10 million Covid cases, half a million deaths

The Covid case count has just topped ten million on Worldometer (it is currently 9.96 million at Reuters and 9.81 million at JHU but they will also pass 10 million today).

New case numbers climbed rapidly in March, levelled off, but then took off again late May and increased by 180,000 on Thursday and 194 thousand on Friday (current numbers are Saturday GMT).

This is just confirmed cases, there are likely to be many more than this.

A quarter of the cases – two and a half million – are in the United States. Numbers there had seemed to peak in April, dropped back a bit from there but have also surged again in the last week with the worst of the problem there moving to different states, where lockdowns were light or relaxed too soon.

Reuters: Florida, Arizona, Nevada hit daily highs for COVID-19 cases

Florida, Arizona and Nevada recorded daily highs for cases of COVID-19 on Saturday, highlighting the worsening spread of the virus in several southern and western states, prompting some of them to rollback their reopening plans.

The surge in cases has been most pronounced in a handful of southern and western states that reopened earlier and more aggressively, serving as a warning to the potentially illusory nature of any perceived progress in controlling the virus.

On Friday, as the United States recorded its largest daily case count of the pandemic, Dr. Anthony Fauci, the nation’s top infectious disease expert, said the government’s current strategy for finding and isolating infected people was “not working,” partly due to significant asymptomatic spread.

The number of deaths world wide is also likely to pass half a million today as well (currently 499,001).

UPDATE: deaths now 500,533

And a quarter of those deaths are in the US (128,000).

It’s not just the deaths that are causing problems – Scientists just beginning to understand the many health problems caused by COVID-19

Scientists are only starting to grasp the vast array of health problems caused by the novel coronavirus, some of which may have lingering effects on patients and health systems for years to come, according to doctors and infectious disease experts.

Besides the respiratory issues that leave patients gasping for breath, the virus that causes COVID-19 attacks many organ systems, in some cases causing catastrophic damage.

“We thought this was only a respiratory virus. Turns out, it goes after the pancreas. It goes after the heart. It goes after the liver, the brain, the kidney and other organs. We didn’t appreciate that in the beginning,” said Dr. Eric Topol, a cardiologist and director of the Scripps Research Translational Institute in La Jolla, California.

In addition to respiratory distress, patients with COVID-19 can experience blood clotting disorders that can lead to strokes, and extreme inflammation that attacks multiple organ systems. The virus can also cause neurological complications that range from headache, dizziness and loss of taste or smell to seizures and confusion.

And recovery can be slow, incomplete and costly, with a huge impact on quality of life.

The broad and diverse manifestations of COVID-19 are somewhat unique, said Dr. Sadiya Khan, a cardiologist at Northwestern Medicine in Chicago.

With influenza, people with underlying heart conditions are also at higher risk of complications, Khan said. What is surprising about this virus is the extent of the complications occurring outside the lungs.

Khan believes there will be a huge healthcare expenditure and burden for individuals who have survived COVID-19.

A lot of work is being done to try to deal with this. As world approaches 10 million coronavirus cases, doctors see hope in new treatments

Doctors say they’ve learned enough about the highly contagious virus to solve some key problems for many patients. The changes could be translating into more saved lives, although there is little conclusive data.

Nearly 30 doctors around the world, from New Orleans to London to Dubai, told Reuters they feel more prepared should cases surge again in the fall.

“​We are well-positioned for a second wave,” Patel said. “We know so much more.”

Doctors like Patel now have:

  • A clearer grasp of the disease’s side effects, like blood clotting and kidney failure
  • A better understanding of how to help patients struggling to breathe
  • More information on which drugs work for which kinds of patients.

They also have acquired new tools to aid in the battle, including:

  • Widespread testing
  • Promising new treatments like convalescent plasma, antiviral drugs and steroids
  • An evolving spate of medical research and anecdotal evidence, which doctors share across institutions, and sometimes across oceans.

Despite a steady rise in COVID-19 cases, driven to some extent by wider testing, the daily death toll from the disease is falling in some countries, including the United States. Doctors say they are more confident in caring for patients than they were in the chaotic first weeks of the pandemic, when they operated on nothing but blind instinct.

A vaccine is probably some time away from becoming widely available despite many teams of scientists working on one.

RNZ – Human trial of new vaccine begins in UK:

About 300 people will have the vaccine over the coming weeks, as part of a trial led by Prof Robin Shattock and his colleagues, at Imperial College London.

Tests in animals suggest the vaccine is safe and triggers an effective immune response.

Experts at Oxford University have already started human trials.

The trials are among many across the world – there are around 120 vaccine programmes under way.

Prof Shattock said: “We’ve been able to produce a vaccine from scratch and take it to human trials in just a few months.

“If our approach works and the vaccine provides effective protection against disease, it could revolutionise how we respond to disease outbreaks in future.”

Healthline: Here’s Exactly Where We Are with Vaccines and Treatments for COVID-19

These drugs are still being tested in clinical trials to see whether they’re effective against COVID-19. This step is needed to make sure the medications are safe for this particular use and what the proper dosage should be.

It could be months before treatments are available that are known to work against COVID-19. It could be even longer for a vaccine.

“Even though technological advances allow us to do certain things more quickly,” Lee told Healthline, “we still have to rely on social distancing, contact tracing, self-isolation, and other measures.”

And that is what we are relying on in New Zealand, with now stringent (after some hiccups) isolation and testing of people coming into the country. While the number of active cases is rising, having been on zero for a while, we have just 16 and they are all contained in quarantine, and are all new Zealand citizens or residents returning to the country.

Some semblance of normality has returned to the country, except for international travel. The borders will have too remain strictly limited and controlled probably for the rest of the year at least. Even the hoped for bubble with Australia looks to be some time away after a resurgence of cases in Victoria in particular.

Even Donald Trump seems constrained after a return to running political rallies proved to be not very popular with the population, and after a number of Covid cases hitting his organising team. And now Journalist who attended Oklahoma Trump rally tests positive for Covid-19

After a number of absurd claims about testing trump now seems to be trying to ignore Covid and belatedly divert – Trump says he is staying in Washington to protect law and order

U.S. President Donald Trump on Friday canceled a planned weekend visit to his golf resort in Bedminster, New Jersey, and said he was staying in Washington “to make sure LAW & ORDER is enforced.”

“The arsonists, anarchists, looters, and agitators have been largely stopped,” Trump wrote on Twitter. “I am doing what is necessary to keep our communities safe – and these people will be brought to Justice!”

