, due to their presumably lower viral load. So for us, social distancing will remain a way of life for a while longer.

Now we’re in lockdown, how can we get out? 4 scenarios to prevent a second wave

theconversation.com/now-wer...

An affiliation of leading Australian research universities invites the Australian government to choose between two contrasting but related strategies: “elimination” of COVID-19, and a “controlled adaptation strategy”.

theconversation.com/new-roa...

Protecting lives and livelihoods: the data on why New Zealand should relax its coronavirus lockdown(The New Zealand lockdown is expected to end this week)

theconversation.com/protect...

Coronavirus weekly: leaders should heed experts and inspire the public to fight COVID-1

theconversation.com/coronav...

Hopefully, we will be able to emerge from this pandemic without country wide lock downs to prevent second and third waves, but this will rely on us having reliable means of tracking outbreaks and ensuring those infected go into voluntary isolation and those that they may have infected, tested. We also need fast and accurate testing! (An Australian philanthropic billionaire Andrew Forrest, has secured 10 million tests for our nation, trebling our detection capability).

This article looks at the success of 6 countries in driving the reproduction number Reff below 1.0. (An Reff of less than 1 means each infected person spreads the virus to less than one other person, on average. By keeping Reff below 1, the number of new infections will fall and the virus will ultimately disappear from the community.) theconversation.com/6-count...

Whereas this article examines the value gained from comparing the results achieved in differing lockdown strategies. theguardian.com/world/2020/...

Importantly, the lifting and reinstating of restrictions will need to be customised for each country.

Some countries are looking at implementing contact tracking via a Bluetooth exchange between our mobile phones. Nearly 3 million Australians have already already downloaded our COVIDSafe tracking app, which is fairly impressive, considering our total population of 25 million!

The coronavirus contact tracing app won’t log your location, but it will reveal who you hang out with theconversation.com/the-cor...

Google and Apple have teamed up for contact tracing COVID-19 app

This app should hit Android and iOS stores in May

abcnews.go.com/Health/googl...

France is also working on a COVID-19 contact app, as are Stanford University in the USA, with many others on the way. These apps work by recording a code of all close range contacts which remains private until you are diagnosed with a COVID-19 infection. Only then is the data used to enable those with whom you have been in close contact to be contacted, warning them of their possible exposure.

This article covers the technology and privacy considerations

nytimes.com/2020/04/29/busi...

We can also analyse our sewage to prevent hotspots from occurring!

Flushing is our next weapon against COVID-19, if you’re happy to have your sewage scrutinised

theconversation.com/flushin...

Researchers have detected genetic traces of the coronavirus in the wastewater in the Bay Area in California and in Massachusetts, as well as in European cities including Rome, Paris and Amsterdam. Netherlands researchers found covid-19 in Amersfoort's wastewater before any cases were reported in that city through testing.

washingtonpost.com/world/20...

For those interested in how close their country is to achieving the conditions for releasing restrictions, I've found this site to provide a very useful portrayal of country status. The plots for Italy, USA, UK, Canada, Australia, New Zealand towards the end, show how dramatically Australia and New Zealand have flattened the curve, giving all of us hope!

nrg.cs.ucl.ac.uk/mjh/covid19/

This is an unlocked post: healthunlocked.com/cllsuppo...

Neil

[Ernest2]

Thanks for that Neil.

I think this kind of thing is the kind of way to get things under control, but it will take another leap of imagination to get people to install. Australians are great at fixing stuff, so I will genuinely watch with interest.

We really ought to know better by now how long SARS-Cov-2 lasts on surfaces. I'm thinking we also need indirect contact tracing, so every supermarket, bar, restaurant, tube train etc. etc. needs to have a smartphone running some version of the app installed at the entrances.

Reading a bit more about these apps I see there are two methods. Google and Apple provide developers facilities for apps where the contact data is stored on the phones. Australia uses that model I think. UK and France however reject that model and plan to entirely develop their own method where data is stored to a cloud (so no doubt gov can use the data). I think a survey to see which method people might sign up to could be useful. Better the blind method with high sign up?

Of course stuck at home as CLLers it will correctly warn us about the neighbours, and deliveries.

I am thinking about our post ladies and gentlemen, and delivery drivers. They may be spending a lot of time off work, or wearing the full respirator kit . . .

Keep on thinking for ways out of it. I guess it will take a combination of ideas including the smartphone one.

Best wishes to all,

Ernest

[Sepsur]

👍

[Sushibruno]

Wow lots of great info, thanks Neil, and again thank you for that beautiful pic. Nature makes me so happy.

[Ghounds]

Thank you Neil for yet another thorough, detailed and well researched post. Interesting article about sewage analysis, don't think we do this in the UK.

[BSMI]

Thanks for all that info Neil. I’m in Australia and also starting to feel a bit confident.

I’ve also found the site below to be a good summary by country. Just scroll down a bit to the table and click at the top of each column to make it ascend/descend.

worldometers.info/coronavir...

The “deaths per million population” might be the most important statistic. The variances are huge, with Spain at 519 and New Zealand at 4.

Interesting that although Singapore has such bad Reff figures it has still managed to keep deaths per million to 2.

Hopefully not about to take another hit.

[morepork]

ANZACs go!

[pati23]

Great info Neil, and all in one place,

thanks

Pat

[bennevisplace]

Excellent post Neil, thanks.

The 6-state review of Covid transmission rates over time (Reff curves) is very interesting, and a persuasive comparison of different strategies and outcomes. I do wonder how accurate the figures are though. I assume the curves are based on official case numbers, which depart from reality to a different extent in different countries.

One big question for any post-lockdown phase is how many unreported cases were there (I have seen an estimate of 50 to 85 times the number recorded). Answering this question would be some kind of guide to how the virus might spread once there's renewed physical interaction between people. So governments contemplating how they are going to unlock should first undertake antibody test progams in the general population (here in the UK only front-line workers and over 65s can even apply to be tested). What say you?

[AussieNeil Partner Administrator in reply to bennevisplace]

As I've said before, timely and accurate testing will be needed. It will also need to be comprehensive. Most current antibody tests have not been validated and some are no doubt giving false positives from other coronavirus infections.

Neil

[bennevisplace in reply to AussieNeil]

Good news on this front.

1. It's been a long time coming, but there is now an antibody test that meets govt spec.

independent.co.uk/news/heal...

2. On radio 4 this morning I heard that both Imperial College and Oxford University are starting epidemiology studies of Covid19 prevalence in the UK population. They are sending out test kits to randomly selected households and hope to be able to have results in a couple of weeks - now seen to be essential input to the unlocking strategy.

I wonder if other countries are doing, or have done, likewise?