International COVID-19 Megathread

[CumbrianLefty]

The issue with the ‘circuit breaker’ concept is, in the absence of a vaccine or some other deus ex machina like mass testing, herd immunity or the virus ‘losing potency’, the case level will immediately begin to creep back up again once these restrictions are lifted, meaning we could be back where we are now in December.

This *may* be happening if the reduced numbers of deaths pro rata are any guide.

(though that will also be improved treatments to an extent)

The problem is, as with so much else, its only possible to be really sure about this in hindsight.

[Silent Hunter]

Also, much as the governments of this world are to blame, there's quite a few idiotic people out there. See how the Bolton spike was caused.

[CumbrianLefty]

Sure, some people are dicks. That will be the case everywhere.

[Knives]

Speaking as someone in Stage 4 Melbourne lockdown, I am horrified by the inaction across Europe. This moves so quickly and you guys barely seem to be moving at all.

[Former President tack50]

The issue with the ‘circuit breaker’ concept is, in the absence of a vaccine or some other deus ex machina like mass testing, herd immunity or the virus ‘losing potency’, the case level will immediately begin to creep back up again once these restrictions are lifted, meaning we could be back where we are now in December.

You could argue that we already had the deus ex machina event of the virus losing potency, as while infections seem to be back on the same level as March, deaths have not followed that and are still rather low (even if they have increased)

[Mike88]

Speaking as someone in Stage 4 Melbourne lockdown, I am horrified by the inaction across Europe. This moves so quickly and you guys barely seem to be moving at all.

In Portugal, the media is already saying Portugal is following the Swedish approach. Costa himself said, yesterday, that he refuses a second lockdown because the economic and social consequences of the first one were "brutal". He added that cases could surpass 1,000 per day after next week but that people need to be responsible.

[Silent Hunter]

The economic and social consequences of the first one were brutal. So we need to avoid any more.

[Knives]

I don't understand how you can say the consequences are so bad when we don't even know the long term effects of this virus on someone that survives.

[Silent Hunter]

Sorry, I'll clarify.

The lockdown in the UK led to a rise in alcohol abuse and domestic violence, along with delays in cancer treatments. The increases in unemployment will have their own impacts on public health; poor people are generally not healthy people. Elsewhere, we've had 25 years of development progress wiped out and hundreds of millions facing starvation.

We need to take the necessary measures to contain this virus so we don't have to resort to the nuclear option. Because it won't just be people dying from the virus as a result.

[Samof94]

I have seen Peru get hit very hard by the Covid virus, even worse than Brazil when scaled for size. Latin America seems even harder hit than most of the rest of the world with exceptions like India or South Africa.

[Silent Hunter]

It's the middle-income countries that are getting it the worst. Rich enough to have obesity problems, but too poor to have totally effective healthcare systems.

[CumbrianLefty]

Hancock: any second UK-wide lockdown is the fault of you, the voters - not us.

I can totally see this ending well

[Silent Hunter]

While the government has its own considerable share of blame for all this (and that isn't helping with compliance), people do have to fulfil their side of the social contract.

Like most problems in society, it's the minority who cause problems for the rest of us.

Also, if we impose a 10pm curfew on pubs, can we keep it? That will do wonders for our NHS.

[Alcibiades]

Neil Ferguson appears to be making the media rounds again, suggesting a second lockdown. Not to sound like a Covid-denialist, but I think there are legitimate reasons to be cautious of his projections, and for the gov’t to not almost exclusively rely upon his advice as they did in March. He has not got a great track record, modelling that 65,000 Brits would die from swine flue (when only 500 did), and has been making some distortions about the Swedish model (of which there are legitimate criticisms to be made, just not the seemingly hyperdefensive ones he has been making). Finally, his background is in theoretical physics, and very mathematical models of infectious diseases are inherently limited by these diseases’ erratic and unpredictable behaviour, while many epidemiologists with more medical backgrounds are more optimistic than him.

Not intended to be a character assassination on him, and the gov’t should still listen to his input, but perhaps diversify their advice a little.

[palandio]

[...]
Finally, his background is in theoretical physics, and very mathematical models of infectious diseases are inherently limited by these diseases’ erratic and unpredictable behaviour, while many epidemiologists with more medical backgrounds are more optimistic than him.