Trump has pledged to take a hard line on anyone destroying or vandalizing historical U.S. monuments and has threatened to use force on some protesters, as activism against racial injustice sweeps the country.

What’s he going too do, personally pepper spray anyone who protests or criticises him? More diversion from the Covid crisis:

There are far more urgent health problems facing the US right now. He has done an abysmal job of leading the country worst affected by Covid and sadly for the US that doesn’t look like changing.

Trump’s decision to cancel his trip to New Jersey comes amid a spike in coronavirus cases in many states.

White House spokesman Judd Deere said the cancellation was not related to New Jersey’s requirement that visitors from states with high coronavirus infection rates self-quarantine for 14 days upon arrival.

Trump visited one of the states with high rates, Arizona, earlier this week.

Trump tweets while the country burns.

Other countries with major and growing Covid problems are Brazil, Peru, India, Russia and Mexico (which may have contracted the problem from neighbouring USA).

The pandemic is going to remain a big problem for some time to come.

 

10 million Covid cases

The Covid case count has just topped ten million on Worldometer (it is currently 9,9 million at Reuters and 9.874 million at JHU but they will also pass 10 million today).

New case numbers climbed rapidly in March, levelled off, but then took off again late May and increased by 180,000 on Thursday and 194 thousand on Friday (current numbers are Saturday GMT).

This is just confirmed cases, there are likely to be many more than this.

A quarter of the cases – two and a half million – are in the United States. Numbers there had seemed to peak in April, dropped back a bit from there but have also surged again in the last week with the worst of the problem there moving to different states, where lockdowns were light or relaxed too soon.

Reuters: Florida, Arizona, Nevada hit daily highs for COVID-19 cases

Florida, Arizona and Nevada recorded daily highs for cases of COVID-19 on Saturday, highlighting the worsening spread of the virus in several southern and western states, prompting some of them to rollback their reopening plans.

The surge in cases has been most pronounced in a handful of southern and western states that reopened earlier and more aggressively, serving as a warning to the potentially illusory nature of any perceived progress in controlling the virus.

On Friday, as the United States recorded its largest daily case count of the pandemic, Dr. Anthony Fauci, the nation’s top infectious disease expert, said the government’s current strategy for finding and isolating infected people was “not working,” partly due to significant asymptomatic spread.

The number of deaths world wide is also likely to pass half a million today as well (currently 499,001).

And a quarter of those deaths are in the US (128,000).

It’s not just the deaths that are causing problems – Scientists just beginning to understand the many health problems caused by COVID-19

Scientists are only starting to grasp the vast array of health problems caused by the novel coronavirus, some of which may have lingering effects on patients and health systems for years to come, according to doctors and infectious disease experts.

Besides the respiratory issues that leave patients gasping for breath, the virus that causes COVID-19 attacks many organ systems, in some cases causing catastrophic damage.

“We thought this was only a respiratory virus. Turns out, it goes after the pancreas. It goes after the heart. It goes after the liver, the brain, the kidney and other organs. We didn’t appreciate that in the beginning,” said Dr. Eric Topol, a cardiologist and director of the Scripps Research Translational Institute in La Jolla, California.

In addition to respiratory distress, patients with COVID-19 can experience blood clotting disorders that can lead to strokes, and extreme inflammation that attacks multiple organ systems. The virus can also cause neurological complications that range from headache, dizziness and loss of taste or smell to seizures and confusion.

And recovery can be slow, incomplete and costly, with a huge impact on quality of life.

The broad and diverse manifestations of COVID-19 are somewhat unique, said Dr. Sadiya Khan, a cardiologist at Northwestern Medicine in Chicago.

With influenza, people with underlying heart conditions are also at higher risk of complications, Khan said. What is surprising about this virus is the extent of the complications occurring outside the lungs.

Khan believes there will be a huge healthcare expenditure and burden for individuals who have survived COVID-19.

A lot of work is being done to try to deal with this. As world approaches 10 million coronavirus cases, doctors see hope in new treatments

Doctors say they’ve learned enough about the highly contagious virus to solve some key problems for many patients. The changes could be translating into more saved lives, although there is little conclusive data.

Nearly 30 doctors around the world, from New Orleans to London to Dubai, told Reuters they feel more prepared should cases surge again in the fall.

“​We are well-positioned for a second wave,” Patel said. “We know so much more.”

Doctors like Patel now have:

  • A clearer grasp of the disease’s side effects, like blood clotting and kidney failure
  • A better understanding of how to help patients struggling to breathe
  • More information on which drugs work for which kinds of patients.

They also have acquired new tools to aid in the battle, including:

  • Widespread testing
  • Promising new treatments like convalescent plasma, antiviral drugs and steroids
  • An evolving spate of medical research and anecdotal evidence, which doctors share across institutions, and sometimes across oceans.

Despite a steady rise in COVID-19 cases, driven to some extent by wider testing, the daily death toll from the disease is falling in some countries, including the United States. Doctors say they are more confident in caring for patients than they were in the chaotic first weeks of the pandemic, when they operated on nothing but blind instinct.

A vaccine is probably some time away from becoming widely available despite many teams of scientists working on one.

RNZ – Human trial of new vaccine begins in UK:

About 300 people will have the vaccine over the coming weeks, as part of a trial led by Prof Robin Shattock and his colleagues, at Imperial College London.

Tests in animals suggest the vaccine is safe and triggers an effective immune response.

Experts at Oxford University have already started human trials.

The trials are among many across the world – there are around 120 vaccine programmes under way.

Prof Shattock said: “We’ve been able to produce a vaccine from scratch and take it to human trials in just a few months.

“If our approach works and the vaccine provides effective protection against disease, it could revolutionise how we respond to disease outbreaks in future.”

Healthline: Here’s Exactly Where We Are with Vaccines and Treatments for COVID-19

These drugs are still being tested in clinical trials to see whether they’re effective against COVID-19. This step is needed to make sure the medications are safe for this particular use and what the proper dosage should be.

It could be months before treatments are available that are known to work against COVID-19. It could be even longer for a vaccine.

“Even though technological advances allow us to do certain things more quickly,” Lee told Healthline, “we still have to rely on social distancing, contact tracing, self-isolation, and other measures.”

And that is what we are relying on in New Zealand, with now stringent (after some hiccups) isolation and testing of people coming into the country. While the number of active cases is rising, having been on zero for a while, we have just 16 and they are all contained in quarantine, and are all new Zealand citizens or residents returning to the country.

