We know that many journalists and decision-makers (“crisis units”, 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 of quoting us.
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Doctor Guillaume Zagury, based in Shanghai and specialist in international public health and “health innovations”, comments on a daily basis the evolution of the epidemic for more than 2 months, and gives us a preview of the elements of understanding on its “country analysis” and the foreseeable consequences (experiences of SARS in 2003 and Covid in China for 3 months).
A. “CovExit”: to get ready now, in order to not suffer
1. We run a marathon, not a 100-metre race
To decree a deconfinement, 2 conditions are necessary, in order to avoid a second wave of covid-19 patients:
1. Epidemiological indicators simultaneously green (epidemiological peak, entries / exits balance for intensive care beds, level of population immunity,…)
2. Good preparation for the prevention of a second wave risk: masks, large-scale tests, etc.
Table: regional intensive care / death indicators
Chart: national hospitalization / intensive care / death indicators
We have not yet mastered certain elements, which can still be game-changing:
– the current level of natural immunity of the different populations exposed (we have some data in China, but they require confirmation),
– therapeutic solutions (drug solution) and vaccine immunity (incompressible time, the first results probably cannot occur before early 2021).
If the confinement is planned for another period of approximately 3 weeks(about approximately 50 days in total), it still seems unlikely that the date will be held.Let’s note that the inhabitants of Wuhan (& Hubei) had the courage to live a “strict” confinement of 76 days that ended only yesterday (permission to leave the province).
We must learn to live with the virus: mask, tests, digital monitoring,etc.
2. Anticipate rather than suffer: be proactive for the D-Day
From one country to another, methods differ to anticipate the risk of a second wave, depending on the epidemiological state and the tools available.
Thus Germany, which has substantial preventive elements (a large number of daily tests, more than 20.000 intensive care beds, …) will be more likely to deconfinate faster than France and therefore to a speedy economic recovery (what we are seeing now in China)
3. Deconfinement with a 360° and simultaneous system approach: the CovExit © tool
This tool is characterized by taking into account the most precise elements necessary for deconfinement: focus on populations at risk of mortality, serological tests (immunity), digitalization of processes for the population, etc.
Our standards have been developed by our international reading committee. They make it possible to follow the probable “D-Day” of each country both at national and regional level.
Our current assessment indicates that France “can do better”. Let us be sure that our leaders of the ministry of health get on with the job, the implementation being often delayed by the administrative burden, used to operating in peacetime with decision-making processes ill-suited to the current emergency.
We suggest two levels of appreciation:
1. overall by country for the strategic aspect and
2. local / regional for the operational and practical aspect.
4. Dashboard
We offer a total of four dashboards to gain height, and help our decision-makers.
4.1. National CovidScore ©
The national Covidscore ©gives a global vision of the situation in terms of preventive and curative care, in order to handle the initial viral wave.
4.2 Regional CovidScore ©(ARS level)
It covers the operational aspect which shall surely be taken up by decision makers.
4.3 Country CovExit
See the detailed presentation of this table above. It allows us to assess the positioning of France and see how we can make suggestions on Asian experiences to adapt or even improve it in our country.
4.4 Local/regional CovExit ©
It makes it possible to anticipate the decisions of containment which will be given at the local / regional level, by stages (like in China, the only country for the moment to have started a deconfinement after a general containment).
We will quickly propose a “region” table (aimed at ARS: regional health agencies), integrating important prevalence data for decision-making: percentage of intensive care beds occupied as the best indicator of the absorption of cases by the health system (remember that the numbers of positive cases and deaths are too subject to measurement bias).
5. In these turbulent times in Western Europe, a positive element seems to emerge, compared to the Asian countries
By mastering the prevention strategy, Asia has certainly prevented its spread (96% of cases and deaths in China have remained concentrated in Hubei, neighboring countries have been very little affected), but East Asia has not yet acquired collective immunity. In other words, the fire is out, but the embers remain …
As Europe has been “submerged” by the speed of the epidemic (due to the weakness of our protective dike: 3M, tests, …) and our confinement was later, the spread of the virus is much more consistent in Western Europe (there are 10 “Wuhan”). As a result, we should have developed better collective immunity
B. Pathology: fundamentals and communication
1. At the epidemiological level: temperature / humidity and coronavirus (hypothesis raised since February 11)
The other two coronaviruses (causing SARS in 2003 and endemic MERS in the Middle East) showed temperature sensitivity: disappearance of SARS in China with the arrival of spring and endemic MERS in the Middle East (host animal : camel).
