A. Short and medium term strategy
Our “Coroscope” indicator assesses the measures taken in a country to reduce the risk of mortality.
This section is produced with discussions with Dr Bachir Athmani in Paris and Mathieu
Bouquet in China.
1. The 3 main lines of action of an effective short-term strategy
The response to the spread of the virus generally consists of 3 parts:
1. prevention
2. identification
3. medicalization (treatment)
Each of these 3 components is divided into several measures, which we have identified in the form of 13 main actions (lines of our table), to which we add the anticipation, preparation and reaction measures shown by the countries.
2.Table
Following the evaluation of the measures adopted, each country is given an overall rating, which changes depending on its reaction to the epidemic. We deliver to you below the first update of this evaluation started yesterday, and which will improve over time.
3. Country assessment: Asia – effectiveness of short-term measures: avoiding the destructive wave for health systems
It appears that to “extinguish the fire” (but without extinguishing the embers), the countries that have so far managed to contain the epidemic are the first historical cases:
– Mainland China (excluding Wuhan and Hubei)
– South Korea, Singapore and Hong Kong among others
This by a “360 °” approach (prevention – identification – treatment) in space and very fast in time.
It is nevertheless advisable to remain vigilant, because the embers are still there and can generate a 2nd potential wave. This is for example the fear in Hong Kong today, with the return of many Europeans. This fear will continue until the arrival of a possible vaccine (probable but not certain, as shown by disappointed hopes in the face of AIDS) intended for vulnerable populations.
4. A “second wave”?
Several elements suggest that a “second wave” is likely in Asia (and elsewhere):
– historical example of the Spanish flu (2 peaks a few months apart)
– in China, workers in different provinces return to mega-cities after the Chinese New Year
– imported cases, as has been the case for a few weeks everywhere in East Asia (around 50 cases per day in China) and which justified the sharp reduction in international flights 48 hours ago (in China, only 1 flight / company air / destination / week, and in several Asian countries, including China, closing borders to foreign citizens, including those in possession of a visa or a resident permit).
– in the medium term: most of the population has not had time to be in contact with the virus and therefore to be immunized. We do not yet have enough data on the evolution of the virus over time: disappearance (as was the case for SARS in 2003) or endemic (with seasonality or not)?
5. The French case
France (overall score of 10 out of 30 in our table, 30 corresponding to the maximum standard) is in our eyes evolving towards a more offensive strategy, and we can only welcome it, hoping that the declarations will be followed by quick effects.
A huge effort is made by the health authorities and they must be congratulated:
– masks: one billion to China (or 56 Antonov round trips) for an estimated use of 18 million units per day.
– tests: a large order in China and a request to our laboratories (human and veterinary) to advance on the development of “minute test”, that certain countries (Belgium, United States, Thailand, Vietnam) are in the process to implement.
– resuscitation beds: treatment capacity for difficult cases from 7,000 to 14,000 beds
Nevertheless, it must be understood that we are in a “state of war” and that if these orders are commendable they are extremely dependent on the outside (China in this case!) And especially on the market: on my scale, I am all days subject to requests from other countries (United States, Israel, …), and China does not have the current capacity to supply masks, tests, respirators simultaneously to the entire planet!
The deliveries announced will take place, but will be largely insufficient compared to the daily needs of the professionals and people at risk of the whole world. Yesterday, a flight transported 5.5 million masks from China to France, for a need estimated at least 15 million per day for the whole country.
B. 6 reassuring key points on pathology
1. A pathology which is certainly contagious, but relatively not very lethal
Being a carrier of the virus, even with symptoms, is far from being a condemnation!
Contagiousness is illustrated in historical cases (example of the liner “Diamond Princess”, with almost 20% of cruise passengers affected in less than 2 weeks: 621/3711) or typical (around 50% of cases in Israel concern Orthodox Jews ).
The lethality (number of deaths out of number of positive diagnoses) is probably around 2% (or even less than 1% as in Shanghai when the health system is not saturated), which brings it closer to the rate of influenza “ Spanish ”of 1918-1919, pandemic having engendered numerous victims, but 100 years before and without the current means.
For reference, the lethality of the Ebola virus (2015-2016) exceeds 50% and that of the plague (1300-1400) more than 30%.
2. In the overwhelming majority of cases, covid-19 spares children and the risk for an adult is relatively low
Children for reasons not yet well documented are certainly large potential vectors of the virus, but very rarely symptomatic, and exceptionally victims (exceptional case of the 16-year-old French girl who died within a few days when she had no medical history )
Mortality affects above all “fragile and vulnerable” populations:
- people over 75: 80% of deaths in France to date (also note that of the 12 deaths observed in Israel, all were over 60 and 8 were over 90)
- patients with risk areas: heart disease, pulmonary pathology, obesity, etc. (as shown by a recent Italian study that we published a few days ago)
If you look at the Chinese data, 1% of deaths are in adults under the age of 60. This explains a few “atypical” but mediatized cases such as, for example, doctor Li Wenliang, whistleblower from Wuhan who died at 35 years of age.
3. It is most often (80% of cases) not very symptomatic
If we refer to Chinese data, only 20% of patients should be hospitalized with the need for medical assistance (oxygen, venous route) and approximately ⅓ (i.e. 5 to 7% of positive patients) would go to intensive care (monitoring and possible ventilation assisted).
