We know that many journalists and decision-makers (“crisis cells”, ministries, …) read this analysis “served at breakfast”, and we are delighted. We simply ask you, when you use our ideas or illustrations, to have the elementary COURTESY to QUOTE us.
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Doctor Guillaume Zagury, based in Shanghai and specialist in international public health and “health innovation”, comments on a daily basis the evolution of the epidemic for more than 2 months, and gives a preview of the elements of understanding on his “Country analysis” and foreseeable consequences (experiences of SARS in 2003 and of Covid-19 in China).
A whole remarkable multidisciplinary volunteer team allows this factual and objective analysis to be carried out (by the way don’t hesitate to join us): “all success is collective”. Our new site will be launched at the beginning of the week and you will be able to put faces on the names.
In terms of form, we decided to evolve like the initial version, towards more visuals (less blah) in order to save you time (“Less is More”).
A. Chloroquine the point: not enough to make it a new “Affaire Dreyfus”
1. The current issue: active or natural immunity is not for the coming quarter:
– Natural (“collective”) immunity: need to have more than 50% (order of magnitude) of the population covered. However, according to the first studies, this rate is much lower than 15% even in countries with high prevalence
– The vaccine will not be available before January 2021
2. “Living with”: with 2 constraints, requiring a compromise with variable geometry according to cultures (history,…):
– Health vision (WHO) “all safe”: maintain long confinement
– Economic vision (White House): economic health (therefore mental) takes precedence over organic health in the specific context of Covid (neither Ebola, nor Hiv)
3. Hope that could reconcile these two antagonisms: the arrival of rapid treatment
– Among all the current trials, only one molecule is currently released (pending interleukins or other drug strategies): chloroquine
4. Its effectiveness is currently being discussed and we are awaiting official Chinese results by the end of the month, because otherwise it is the classic “expert against expert” debate: 3 objective elements for its interest
– It is a drug known for more than 50 years and therefore no longer need to carry out long marketing studies (animal toxicity, humans, …)
– The Chinese are the most experienced / Covid treatment (more than 3 months) and they have the advantage of the volume effect: we know that they use it for Covid cases, even asymptomatic (recent case followed in Shanghai)
– A recent Chinese study on patients treated with chloroquine for another pathology (in this case lupus) shows a lower prevalence of cases / control population
– Let’s quickly do a retrospective study (this goes quickly and is inexpensive) in Europe on our Lupus patients on chloroquine treatment (it’s not the majority but we can find some!), And compare them to a control group (age , gender,…).
5. Another element that could avoid this trade-off between health and the economy: the impact of the climate (spring)
– Can the temperature (a priori less incidence in the South East of China) and the humidity play (as for the Sars in 2003)? To follow (important for the African continent and the Indian subcontinent.
B. France D22: “Living with”
1. France follows the same dynamic as Italy: not a peak but a plateau
– France is 5 days early in its decline compared to Italy (to follow)
2. Resuscitation: 3 consecutive days of decline
– On a national level
– Our resuscitation beds are always 75% occupied (7000/9000)
– At the regional level: calm but remain vigilant (because the number of hospitalizations has not decreased)
3. Decrease in daily deaths in all regions:
– Note that 1/3 of the deaths occur in the EPHAD
4. But the new hospitalized cases are always around 2,800 / day (with a heterogeneous difference by region: IDF still under tension)
5. Special CovidMinute / Significant decrease in certain pathologies in the emergency room:
5 – 1 Vascular pathologies: Infarction & stroke (250 / day usually)
Two hypotheses:
1- patients at risk are already hospitalized because of the Covid (these are the same types of profiles: ages, etc.)
2- these patients are at home without being taken care of (Inserm has noted an increase in deaths at home more than before)
To be continued…
5 – 2 Public Road Accident: 160 young people spared in March
. As we pointed out in February in Hubei with the significant drop in AVP and accidents at work (many in China).
. 160 fewer victims (/ 2019) on the roads (i.e. a 40% decrease). Especially since they are young people (pedestrians, 2 wheels, etc.) for the most part.
6. Miscellaneous: 50 CDG cases (last stop M1 at Brest)
Case of the CDG ship with 50 cases out of 1760 sailors, i.e. 3%: 3 remarks
. Lack of means to identify Covid + cases: indeed we will only test clinically suspect cases (a priori for lack of tests!) And therefore all asymptomatic carriers will contaminate their neighbors.