Not intended to be a character assassination on him, and the gov’t should still listen to his input, but perhaps diversify their advice a little.

In my opinion there are many great mathematical (often probabilistic) models that can help to explain certain aspects of an epidemic.

The problem is that there are so many factors which can be relevant and not enough data to really calibrate something like a Grand Unified Model. And something like that would be needed to e.g. predict how many people would die under which policy.

It's interesting that among the pro-lockdown epidemiologists cited in German media there is a disproportionate part of theoretical physicists, too (Michael Meyer-Hermann, Viola Priesemann, Matthias Schneider, etc.). When reading interviews and publications, my impression is that they confound their simplicistic models with reality and fail to account for obvious objections (inhomogeneous exposure, re-imported cases, cross-immunity, etc.). And based on their results they try to give political advice.

[CumbrianLefty]

While the government has its own considerable share of blame for all this (and that isn't helping with compliance), people do have to fulfil their side of the social contract.

Like most problems in society, it's the minority who cause problems for the rest of us.

Also, if we impose a 10pm curfew on pubs, can we keep it? That will do wonders for our NHS.

Sure, but as I said you get a minority behaving stupidly in all countries. That doesn't alter the fact some governments have undoubtedly handled this crisis better than our own - not least because their messaging has often been less vague and contradictory.

[Alcibiades]

[...]
Finally, his background is in theoretical physics, and very mathematical models of infectious diseases are inherently limited by these diseases’ erratic and unpredictable behaviour, while many epidemiologists with more medical backgrounds are more optimistic than him.

Not intended to be a character assassination on him, and the gov’t should still listen to his input, but perhaps diversify their advice a little.

In my opinion there are many great mathematical (often probabilistic) models that can help to explain certain aspects of an epidemic.

The problem is that there are so many factors which can be relevant and not enough data to really calibrate something like a Grand Unified Model. And something like that would be needed to e.g. predict how many people would die under which policy.

It's interesting that among the pro-lockdown epidemiologists cited in German media there is a disproportionate part of theoretical physicists, too (Michael Meyer-Hermann, Viola Priesemann, Matthias Schneider, etc.). When reading interviews and publications, my impression is that they confound their simplicistic models with reality and fail to account for obvious objections (inhomogeneous exposure, re-imported cases, cross-immunity, etc.). And based on their results they try to give political advice.

Yes. This reminds me of a quote I saw, something along the lines of “all models are inaccurate, but some are helpful.” I do wonder if these theoretical physicists-turned-infectious disease modellers, while undoubtedly very quantitatively gifted, appreciate how statistics and data are treated very differently in the social sciences than the hard sciences.

[Silent Hunter]

While the government has its own considerable share of blame for all this (and that isn't helping with compliance), people do have to fulfil their side of the social contract.

Like most problems in society, it's the minority who cause problems for the rest of us.

Also, if we impose a 10pm curfew on pubs, can we keep it? That will do wonders for our NHS.

Sure, but as I said you get a minority behaving stupidly in all countries. That doesn't alter the fact some governments have undoubtedly handled this crisis better than our own - not least because their messaging has often been less vague and contradictory.

Indeed. That contradictory messaging is arguably damaging compliance too. If people get told they can't go to each other's houses, but they can go to the pub, then it's something very hard to explain to the public at large.

"Hands, face, space" actually makes some degree of sense. Better than "control the virus".

Also, the "Protect the NHS" message isn't resonating because many of us can just look at the government's own statistics, see that hospital patient numbers are broadly flat, then conclude there isn't a problem.

Thirdly, when do people listen to politicians in general?

[Filuwaúrdjan]

One important difference between the Spring outbreaks and whatever we're heading into now is that, of course, corticosteroids will be routinely used to treat patients whose covid has progressed into pneumonia: many lives will be thus saved.

Anyway, I mention this not just because threads like this can become very unhealthy very quickly - everyone talking themselves and everyone else into a black depressive spiral - but to make a little analogy. Steroids are very effective as a treatment for many illness on their first use: remarkably effective, practically miracle drugs, actually. But they get a little less so on the second dose. And the third. In fact the more you use them, the less effective they are. After a certain point, the impact of the side-effects becomes more pronounced than any remaining benefit from the drug.