Some semblance of normality has returned to the country, except for international travel. The borders will have too remain strictly limited and controlled probably for the rest of the year at least. Even the hoped for bubble with Australia looks to be some time away after a resurgence of cases in Victoria in particular.

Even Donald Trump seems constrained after a return to running political rallies proved to be not very popular with the population, and after a number of Covid cases hitting his organising team. And now Journalist who attended Oklahoma Trump rally tests positive for Covid-19

After a number of absurd claims about testing trump now seems to be trying to ignore Covid and belatedly divert – Trump says he is staying in Washington to protect law and order

U.S. President Donald Trump on Friday canceled a planned weekend visit to his golf resort in Bedminster, New Jersey, and said he was staying in Washington “to make sure LAW & ORDER is enforced.”

“The arsonists, anarchists, looters, and agitators have been largely stopped,” Trump wrote on Twitter. “I am doing what is necessary to keep our communities safe – and these people will be brought to Justice!”

Trump has pledged to take a hard line on anyone destroying or vandalizing historical U.S. monuments and has threatened to use force on some protesters, as activism against racial injustice sweeps the country.

What’s he going too do, personally pepper spray anyone who protests or criticises him? More diversion from the Covid crisis:

There are far more urgent health problems facing the US right now. He has done an abysmal job of leading the country worst affected by Covid and sadly for the US that doesn’t look like changing.

Trump’s decision to cancel his trip to New Jersey comes amid a spike in coronavirus cases in many states.

White House spokesman Judd Deere said the cancellation was not related to New Jersey’s requirement that visitors from states with high coronavirus infection rates self-quarantine for 14 days upon arrival.

Trump visited one of the states with high rates, Arizona, earlier this week.

Trump tweets while the country burns.

Other countries with major and growing Covid problems are Brazil, Peru, India, Russia and Mexico (which may have contracted the problem from neighbouring USA).

The pandemic is going to remain a big problem for some time to come.

 

The White House versus WHO

It’s not surprising to see Donald Trump blaming others for their handling of the Covid-19 pandemic, that’s what he frequently does to divert from his own problems or mistakes. He has taken a swipe at the World Health Organisation and threatened to withdraw US funding, although as is also common with him, soon after that (in the same media conference) he contradicted himself.

Financial Times: Donald Trump threatens to freeze funding for WHO

President Donald Trump threatened to freeze funding for the World Health Organization as he accused the body of withholding information about coronavirus in Wuhan and being “wrong” about the outbreak in China.

Mr Trump said the WHO had “missed the call” when it came to the early detection of the virus in Wuhan and called the organisation very “China-centric”. He also blasted WHO for what he said was criticism of his decision in January to ban flights from China to the US.

“They could have called it months earlier,” Mr Trump said at a White House press briefing on Tuesday. “They would have known and they should have done. And they probably did know, so we’ll be looking into that very carefully. And we’re going to put a hold on money sent to the WHO.”

Mr Trump said he would put a “very powerful hold” on the funding. But when pressed on whether the US should withhold funds during the pandemic, the president softened his threat — one of the many examples of the president contradicting himself during the same press conference. “I’m not saying I’m going to do it, but we’ll have a look,” Mr Trump said. “You know what, they called it wrong. And if you look back over the years . . . everything seems to be very biased toward China. It’s not right.”

Mr Trump’s criticism reignited a debate about blame for the spread of the disease, which has been contracted by 1.43m people around the world and caused 82,000 deaths, according to Johns Hopkins University. The number of US cases has soared to 399,000, with almost 13,000 fatalities.

The WHO in mid-January said there was no evidence of human-to-human transmission, even after one of its experts said the opposite. Days later, it pointed to “some limited” direct transmission among humans, as China also confirmed the first cases of human-to-human transmission.

Later in January the WHO described the virus as a global emergency, but recommended that nations keep borders open to reduce the number of people crossing borders in irregular ways that would prevent health checks. Later that day Mr Trump banned most travel from China.

Mr Trump has been criticised for not taking the virus seriously early on, and particularly for saying it would disappear “like a miracle”. Each time he has come under attack, he has touted his move to ban flights from China, and sometimes his later step to expand restrictions to travel from Europe.

“They seem to come down the side of China,” said Mr Trump, who claimed that the WHO missed the early signs despite sending a team to Wuhan. “They didn’t see what was going on in Wuhan . . . How do you not see it?”

Trump’s deputy has also waded in: Pence vows US will ask WHO ‘tough questions’ over how ‘they could have been so wrong’ about coronavirus

Vice President Mike Pence told “Hannity” Wednesday night that the U.S. will ask “tough questions” of the World Health Organization (WHO) over its handling of the coronavirus pandemic after the global health agency’s director warned President Trump and other world leaders against “politicizing” the outbreak.

“This is a president who believes in accountability, and the American taxpayers provide tens of millions of dollars to the World Health Organization. And as the president said yesterday, I suspect we will continue to do that, but that doesn’t mean that at the right time in the future we aren’t going to ask the tough questions about how the World Health Organization could have been so wrong.

“Literally at the time President Trump stood up the coronavirus task force in January and suspended all travel from China, just days before that, the World Health Organization was continuing to diminish the threat of the coronavirus and its impact in China. We’ll get to the answers of that and we’ll create accountability, just like the American people would want us to do.”

Note that this is on the president friendly “Hannity” and will be playing to an audience.

WHO deserves some criticism of their handling of the pandemic, but it would have been impossible for them to handle it perfectly.

But the president spraying around blame is likely to be more about diverting from the growing Covid problems in the US (although the worst hot spot, New York, seems to be flattening off now), where things haven’t been handled perfectly either.

There are now over 450,000 confirmed cases in the US and 16,000+ deaths (increasing by close to 2,000 a day).

Over the past week or so about a third of the world increase of cases has been in the US, and about a quarter of deaths.

It is too serious to get distracted by bitching and blaming.

But due to major restrictions on borders and social distancing and a big effort to increase testing and healthcare supplies the modeled scenarios are looking a lot less grim.

NPR: Fauci Says U.S. Coronavirus Deaths May Be ‘More Like 60,000’; Antibody Tests On Way

The U.S. is enduring a “very bad week” during the COVID-19 pandemic, Dr. Anthony Fauci says. But he also says that the American public’s embrace of physical separation and other restrictions is sharply reducing projections of the death toll from the respiratory virus.

