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Doctor Guillaume Zagury, based in Shanghai and specialist & consultant in international public health, comments on a daily basis the evolution of the epidemic for more than 3 months, and gives us a preview of the elements of understanding on its “country and regional analysis” and the foreseeable consequences (experiences of SARS in 2003 and Covid 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): “each success is collective”. Our new site will be launched soon and you will be able to put faces on the names.
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A. This virus highlights 4 types of countries, result of our histories and our cultures
Nevertheless, all effective strategies inevitably lead to our “CovidScore” tool.
Let’s be lucid and objective: the matrix Ok / Not Ok and T0 (surprise or not) / Tn (fast and pragmatic action / evolution)
1. Anticipation and reactivity: Asian tigers and other parts of Asia
Tiger : Taïwan, Hong Kong, Singapore
Tiger cub : Vietnam, Thaïland
The specific case of Japan: let’s see how this country (8 000 cases and 180 deaths, roughly 1% of France for a higher population and an earlier arrival of the virus!) will manage a recent resurgence of cases (350 cases /day)
Central European countries: Czech Republic, Hungary, …
2. Initial surprise, but quick action
2 countries illustrate this type: China (strict lockdown of Hubei) and South Korea (many tests to identify and isolate the outbreaks). China (around 20 times South Korea or France in terms of population) after a period of “panic” of around 2-3 weeks in Wuhan, quickly regained control.
An interesting country: Israel (10% of the French population – 8 times less deaths per inhabitant), has just introduced the compulsory wearing of mask to go outside.
Germany, Austria and some Scandinavian countries.
3. Initial anticipation then overflow
We would like to say that Russia, India, Indonesia and Africa were little affected initially, but the lack of available tests, and certain opacity of the data do not allow us (Dr Bachir Athmani, Mathieu Bouquet and our committee of reading) to seriously assess this type of situation: to be continued …
4. Low anticipation and overflow: a large part of the western countries
This evaluation can be objectively approximated on the mortality per million inhabitants or on the number of deaths per day.
Western European countries: such as France (overall score: C, can do better), which was able to react to raise its score from 9 to 16/30. However, there is still more to do and in particular to isolate asymptomatic Covid patients in hotels (I even made a video about this almost 3 weeks ago). Note that Spain and Italy have gone from an overall score of D to B.
The United Kingdom.
The United States and Brazil.
Iran.
5. Above all, do not remake the match, but stimulate and enlighten our leaders positively via our “CovidScore” tool.
It would be too easy to judge past decisions in the light of recent knowledge.
We are the fruit of our culture and time for reflection is important in Europe, while pragmatism prevails in Asia and is better accepted by the populations.
Let’s be modest, because the situation remains evolving:
– a second explosive wave in a country that reacted well initially is not impossible,
– we understand better the precautions taken by border authorities to avoid re-imported cases (see China, Hong Kong, Japan, Southeast Asian countries, …). An estimated 800,000 foreigners have visas to return to China, and are awaiting a health green light (in my opinion, it won’t be until early July).
B. Europe and France D30: the scissor effect is emerging
1. A Europe with an East West gradient observed in terms of number of diagnosed cases and mortality
Remember that if there is an economic Europe, health is managed by the States and even very often by the regions. Thus, among the Länder (regions) of Germany, the Rhineland is little affected and conversely Bavaria (proximity to Italy and France) is much more. The end of lockdown will therefore probably be heterogeneous across the Rhine.
Source : John Hopkins University
2. A 3-speed European lockdown
1. Epidemiologically ready and equipped countries (Denmark, Austria, Germany, etc.)
2. The countries which will possibly be epidemiologically ready within 1 month and may be equipped (Italy, France, Spain, etc.)
3. Country still in epidemic phase: United Kingdom
As a result, we are seeing probable dates of start of end of lockdown depending on the epidemiological situation:
– Denmark: April 15
– Spain: April 25
– Switzerland: April 26
– Germany: May 3
– France: May 11 (after the weekend of May 8!)
– Italy: May 13
3. France D30: drop in intensive care occupancy rate (around 72%) and hospitalizations linked to Covid-19 (-1.5%)
3.1. France follows the same dynamic as Italy
Italy seems to have reached not a peak but a high plateau (the occupation of intensive care beds being the least questionable indicator): 7th day in a row of decline and 75% of occupancy rate (3000/4000 ). France follows with 10 days late and a higher plateau.