.. Given the Princess Diamond experience (16% of passengers infected), in my opinion, it could be that more than 280 cases appear within 10 days.
.. Last stopover a month ago in Brest: epidemiological investigation to detect the initial case.
C. World: more than 100,000 deaths in 3 months and more than 1.2 million active cases
With the contribution of Mathieu Bouquet and Stéphane, companions from the start, whom I thank again for their unfailing support.
1. Pay attention to the numbers: extremely questionable!
The definition of the cases is made with geometry which is too variable from one country to another, with measurement biases and therefore a major under-declaration:
– many forms with little or no symptom: in some countries, especially in the West (and particularly in France), these cases will not be counted, whereas they are in other countries, notably Asian.
– under-equipment in tests: Italy, which has only used 1 million tests so far, will use 2.5 million this week. Africa, among others, has only a few positive cases, but probably mainly due to a lack of tests.
Predictive models are therefore to be taken with caution, as they are based on estimates that only very partially reflect reality.
Similarly, there are many biases in terms of “macabre accounting”: declaration (hospital and extra-hospital mortality in France, versus hospital mortality in Italy), or measurement (biological tests performed or not post-mortem, filling in certificates with the initial or secondary cause, etc.).
In our view, only certain relatively objective data such as the number of Covid patients in intensive care are relevant parameters to follow.
Note that in China there were 52 new cases in Shanghai yesterday, including 51 who arrived from Russia in the same plane …
2. Prevalence: 1.26 million active cases confirmed under observation
Geographical distribution
Source : John Hopkins University
Top 10 countries: The United States leads both in terms of current cases, cumulative, and mortality. Note that New York alone represents ⅓ of the American cases.
United States 481k (475 yesterday)
Italy 100k (98 yesterday)
France 89k (87)
Spain 87k
United Kingdom 69k (65)
Germany 65k
Turkey 48k
Iran 24k
Netherlands 22k
Brazil 20k
By continent: 81% of cases diagnosed in the West
3. Incidence: 78 k new cases diagnosed (96 k yesterday) and an epidemic wave that still sweeps west
Incidence: 78,000 new cases detected yesterday
Graph: evolution of the number of new daily cases
By country: note that the number of cases diagnosed is an indicator to be taken with caution (thus the Americans launch massive campaigns of screening tests and therefore display figures in proportion much higher than many European countries which have only very few tests).
United States 28k (-4k)
Spain 5k (+ 0k)
United Kingdom 5k (-4k)
France 5k (-2k)
Italy 5k (+ 1k)
Turkey 5k (+ 0k)
Germany 3k (-1k)
Iran 2k (-0k)
Brazil, Canada, Russia, Netherlands, Belgium, 1 to 2k
By continent: 3 households – United States, Europe and the Middle East
Graph: evolution of the number of new cases by country (beware of measurement bias: see USA massive tests)
4. Decontainment ”D.Day” soon possible for certain countries: Austria, Switzerland, Germany …
5. Resuscitation beds occupied, mortality (more objective indicators): comparative evolution in space and time
6. Evolutionary tables for the followers of the figures
Evolution of the incidence in the 11 most affected areas
Virus Preventions 4 W’s:
Wear a mask, Wash your hands, Watch out for sick people, Wait for new updates from covidminute.com !
Protect yourselves, and above all protect the most vulnerable!
Dr. Guillaume ZAGURY,
Specialist in Public Health and Health Innovations
Consultant at “Health Innovations”
HEC
In China for 20 years“All success is collective”, thanks to:
– the whole “Back Up” team (Mathieu Bousquet, Carole Gabay, Flavien, Marie, Laetitia, Anne-Sophie, …), without whom this project would not have been possible.
– all the “Medical” team (Dr Bachir Athmani, Dr Ibrahim Souare, Dr Taieb, Dr Viateur …) who allow this project to exist,
– all historical financial sponsors (Jerome, Benjamin Denis & B Square, Benoit Rossignol, Arnault Bricout) who work for “Citizen Actions”
If you feel like a patron or of partners to finance IT development, don’t hesitate to contact me (guillaume@covidminute.com).
Also, even if part of the team is based in Shanghai, do not hesitate to come and join us, because there is no shortage of work :-)If you want to find more analyses and infographics, follow our account at:Know the latest updates
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