My suspicion is that this is likely to be prove to be true of 'lockdowns' and similar measures. Actually what evidence we have from recent 'local' (which are often actually regional) lockdowns strongly suggests this. Part of the issue is simply that it is a huge thing to ask of people. They have already made massive sacrifices - nearly everyone here, at least, did during the Great Lockdown; including people who are normally feckless wastrels - and there is a limit to what people can be reasonably expected to take. Especially when governments have so patently and repeatedly erred. Everyone has a breaking point: it is forgotten now, because it suits no one to remember this, but a majority of striking miners in '84/85 went back to work before the formal surrender. Their families were starving.

[urutzizu]

New restrictions in France



In Marseille and Guadeloupe:

-Total closure of the hospitality sector from Saturday.
-Closure of all establishments open to the public except those with a strict health protocol (such as Shops or Museums).

Major Urban areas including Bordeaux, Lyon, Toulouse, Nice, Saint-Etienne, Rennes, Montpellier, Lille, Paris and inner suburban departments, Rouen and Grenoble:

-Ban on gatherings of more than 10 people in public spaces.
-Hospitality Curfew from 10 pm
-Closure of sports areas and gymnasiums.
-Teleworking mandatory wherever possible

France was trying to emulate the Swedish strategy in regards to the second wave. Since the Summer the French government has been one of the most vocal in Europe in ruling out a return to confinement measures and learning to live with the Virus, even Friday two weeks ago, when the situation had already gotten quite bad, Castex and Macron unexpectedly rejected a tightening of restrictions. Now the worsening situation in the hospitals and ICU's has forced their hand. The problem ends up being, that at the end of the day the French were probably a bit too French for the Swedish model. Government strategy can only do so much, it would seem that it is difficult to emulate the Swedish model without the corresponding traits in the population. Certain quite tangible restrictions are in my view likely necessary permanently in most European Countries until a vaccine is found.
Another conclusion from the situation in France (and Spain) is the the effectiveness of mandating Masks in open spaces is probably zero, if not counterproductive. I am happy that we haven't (yet) fallen to that particular kind of political actionism. 

[palandio]

Another conclusion from the situation in France (and Spain) is the the effectiveness of mandating Masks in open spaces is probably zero, if not counterproductive. I am happy that we haven't (yet) fallen to that particular kind of political actionism. 

The city of Munich has actually mandated masks in the pedestrian area in the city center, including the main pedestrian routes between Marienplatz, central station, Sendlinger Tor, Odeonsplatz and Isartor and popular places like the Viktualienmarkt and the alleys around the cathedral.

Additionally alcohol consumption is forbidden in four busy spots (Gärtnerplatz, Baldeplatz, Wedekindplatz, Gerner Brücke) and the Isar meadows between Wittelsbacherbrücke and Reichenbacherbrücke. The sale of alcohol for takeaway is forbidden in buffer zones around these spots which include basically all of Munich's most popular nightlife districts (Isarvorstadt, Au, Alt-Schwabing).

Earlier plans for a city-wide alcohol ban (in public spaces outside of restaurants) were struck down by the courts.

To me this sounds very much like political actionism. Gathering outside is not as safe as not gathering at all, but it is far less dangerous than gathering inside. But a major problem is that outside other people will see these gatherings and feel irritated.

[CumbrianLefty]

There really isn't much evidence masks *outside* make much of a difference at all.

[President Johnson]

There really isn't much evidence masks *outside* make much of a difference at all.

Yes, I think this is more symbolic, though it may help somewhat in more crowded space (though crwods should generally be avoided).

Still, most infections take place in private gatherings and not in public such as transportation. At least data from Germany is indicating that.

[Tender Branson]

Austrian scientists have developed a drug that successfully cures Coronavirus without the need of vaccination:

Privately-held Austrian biotech APEIRON Biologics has announced that first, encouraging data with its clinical drug candidate APN01 (rhsACE2) to treat severe COVID-19 has been published in The Lancet Respiratory Medicine.

The case report describes the first treatment of a person suffering from severe COVID-19 with APN01 in named patient use. The data published show the expected observations of an adaptive immune response, a rapid loss of virus load and reduction in inflammatory mediators, and the development of high titers of neutralizing antibodies against SARS-CoV-2 leading to a significant clinical improvement of the patient treated.