In the overwhelming majority of cases, covid-19 has little or no symptoms.
4. A disease much better known than initially
In 3 months, the disease is better and better known thanks in particular to the Chinese (first standard) and Italian examples: on the virus (genomic sequencing from the end of December 2019, biological tests, etc.), epidemiological (children spared but with potential contagiousness, proportion of cases in intensive care, …), clinical (better and better coded care).
5. Short term solutions exist … others will happen in the longer term
In the short term, solutions exist to extinguish the fire quickly, as shown by the Asian examples (see our Coroscore table: in China, in South Korea,…).
It is nevertheless advisable to remain vigilant, because the embers are still there and can generate a 2nd wave, as mentioned previously.
In the long term, since China and its neighbors cannot forever live in autarky, effective preventive therapy targeted at vulnerable populations (such as the Covid vaccine, equivalent to our influenza vaccine) should be offered.
The intelligence of the planet is put to contribution and all the laboratories are in effervescence with “global” teams 24/7: example of the project GVN (“Global Virus Network”) of Professor Robert Gallo in Baltimore, for the development of a vaccine. While remaining cautious on its development (see hopes dashed in the face of HIV), it will not be able to see the light of day until the end of 2020.
6. Lucky to be French (or European)
Social protection covering almost “from birth to grave” (to compare with the case – probably not unique – recent of an American covid-19 patient who could not access the health system due to a credit card) .
European governments immediately provided economic and social support. France plans to inject 345 billion euros, or 16% of GDP, to deal with this crisis, which is expected to last at least 1.5 months. Note that 1.5 months corresponds to 16% of the year … hence probably 16% of GDP!
European countries as a whole can also rely on a well-developed hospital capacity and dedicated and high-quality caregivers.
The French government is regaining an “offensive” dynamic, even if the measures announced (mask, tests, …) risk being implemented a little late, because for the time being too dependent on outside (China essentially!).
C. France D14 – French health service on the front line
The elements below are to be read with the reservations concerning the validity of the data (case definition, possible underestimation, etc.) already mentioned above, and keeping in mind that it is the trends that count, rather than the raw figures taken at time t.
1. Incidence: 2,599 new confirmed cases (4,611 yesterday, 3,809 the previous day) including 2,530 in hospitals
We are still in the epidemic growth phase. The drop in the number of new cases over 24 hours is not enough to indicate a slowdown in the epidemic, we should wait for the days to come.
2. Prevalence: 30,366 active cases under observation (29,500 yesterday)
On this basis alone, the doubling time increases compared to yesterday (but a trend measured over only 2 days is not significant: the trend was reversed yesterday) and is now between 7 and 8 days.
3. Trend (comparison with Italy): close trajectory
To date, France’s trajectory remains relatively close to that of Italy, with a lag of around 10 days. It seems to have diverged (favorably) over the past 24 hours, but a trend measured over 24 hours is not significant, and it will be necessary to wait for the next few days to confirm or not.
4. Health system
The Ile de France is under tension, the Grand Est is saturated, but hospitalized patients are transferred to the South (“health TGV”) and to Germany. If there is a shortage of certain equipment (being corrected following government announcements), the quality of French infrastructure and the establishment of European cooperation must be underlined, which somewhat relieves the health system.
5. Territorial distribution: always Ile de France and Grand Est
A new counting method is being implemented, with an expected significant reassessment of the number of cases following the authorities’ declarations. The figures by region will be provided in a more usable way for everyone in a few days.
D. World impact: an exponential dynamic
Thanks to Stéphane, a companion from the start, for his participation.
Of course with all the necessary reservations regarding the validity of the figures (availability of tests, validity of the data, etc.), but what is essential is the trend.
1. Incidence: 56,000 new cases diagnosed (66,000 yesterday, 62,000 the day before)
This is around 20 times the figures observed in China (around 1 / 5th of the world population) at the time of the peak in Hubei (3,000 per day).
2. Spatial vision: 90% of new cases are detected in the West (60% in Europe and 30% in the Americas)
2.1. By country
The United States and Spain remain in an exponential phase.
- United States 18,500 (stable)
- Spain 7,000 (-1)
- Italy 5,000 (-1)
- Germany 4,700 (-2)
- France, Iran and England 3,000
- Turkey Switzerland, Netherlands, Belgium: 1,000 to 2,000 approximately
Table: evolution by country
Chart: evolution by country
2.2. By continent: ⅓ new cases in the Americas
E. Prevalence worldwide – In a few days, the United States has a number of cumulative cases greater than that of China (80,000) in 2 months!
1. Figures (active cases) : 534,000
The doubling time is 5-6 days (stable).
2. Spatial vision
2.1. By country
Top 6 countries :
- United States 135,000 (18,000 yesterday): ¼ of the active cases on the planet
- Italy 74,000 (70,000 yesterday)
- Spain 59,000 (55,000)
- Germany 53,000 (49,000)
- France 31,000 (30,000)
- Iran 23,000 (21,000)
2.2. By continent
Westerners currently represent 83% of patients diagnosed!
Thanks to Mathieu Bouquet, partner from the start, for his precious help.
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
Powered byMedicilline