The final toll currently “looks more like 60,000 than the 100,000 to 200,000” that U.S. officials previously estimated, Fauci said.

Even earlier warnings were of potentially millions of deaths if nothing was done to limit the spread of the virus, so 60,000 doesn’t look so bad (but is still substantial).

Channel News Asia: WHO urges global unity, defends handling of pandemic after Trump’s criticism

The World Health Organization (WHO) on Wednesday (Apr 8) pleaded for global unity in fighting the coronavirus and gave a strident defence of his agency’s handling of the pandemic, in response to US President Donald Trump’s criticism.

As the WHO prepares to mark 100 days on Thursday since it was first notified of the outbreak in China, director-general Tedros Adhanom Ghebreyesus hit back at accusations that it had been too close to Beijing.

Tedros urged the United States to join with China in combating the disease rather than indulging in a blame game, as he issued a stern defence of the WHO’s management of the pandemic.

“The United States and China should come together and fight this dangerous enemy,” Tedros told a virtual press briefing in Geneva.

“The focus of all political parties should be to save their people. Please don’t politicise this virus.

“If you want to have many more body bags – then you do it. If you don’t want many more body bags, then you refrain from politicising it.

Tedros also rejected Trump’s suggestion that the WHO was “China-centric”, saying: “We are close to every nation, we are colour-blind.”

Citing the death toll and number of infections, Tedros implored: “For God’s sake … is this not enough?”

WHO, Trump and many others are under extreme pressure trying to combat Covid. They all need to work together and cooperate as much as possible regardless of past mistakes or questionable decisions.

Covid-19 projections may be high, but measures may have helped

Modeled projections of numbers of deaths from Covid-19, even modified and moderated projections after more stringent restrictions were increasingly put in place around the world, seem a bit high at this stage, but it’s hard to know what will happen months away or in a year as ongoing bounce backs are expected as restrictions are lifted.

It may be that ‘worst case’ and even more moderate projections spurred governments and health authorities to pull out all stops (or a lot of stops) to limit the spread of the virus and to substantially ramp up health care supplies and facilities. This will have had some impact, but it’s impossible to know how much.

New Zealand seems to have got off relatively lightly. In proportion to population we have a similar case rate as Australia, but we have just one death to date, and Australia now has 48. Australia has had fairly tight restrictions but not as comprehensive as New Zealand.

A week ago US projections were for 100,000-240,000 deaths, but there is a more optimistic but undefined view now, even as the death rate increases at over a thousand a day. The current total is 12.274 which is well short of projections, but the death toll has doubled in less than a week, with 1,255 yesterday and already 1,522 1,681 1,821 1,934 so far today.

The US continues to have about a third of the daily world increase in cases, and a quarter of the daily increase in deaths.

Nearly half of the deaths have been in New York, which may be simply because the virus took hold there in a big way sooner than many other parts of the US. Despite a record number of deaths in the last day things may be plateauing in New York: New York’s Cuomo sees coronavirus plateau approaching even as daily death toll hits high

New York state, the U.S. epicenter of the coronavirus, is nearing a plateau in number of patients hospitalized, Governor Andrew Cuomo said on Tuesday, a hopeful sign even as deaths in his state and neighboring New Jersey hit single-day highs.

In addition, the U.S. surgeon general said the pandemic may kill fewer Americans than had been projected.

New York state’s death toll rose by 731 to 5,489 over the past day, Cuomo said, though he called that a “lagging indicator” illustrating past trends. He said the state was “projecting that we are reaching a plateau in the total number of hospitalizations” due to the coronavirus.

New Jersey Governor Phil Murphy said his state recorded 232 coronavirus deaths in the past day – also a new high – bringing its total death toll to 1,232.

New York state overtook Italy on Tuesday, reporting overall coronavirus cases second in the world only to Spain, according to a Reuters tally.

The tally showed New York has 138,836 reported cases compared with Italy at 135,586. Spain has the most cases at 140,510. In total, the United States has recorded 380,000 cases and 11,800 deaths.

Deaths in Italy and Spain seem to have steadied for now but both are still around 600-700 a day.

The death rate in France is climbing fast, with 833 yesterday but a surge to 1,417 so far today with their current total now over 10,000. And France’s Covid pandemic has not yet peaked, says health minister

“We are still in a worsening phase of the pandemic,” Véran told broadcaster BFM TV. He also said that the country’s lockdown would last as long as necessary.

France’s coronavirus figures on Monday showed that the rate of increase in fatalities – at almost 9,000 – sped up again after several days of slowing.

Neighbouring Belgium has also surged with 403 deaths today.

While the news focus in the UK is Boris Johnson breathing without aid in intensive care the overall picture is worsening, with 439 deaths yesterday and 786 so far today.

And there’s another study: UK will have Europe’s worst coronavirus death toll, study predicts

World-leading disease data analysts have projected that the UK will become the country worst hit by the coronavirus pandemic in Europe, accounting for more than 40% of total deaths across the continent.

The Institute for Health Metrics and Evaluation (IHME) in Seattle predicts 66,000 UK deaths from Covid-19 by August, with a peak of nearly 3,000 a day, based on a steep climb in daily deaths early in the outbreak.

The analysts also claim discussions over “herd immunity” led to a delay in the UK introducing physical distancing measures, which were brought in from 23 March in England when the coronavirus death toll stood at 54. Portugal, by comparison, had just one confirmed death when distancing measures were imposed.

But:

The newly released data is disputed by scientists whose modelling of the likely shape of the UK epidemic is relied on by the government. Prof Neil Ferguson, of Imperial College, said the IHME figures on “healthcare demand” – including hospital bed use and deaths – were twice as high as they should be.

These studies are informed guesses in a rapidly changing environment, so they will need to keep being revised.

But most news is still of significant problems. Europe toll passes 50,000 as Japan declares emergency

Europe has passed the grim milestone of 50,000 Covid-19 deaths and Japan has declared a state of emergency to curb the virus’s spread, as China declared no new fatalities for the first time since January and lifted the 11-week lockdown of Wuhan.

While Denmark and Norway announced plans to lift some of their physical distancing measures on Tuesday, the Japanese prime minister, Shinzo Abe, declared a month-long state of emergency in major population centres, including Tokyo, where the number of cases has more than doubled this week to 1,116.

While studies and projections will continue to make predictions and be contested and debated, two things are not in doubt.

Numbers of cases and numbers of deaths will continue to grow around the world.

And Covid-19 will dominate news and government actions for months at least.