3.2. At the regional level: Ile-de-France in slight decline
4. France: slight drop in hospitalizations with -513 cases out of 31 800 (i.e. -1.5%)
5. Epidemiology – Italian study just published (04/15)
This study concerns Italy, care must be taken to transpose the results to France without any other form of trial, because the national situations are not identical.
key figures to understand the epidemiological elements of end of lockdown:
5.1. Distribution of positive cases
Distribution 50-25-25: 50% (46% exactly) of the cases currently diagnosed are less than 60 years old, 25% more than 80 years old and 25% between 60 and 80 years old.
Small epidemiological difference with the historical cases of China, which has no more value at present (the population of Hubei is generally younger than the Italian population).
5.2. Mortality is 95% concentrated in people over 60
Among them, 50% were over 80 (the approximate average age of male / female death combined in France).
Only 5% of deaths occurred in people under the age of 60.
We have also included the fatality rates by age (probability of death by age), and a historical comparison which had been very important in China during February.
About 18 million French people (about 20% of the population) are considered to be at risk (because of their age or because they are affected by co-morbidity). It is on them (and their environment) that prevention must focus first.
6. High contagiousness: case of Charles de Gaulle aircraft carrier
Extreme contagiousness in “enclosed” spaces: as I announced to you at the end of last week where we estimated that more than 20% of the sailors of the aircraft carrier would be affected in week 2 (see episode of the Diamond Princess: 20% of cruise lines tested positive). In fact, the figure rises to more than a third (670/2000, including 30 hospitalized and a sailor in intensive care).
It is for this reason that some spaces must be the subject of extreme attention and a preventive attitude: Ehpad, prisons, religious gatherings, …
C. World: more than 130 000 deaths in 3 months and more than 1.4 million active cases
With the contribution of Mathieu Bouquet and Stéphane, companions from the beginning, whom I thank again for their unfailing support.
Beware of certain figures (number of cases, deaths, etc.) which are extremely questionable as they vary from one country to another (example: availability of tests), with measurement bias and therefore major under-reporting in certain countries.
1. Prevalence: 1.4 million active cases confirmed under observation
Map: worldwide distribution of active cases
Source : John Hopkins University
Top 10 countries: USA largely first in terms of active cases (more than all of Europe)
Top 10 countries
USA 564k (yesterday 546k)
Italy 105 (yesterday 104k)
France 100k (yesterday 99k)
Spain 88k (yesterday 88k)
UK 85k (yesterday 81k)
Germany 57k (yesterday 60k)
Turkey 62k (yesterday 59k)
Netherlands 25k (yesterday 24k)
Brazil 22k (yesterday 22k)
Russia 22k (yesterday 19k)
By continent: 80% of cases diagnosed in the Western countries (evenly distributed between Western Europe and USA)
2. Incidence: potential slowdown… but watch out for 3 new “emerging” outbreaks: BRI
85 000 new cases detected yesterday (watch out for measurement bias). L’épidémie semble accélérer au Brésil, en Russie et en Inde.
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 much higher proportion than many European countries which have very few tests ).
Chart: evolution of the number of new daily cases
By continent: 3 outbreaks – USA, Europe and Middle East
By country: America still in epidemic phase
By country
USA 28k (24k yesterday)
UK 5k (5k yesterday)
France 5k (7k yesterday)
Turkey 4k (4k yesterday)
Spain 4k (2k yesterday)
Russia 3k (3k yesterday)
Italy 3k (3k yesterday)
Brazil 3k
India, Iran, Peru, Canada, Belgium, Ireland, Netherlands, Germany : 1 à 2k
3. America remains the current epicenter of the epidemic
The epidemic has not been controlled and is distributed from east to west (New York: 50% of cases).
Source : Politico
We know that mortality generally follows incidence 15 days apart, so it is important to understand that as long as the epidemic spreads to the West, the number of new cases will have an impact on D + 15- 21, in terms of lethality.
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With the arrival of our new website (much more dynamic than this blog), within a few days, you will have access to all the tables of Carole Gabay (our expert in data analysis).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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