'Blocks and protects'

Josef Penninger, co-inventor of APN01, founder of APEIRON and co-author of the publication, said: “Providing first data on the effect of blocking the viral spike glycoprotein in patients with COVID-19 is of paramount importance. The data confirm the mode of action of APN01 specifically targeting the SARS-CoV-2 virus.

“Our findings from the first SARS epidemic and recent research have identified ACE2 as the entry door for both corona viruses, SARS-CoV and SARS-CoV-2, to infect human cells. The new data further support the ability of APN01 to locking the door for the virus. Importantly, in contrast to basically all other drug candidates, APN01 has a dual action – it blocks the virus and can protect the lung, blood vessels or the heart from injury via its enzyme function. The compassionate use findings provide essential data that this important enzyme function of APN01 is preserved in treated COVID-19 patients.”

Hopes for accelerated approval

Peter Llewellyn-Davies, chief executive of APEIRON, said: “We are delighted our drug candidate APN01 may have helped this patient to overcome the life-threatening disease and are confident to confirm these positive results in our ongoing and progressing pivotal clinical Phase II trial. The further scientific validation by this renowned journal encourages us in our efforts to providing an efficacious therapy against COVID-19 for the benefit of patients and society.”

It is possible that, if the current Phase II study is positive, accelerated market approval could be granted.

The company-sponsored Phase II study is ongoing in Austria, Germany, Denmark, UK, and Russia and is expected to be expanded to the USA. The double-blind, randomized, placebo-controlled study aims to treat 200 patients with severe COVID-19 disease.

https://www.imba.oeaw.ac.at/research-highlights/case-study-confirms-effect-of-ace2-drug-candidate-against-covid-19/

[Alcibiades]

Austrian scientists have developed a drug that successfully cures Coronavirus without the need of vaccination:

Privately-held Austrian biotech APEIRON Biologics has announced that first, encouraging data with its clinical drug candidate APN01 (rhsACE2) to treat severe COVID-19 has been published in The Lancet Respiratory Medicine.

The case report describes the first treatment of a person suffering from severe COVID-19 with APN01 in named patient use. The data published show the expected observations of an adaptive immune response, a rapid loss of virus load and reduction in inflammatory mediators, and the development of high titers of neutralizing antibodies against SARS-CoV-2 leading to a significant clinical improvement of the patient treated.

'Blocks and protects'

Josef Penninger, co-inventor of APN01, founder of APEIRON and co-author of the publication, said: “Providing first data on the effect of blocking the viral spike glycoprotein in patients with COVID-19 is of paramount importance. The data confirm the mode of action of APN01 specifically targeting the SARS-CoV-2 virus.

“Our findings from the first SARS epidemic and recent research have identified ACE2 as the entry door for both corona viruses, SARS-CoV and SARS-CoV-2, to infect human cells. The new data further support the ability of APN01 to locking the door for the virus. Importantly, in contrast to basically all other drug candidates, APN01 has a dual action – it blocks the virus and can protect the lung, blood vessels or the heart from injury via its enzyme function. The compassionate use findings provide essential data that this important enzyme function of APN01 is preserved in treated COVID-19 patients.”

Hopes for accelerated approval

Peter Llewellyn-Davies, chief executive of APEIRON, said: “We are delighted our drug candidate APN01 may have helped this patient to overcome the life-threatening disease and are confident to confirm these positive results in our ongoing and progressing pivotal clinical Phase II trial. The further scientific validation by this renowned journal encourages us in our efforts to providing an efficacious therapy against COVID-19 for the benefit of patients and society.”

It is possible that, if the current Phase II study is positive, accelerated market approval could be granted.

The company-sponsored Phase II study is ongoing in Austria, Germany, Denmark, UK, and Russia and is expected to be expanded to the USA. The double-blind, randomized, placebo-controlled study aims to treat 200 patients with severe COVID-19 disease.

https://www.imba.oeaw.ac.at/research-highlights/case-study-confirms-effect-of-ace2-drug-candidate-against-covid-19/

Interesting, most of the focus has been on a vaccine so far rather than a highly effective treatment. A vaccine will still probably be needed to end the pandemic, but a drug like this would also go a long way in helping. If it continues to be successful in trials, do you know when it might get approval?