It’s just a matter of how bad and for how long.


Relevant to this: Adjusted coronavirus model predicts fewer people in US will need hospitals, but 82,000 will still die by August

An influential model tracking the coronavirus pandemic in the United States now predicts that fewer people will die and fewer hospital beds will be needed compared to its estimates from last week.

As of Monday, the model predicted the virus will kill 81,766 people in the United States over the next four months, with just under 141,000 hospital beds being needed. That’s about 12,000 fewer deaths — and 121,000 fewer hospital beds — than the model estimated on Thursday.

A “massive infusion of new data” led to the adjustments, according to the model’s maker, Dr. Christopher Murray, who serves as director of the Institute for Health Metrics and Evaluation at the University of Washington School of Medicine.

But the newest version of the model underscores just how important social distancing continues to be: It assumes that those measures — such as closing schools and businesses — will continue until August, and it still predicts tens of thousands of deaths.

While the analysis has been repeatedly cited by Dr. Deborah Birx, the White House’s coronavirus response coordinator, the administration’s current guidelines only recommend social distancing through April 30.

Sir David Skegg – NZ could eliminate the virus if we “don’t go soft to soon”

Sir David Skegg, speaking at the Epidemic Response Committee again. says that New Zealand could be the only country to eliminate the Covid-19 virus, but says border restrictions and quarantining needs to be strictly enforced, and he hopes “we don’t go soft to soon”.

From Live Covid-19 updates from New Zealand and around the world on 7 April

Sir David Skegg says he agrees with Professor Michael Baker that New Zealand could be the only western country to eliminate Covid-19.

“If we can show we’re on the path to elimination, we can move out of the lockdown more quickly. Provided we are successful, life can return to something near normal.”

He says border restrictions will have to continue.

Sir David says that if border quarantining isn’t more strictly enforced, the lockdown will have to be extended. He says we need to figure out a quicker way to contact trace through phone apps before the lockdown is lifted.

Sir David says from a purely health perspective, he would suggest being in lockdown for six months, but he acknowledged it can’t be done and people’s tolerance would wear thin.

He says it’s a worrying sign that the criteria of “essential services” continues to expand.

“We talked about going early and hard, I just hope we don’t go soft to soon.”

Obviously if we are going to minimise or eliminate the virus borders will have to be strictly controlled. Ideally that should have happened before the lockdown, but the reality was there were many people needing to get out of the country, and a large number of citizens and residents who needed to return home, and it would have been logistically very difficult to impose full tests and quarantine for tends of thousands of people.

If we stop the virus spreading internally we should have restrictions reduced and businesses that can do so safely should be able to get back into action, along with employees.

A six month lockdown would likely be unacceptable to the public and would be at risk of increasing abuse of the rules. We have to find a way of reasonably safely returning to as normal as possible as soon as possible.

Possible benefits but risks promoting unproven coronavirus treatments

Normally drugs are trialed and tests are peer reviewed before allowing use by the public. There’s a good reason for this. While drugs can be relieving and life saving, they can also cause major problems with unexpected side effects, and some drugs can make some illnesses worse.

We are not in normal times as the Covid-19 virus sweeps around the world and, so far, 68,000 people have died and many more have sustained lung damage and other adverse effects.

The speed with which the virus has spread around the world – it has been out of China not much more than three months – has had scientists and laboratories  racing to develop treatments and vaccines (vaccines usually take 1-2 years to develop and test before going public).

People will inevitably self-medicate, either as a hoped for prevention, treatment or cure. But what if a very prominent person promotes an unproven drug? Do the circumstances justify ignoring well established test and certification procedures? What about for future outbreaks? Just try anything that sounds like it may help?

Tricky territory.

Donald Trump publivly promoted a drug that may or may not help treat Covid-19, and may or may not make Covid worse.

Reuters exclusive: Pressed by Trump, U.S. pushed unproven coronavirus treatment guidance

In mid-March, President Donald Trump personally pressed federal health officials to make malaria drugs available to treat the novel coronavirus, though they had been untested for COVID-19, two sources told Reuters.

Shortly afterward, the federal government published highly unusual guidance informing doctors they had the option to prescribe the drugs, with key dosing information based on unattributed anecdotes rather than peer-reviewed science.

While Trump, in a series of tweets and press comments, had made his opinions on the drugs, chloroquine and hydroxychloroquine, well known, the nature of his behind-the-scenes intervention has not been previously reported. The guidance, published by the Centers for Disease Control and Prevention, has received scant notice outside medical circles.

The episode reveals how the president’s efforts could change the nature of drug oversight, a field long governed by strict rules of science and testing. Rarely, if ever, has a U.S. president lobbied regulators and health officials to focus their efforts on specific unproven drugs.

“The president is short-circuiting the process with his gut feelings,” said Jeffrey Flier, a former dean of Harvard Medical School. “We are in an emergency and we need to rely on our government to ensure that all these potential therapies are tested in the most effective and objective way.”

I normally avoid taking any drugs – or supplements or artificial vitamins – as much as possible. When I had bad toothache (an abscess) recently I had to search the house for painkillers and took some that were past their use by date by a couple of years. When my dentist prescribed antibiotics I took the full course, but I can go for a year or two without using any pills.

If I caught some new virus or disease and there were no proven treatments, I don’t know what I would do if drugs used for other things may or may not help. I would be reluctant, because I think it would be quite a risk. Self treatment based on tweets or other online advice should be viewed with a lot of suspicion. But what if a president promotes it?

In a statement to Reuters, the White House said the president had not launched a “pressure campaign” but was taking appropriate action.

“The President’s top priority is the health and safety of the American people which is why he has brought together the federal government and private sector, including doctors, scientists, and medical researchers, for an unprecedented collaboration to expedite vaccine development,” said the statement, which did not address Reuters questions about the CDC guidance.

In the past a top priority in ensuring health and safety has been extensive testing, both for effectiveness and for side effects and adverse effects.

Online anecdotes are something I would be very cautious about using to inform my treatment.

Administration supporters say the CDC document, highlighting options, makes sense at a time of medical calamity with no proven treatment. And, they note, chloroquine and hydroxychloroquine have been prescribed for years with known risks. Any potential risk to coronavirus patients, some argue, is worth taking given the health crisis.

“In a perfect situation you would never do this,” said a public health specialist who recently left government. “But if you know what the safety downside is, and the patient is ready to try it, it’s worth a try.”