Some “tropical” countries seem to be epidemiologically less affected (Thailand, Malaysia, Australia, etc.), but there are many measurement biases, notably the availability of tests, which prevent any categorical conclusion.
Research is continuing and I will inform you of any contributory publication.
2. Two observations on hospital care
Note the lower incidence of myocardial infarction cases since confinement (which promises good studies on the evolution of different pathologies): probably less cortisolemic rushes (the hourly peak of myocardial infarction is early in the morning).
Let’s note also the interest of CIPAP (mechanical system which allows to double the oxygen concentration necessary to stabilize the patient) in emergencies during acute inflammatory phase: this would give a therapeutic chance to the elderly and also avoid certain intubations in younger patients. There are tutorials on the technique (see Henri Mondor Hospital in Créteil).
3. In the absence of a pharmacological solution, prevention remains the most effective weapon
We offer (with my colleague and friend Hugues Lefort) a memo for caregivers which may be useful to the greatest number (do not hesitate to spread it):
French version :
English version :
Also note the memo from my colleague and friend Denis Boutry, below.
Collective care measures of Covid “3 T” :
– Test : have substantial amounts of rapid diagnostic tests
– Triage (sort) : the positive cases must be isolated – while in France many are those who stay at home, in Asia or in Spain they are referred to specific structures (hospitals, hotels, …).
– Tracking : a key element to the Korean success (based, among other things, on digital monitoring)
With these 2 memos (4 M and 3 T), you already have a good vision of the measures to be taken against the pathology. These memos will no doubt be part of the 2021 edition of my recent book published in February, “Medi-Memo-Minute” (www.medicilline.com)
C. “Geopathology”: France D23 and the world – Still in the epidemic phase
Analysis with the contribution of Dr Bachir Athmani and Stéphane, companions from the start.
All the information is already present in the media, so I give you 5 summary points.
1. Worldwide prevalence : 80% of currently active cases identified are in the Occident
As there are large measurement biases (e.g. Africa), this information is indicative of trends (same level of measurement over time for a given area).
4 billion people are currently confined in the world.
Geographic vision (source: John Hopkins University)
Vision by continent
Prevalence by country
2. Global incidence: 84,000 new cases
Geographical location: 80% in the Occident
By country: America at the same level as Europe
USA 33k (+6k)
UK 4k (-0k)
France 11k (+6k)
Spain 5k (-0k)
Italy 3k (-1k)
Germany 4k (+1k)
Turkey 4k (+1k)
Iran 2k (-0k)
India, Russia, Brazil, Canada, Netherlands, Belgium, Switzerland : 1k
3. Extremely questionable figures
The case definition is made with geometry too variable from one country to another, with measurement biases and therefore a major under-declaration :
– many forms with few or no symptom: in some countries, especially in the Occident (and particularly in France), these cases will not be counted, whereas they are in other countries, notably Asian countries.
– under test equipment: 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 reflect reality very partially.
4. France: stabilization of the number of new cases in intensive care and decrease in Italy (but let’s remain cautious)
Comparative evolution France-Italy
Regional figures
5. Viral diplomacy
China is believed to have suggested to the UN (United Nations) the city of Xi’an to host important headquarters meetings, because New York is in chaotic situation!
It is obvious that in the short term, the Chinese thanks to their image (“we solved the problem in 3 months”) and especially their factories of medical goods (masks, disposable gowns, …) will take advantage from a commercial (what an abuse to sell masks 5 to 10 times the price of 2019!) and diplomatic point of view.
But everything can be seen for the medium term, because the immunity of the population would a priori be much lower than in the Occident.
To be continued…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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