Maybe, but is it really worth the risk if you have no idea if it will work?

Apart from the possibility of adverse side effects or it being detrimental to treatment of the condition it is being used to try to treat, or the risk of addiction (there’s a good reason morphine isn’t promoted for all sorts of conditions) there’s another potential problem.

Some people may choose to self-treat with the unproven drug and think that’s all they need to do. If the drug is ineffective that may delay getting treatment that will help.

And if it’s a contagious diseases like a virus, they could spread it around while they think they are treating themselves.

In a series of conversations last month, President Trump personally instructed top officials at the Centers for Disease Control, the Food and Drug Administration and the National Institutes of Health to focus on the two drugs as potential therapies, said two sources familiar with the president’s efforts.

In seeking a medical breakthrough to the global crisis, Trump had contacted Dr. Stephen Hahn, the FDA administrator, and other top health officials, questioning whether they were moving rapidly enough to make the drugs more widely available, one source said. “He was not happy because of the bureaucracy.”

There’s another potential problem. If what Trump was pushing for does turn out to be a useful treatment, what then? What if Trump decides then to reduce the bureaucracy generally for drug testing? What if Trump promotes other drugs for other illnesses?

What if he starts to tweet about quack remedies, cancer cures, dementia preventers, skin tone improvers?

There are lot of risks with Covid-19. There are a lot more risks in making drug recommendations and availability for Covid and for other conditions unrestricted open slather. Drug companies have been found in the past to cheat normal tests to make money by getting their drugs to market.

Desperate ill and dying people can do desperate things, and can be more gullible to Internet promoted remedies.

There are a lot of risks.

Trump did not raise his voice or express anger, but did emphasize the “urgency” of fast-tracking access to the drugs, the other source said. A cascade of federal action soon followed to make the drugs more available, including the federal government’s grant of emergency authorization to supply them nationwide.

Drug authorisation by President is a dodgy development, especially drug promotion by Trump, who has a history of putting business before health of the environment (and people).

An FDA spokesperson declined to discuss any push by the president or address the CDC-issued guidance. The agency, in a statement to Reuters, said it acted appropriately when, later in March, it issued an emergency order allowing the drugs to be prescribed and distributed.

“It was determined, based on the scientific evidence available, that it is reasonable to believe that the specific drugs may be effective in treating COVID-19, and that, given there are no adequate, approved, or available alternative treatments, the known and potential benefits to treat this serious or life-threatening virus outweigh the known and potential risks,” the FDA statement said.

So will the FDA use this as a precedent and fast track more drugs and treatments? “It is reasonable to believe that the specific drugs may be effective” is a major shift from normal approval practices.

In this case what they ‘believed’ may prove to be correct and the drug may turn out to be a successful treatment.

But if bypassing normal checks and balances becomes common practice, it’s probably just a matter of time we get another thalidomide, or some adverse effect that could be worse than the benefits.

Especially if drug companies learn how to speed up their profits at the cost of safety checks.

 

Strategic shift from mitigation to suppression of Covid-19

New Zealand appears to be shifting from mitigation (“flatten the curve”) of the Covid-19 to “one of stamping it out and elimination” of the coronavirus until a vaccine is developed – “which is at least January 2021″.

From WRITTEN BRIEFING TO THE EPIDEMIC RESPONSE COMMITTEE (from John Ombler, All of Government Controller)

Standing up the national response to COVID-19

1. In the two months since the National Security System was first established in response to COVID-19 (January 27), there have been several significant and fast paced actions taken to ensure the leadership and organisation of the national response to COVID-19 is appropriately configured for the magnitude of the event. These actions have been taken to:

  • respond to the growing magnitude of the challenge that COVID-19 presents to New Zealand and New Zealanders
  • respond to a strategic shift from mitigation or “flatten the curve” approach to the current stamp it out and elimination strategy
  • broaden and deepen the national effort to increase the pace of delivery for a series of critical interventions and measures.

9. We have made a key strategic shift from a strategy of mitigation to one of stamping it out and elimination. We do not want to end up in a scenario of widespread outbreaks which would significantly overwhelm the health system, as we have seen in Italy, Spain and other countries that have experienced extensive outbreaks. Our current strategy centres around breaking the chain of community transmission through tougher public health measures, in particular intense physical distancing and travel restrictions, which are set out in Alert Level 4.

10. The strategy does incur significant economic and social disruption, but if we are successful at eliminating COVID-19 from New Zealand we will have better economic and social outcomes. Widespread outbreaks would lead to major health, economic and social impacts for New Zealand.

COVID-19 Mitigation versus suppression

  • Our strategy is focusing on keeping COVID-19 out, stamping it out and slowing it down.
  • Our aim is to prevent widespread outbreaks. Allowing widespread outbreaks (ie trajectories along the orange and blue curves (‘flattening the curve’)) will significantly overwhelm the health system.
  • The strategy centres on border restrictions, intense testing, aggressive contact tracing, and stringent self-isolation and quarantine.
  • Physical distancing will also be required to varying degrees as we continue along this path.
  • We can call this a suppression strategy.
  • Should outbreaks occur, a suppression strategy aims to reverse epidemic growth through tougher public health measures – eg by more intense physical distancing and travel restrictions.
  • The aim is to ensure that health system capacity is not exceeded through strengthening public health measures.
  • When cases fall, public health measures can be eased slightly.
  • This cycle repeats itself (refer squiggly green line).
  • However, we must still prepare for times when capacity of the health system is exceeded by having ‘surge’ options.
  • A suppression strategy does incur significant economic and social disruption. Longer periods of physical distancing, including school closures, will be required.
  • However, many lives will be saved and more people remain well so are able to operate the economy and the health care system.
  • We would need to maintain this approach until a vaccine is developed, which is at least January 2021, and/or the global pandemic has passed.
  • This approach is distinct from a mitigation strategy, which focuses on reducing the size of the peak (ie moving from the orange curve to the blue curve).

Covid-19 update – first NZ death reported

The Prime Minister and Director-General of Health are holding a joint press conference at Parliament today (PM Ardern has been having a separate one later in the afternoon).

 

Director-General of Health Ashley Bloomfield (who had his first day off for a while yesterday) case update:

First death from Covid-19 on the West Coast, a woman in her seventies. She was admitted to hospital with what was thought to be influenza they were well known to the hospital due to other health conditions. When she was initially treated staff were not fully Covid protected, so 21 staff have been put in 14 day isolation (that makes it tough on health staffing).

Dr Bloomfield says that in preparation for Covid all hospitals have stopped elective surgery and other non-urgent work so are running at about 50% capacity, so staffing levels aren’t a concern.

63 new cases in the last 24 hours (up to 9 am Sunday) – so this is a lower increase than for the lastt few days, but this doesn’t mean a general downturn. It could still rise again.

56 now recovered.

9 in hospital, 1 in ICU on a ventilator.

The combined total of cases is now 514.

Summary

As at 9.00 am, 29 March 2020
Total to date New in last 24 hours
Number of confirmed cases in New Zealand 476 60
Number of probable cases 38 3
Number of confirmed and probable cases 514 63
Number of cases in hospital 9 (28 total to date)
Number of recovered cases 56 6
Number of deaths 1

View full details of the confirmed cases.

Prime Minister Jacinda Ardern:

The first death brings home why the measures have been taken to stop the spread.

“It is critical we all stay at home to stop the spread.”

Ardern is critical of online bullying of people who have contracted Covid-19.

Some people have been flouting restrictions. This puts others at risk, and risks extending the lockdown period.

Police have launched an online form  to report breaches of home isolation at 105 Police Non-Emergency Supporting Information

(More details when they post them online)

In an emergency, always call 111.

You can now report to Police online

  • Suspected COVID-19 L4 isolation breaches
  • Businesses you suspect are breaching the essential services rule.

Before making your report, please refer to information from the Ministry of Health about self-isolation(link is external) the Government guidelines about Essential businesses(link is external).

To complete this report you will need to provide your name and email address so we can contact you if required.

Start your COVID-19 L4 breach report

Police non-emergencies

For all other Police non-emergencies that don’t need urgent Police assistance, please refer below.

Please read the information in the ‘Assistance required’ options listed below for the best way to report a non-emergency, get advice or request something – before making an online report. This will help us work though the high volume of online reports resulting from the COVID-19 Pandemic.

When making an online report please note:

  • You will need to provide a date of birth, email address and phone number to complete this report.
  • Please allow up to 10 minutes to complete this report.
  • The report cannot be saved to complete later.

 

Trump considers quarantine as Covid-19 keeps climbing in US and world

|Earlier this week President Donald Trump said he wanted business and congregations back to normal by Easter Sunday, but with Covid-19 cases and deaths climbing in the US he is now considering imposing quarantines in some areas. However the horse may have already bolted, with a lot of people movement around the country over the last couple of weeks, and new cases and deaths surging.

Cases in the US currently are 105,573 (UPDATE half an hour later 112,468), with deaths now at 1,841 and climbing by hundreds each day.

NHS medical director: if the UK were to keep the number of deaths from coronavirus below 20,000, “we will have done very well”.

On Tuesday Trump’s Easter goal in war on virus a nod to faith, business

President Donald Trump’s “beautiful” idea to reopen the U.S. economy by Easter Sunday and pack church pews that day was dreamed up during a conference call among business leaders desperate to get the country back up and running.

But his target date for easing coronavirus restrictions is another outstretched hand to a group he has long courted: evangelical Christians.

Cooped up at the White House and watching the stock market tumble, Trump had already been eager to ease federal guidelines aimed at halting the spread of a virus that had infected more than 55,000 Americans when about a dozen business leaders convened a conference call on Sunday.

His rush to get back to business as usual was questioned – Trump’s plan to reopen the economy by Easter could cause more damage in the long run, according to LinkedIn’s top US economist

However, framing America’s response as a direct trade-off between the health of its people and the health of its economy could ultimately harm both, according to LinkedIn principal economist Guy Berger.

“There’s no economy without people, so getting them healthy is the way to get the economy off the ground,” Berger told Business Insider.

“That’s why the public health measures are so important and why they’re essential, even though they’re hard in the short run, that’s the only way to really end up rebooting the economy,” he said.

Easing lockdowns and social distancing measures too early, while the virus is still spreading rapidly, could ultimately cause more people to get sick, forcing them out of the workforce and causing an even more negative impact on the economy.

The message must have got through to Trump about the risk – to health, lives and to business – of rushing back to no restrictions.

Fox News: Trump mulls coronavirus quarantine on New York, New Jersey, Connecticut

“Some people would like to see New York quarantined because it’s a hotspot — New York, New Jersey, maybe one or two other places, certain parts of Connecticut quarantined,” he said outside the White House.

“I’m thinking about that right now. We might not have to do it but there’s a possibility that sometime today we’ll do a quarantine — short term, two weeks for New York, probably New Jersey and certain parts of Connecticut.”

He said that if such a move happened, it would be primarily a restriction on residents of those states traveling to other parts of the country.

“This will be an enforceable quarantine, but hopefully we won’t need it,” he said.

The move would be a dramatic escalation of the efforts to stop the spread of the coronavirus, and comes on the back of those states essentially shuttering daily life — closing schools, businesses, leisure activities and urging residents to stay at home.

But this could be too late. Movement of people has been a problem elsewhere in the country for weeks.

Fox News: Frightening cellphone ‘heat map’ shows coronavirus’ potential spread as spring break revelers went home

Heat maps that show cellphone location data in the U.S. paint a disturbing picture of the potential spread of coronavirus as the country grapples with lockdown meaures and tries to stem the virus’ tide.

Tectonix, geospatial data visualization platform, working in partnership with location company X-Mode Social, created an alarming map that shows the impact of ignoring social distancing restrictions.

Focusing on just one group of spring break revelers on part of one beach in mid-March when they left Fort Lauderdale, Fla., it quickly becomes obvious that the thousands of people who were at the beach ended up all over the country — in the Midwest, the Northeast and other parts of the South.

That’s just one example. Contract tracing must be a nightmare.

Reuters: U.S. coronavirus cases surpass 100,000

The sum of known coronavirus U.S. cases soared well past 100,000, with more than 1,600 dead, as weary doctors and nurses coping with shortages resorted to extremes ranging from hiding scarce medical supplies to buying them on the black market.

Reuters: As virus threatens, U.S. embraces big government, for now

Whatever the motivation, in the scope of two frantic weeks, U.S. elected officials and central bankers have engineered an economic intervention unparalleled outside of wartime.

All in it would supplant perhaps 30% of gross domestic product with government spending and loans, drive the federal deficit as high as needed to make that happen, and broaden U.S. social spending in ways that just a few weeks ago Republicans and President Donald Trump were branding as “socialist.”

In the time taken to put this post together (so far) US cases jumped to 112,468 – that’s how rapidly Covid-19 is growing in the US.


BBC: Number of UK deaths rises above 1,000

The number of people to have died with the coronavirus in the UK has reached 1,019.

The latest government figures on Saturday showed there were another 260 deaths in the UK in a day, up from 759 on Friday.

There are now 17,089 confirmed cases in the UK.

The jump in deaths is the biggest day-on-day increase the UK since the outbreak began. The number of deaths is 34% higher than Friday’s figure.

NHS England Prof Stephen Powis said if the UK were to keep the number of deaths from coronavirus below 20,000, “we will have done very well”.


BBC: More than 900 deaths in a day in Italy

Italy has recorded 919 new coronavirus deaths, its highest daily figure in the outbreak so far.

It means 9,134 people have now died from the virus in the country.

Earlier World Health Organization chief Dr Tedros Adhanom Ghebreyesus said a “chronic global shortage” of protective equipment was one of the “most urgent threats” to the ability to save lives.

Italy is the worst-affected in Europe. Almost everything has been closed and people told to stay at home.

Earlier on Friday, authorities warned that restrictions were likely to be extended beyond 3 April.

That seems inevitable.

Deaths now recorded on JHU&M CRC are at 10,023, cases have jumped to 92,472 (they were 80,589 this time yesterday) so the problem is far from over in Italy.


Spain’s coronavirus death toll rose by 832 in 24 hours, bringing it to 5,690. However, the number of people recovering is also increasing, with a total of 12,285 out of over 72,000 cases

French PM: ‘Fight is just beginning’

The first 15 days in April will be “even more difficult than the 15 we have just left”, French Prime Minister Edouard Philippe has warned.

France has recorded 1,998 deaths and has been in lockdown for 10 days, a period which has now been extended until 15 April.

“I want to speak clearly to the French,” said Mr Phil

Total confirmed coronavirus cases in Africa: 3,926

South Africa has 1,170 but it is spreading across the continent.


There are improvements in places that first has major problems,

The Chinese city of Wuhan, where the virus first emerged, has partially reopened after more than two months in isolation

South Korea says it has more people who have recovered from the virus than infected.


Brazil’s Bolsonaro questions coronavirus deaths, says ‘sorry, some will die’

Following the advice of public health experts, the vast majority of the country’s 26 governors have banned non-essential commercial activities and public services to contain the outbreak in their states.

“I’m sorry, some people will die, they will die, that’s life,” Bolsonaro said in a television interview on Friday night. “You can’t stop a car factory because of traffic deaths.”

Bolsonaro said that in the state of Sao Paulo, Brazil’s economic powerhouse, the death toll seemed “too large.” Sao Paulo has the most cases and deaths so far of coronavirus in Brazil, at 1,223 cases and 68 deaths.

“We need to look at what is happening there, this cannot be a numbers game to favor political interests,” Bolsonaro said.

Earlier on Friday, Sao Paulo Governor Joao Doria, a former Bolsonaro ally who many expect to be a rival in the 2022 presidential election, accused Bolsonaro of promoting “disinformation” by launching a TV ad campaign criticizing the restrictions, featuring the slogan “#BrazilCannotStop.”

The slogan is similar to a campaign in Milan before deaths in Italy soared.

Currently 3,477 cases in Brazil with 93 deaths.

 

Successful lockdown could buy enough time for a vaccine

But that sounds like a lockdown far longer than 4 weeks, although a month could be sufficient if all measures are rigidly followed and enforced.

Te Pūnaha Matatini, the centre for research excellence that Shaun Hendy leads, studies complex systems and networks. Right now, he and the centre’s other researchers are working to predict how Covid-19’s web of infection might spread – and if it’s possible to slow it down or even stop it.

Modelling shows NZ’s lockdown could buy time for a vaccine:

Modelling done by New Zealand researchers shows the lockdown measures now in place could buy the country more than a year for a vaccine or treatment to be developed.

However, the research shows that without a vaccine or cure, cases of Covid-19 will still peak well beyond hospital capacity as soon as any lockdown ends.

The modelling, released today by Te Punaha Matatini, shows measures similar to those now in place can suppress the virus for up to 400 days but infections could spike as soon as they are gone, because the population will not have developed any herd immunity.

However, any fewer restrictions would result in a peak of at least six times hospital capacity within just a few months.

The paper compares a “suppression strategy” – a sustained period of restrictions – with a “mitigation strategy”, where controls are lifted for brief periods before being put in place again as infections rise and ICU beds fill up.

In all scenarios, the lockdown period is modelled to last significantly longer than the initial four weeks that began today.

However, one of the researchers, University of Auckland Professor Shaun Hendy, told RNZ the current lockdown could be sufficient if all measures were rigidly enforced.

“Provided the contact tracing, testing, and containment strategy works then we may be able to relax in four weeks. But we need to cut cases to just a handful.”

The researchers wrote that both strategies were “fraught with uncertainty” but suppression at least had the advantage of buying New Zealand time until a vaccine or treatment became available.

“The initial modelling the team published yesterday is stark and, frankly, terrifying”:

Left unchecked, the virus would eventually infect 89 percent of New Zealand’s population and kill up to 80,000 people in a worst-case scenario.

ICU beds would reach capacity within two months and the number of patients needing intensive care would exceed 10 times that capacity by the time the virus peaked.

“Tens of thousands of people would die, our health system would collapse and people wouldn’t be able to get proper treatment. That explains why the government’s been prepared to take such drastic steps,” Hendy says. “The worst-case scenario is a really unpalatable one.”

Even the best-case scenario is hard to swallow. It assumes restrictions similar to the lockdown now in place – but suggests that unless testing, contact tracing, and isolation cut the number of cases to just a handful, the restrictions might need to remain in place for over a year.

And if the cases can’t be stamped out under those restrictions, the eventual peak will swell well beyond hospital capacity as soon as any lockdown ends, unless a vaccine or treatment is found in the interim.

“When controls are lifted after 400 days, an outbreak occurs with a similar peak size as for an uncontrolled epidemic,” Hendy and his colleagues wrote in a paper rushed out yesterday. “In other words, these strategies can delay but not prevent the epidemic.”

The good news – if there is any – is that while strict suppression measures remain in place, fatalities should remain in the low dozens and hospital capacity wouldn’t be exceeded. That would buy New Zealand time to wait for a vaccine or a successful treatment.

A lot of guesswork but also a lot of cause for concern.