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With reference to containment and elimination and lockdown and masks: From a practical point of view, we can all see that the circulating influenza viruses change every season. Influenza virus strains seem to have a season limited virulent time span. Thus, indeed I don't think you can call that "*elimination*" of the influenza viruses, particularly as influenza vaccines don't appear to help e.g. the vulnerable elderly. https://annals.org/aim/article-abstract/2762506/effect-influenza-vaccination-elderly-hospitalization-mortality-observational-study-regression-discontinuity The pathogenic influenza viruses do seem to become non-pathogenic after the wintertime: the influenza nose swab curve shows an increased incidence rate over the wintertime. Could such a curve showing a fading of virulence also be with coronaviridae and COVID19 in particular? If expecting that it will continue to remain infectious then elimination, from a *global perspective* will not be possible? *Containment* is the remaining option, like the former Swedish chief epidemiologist Johan Giesecke suggests, to protect the vulnerable, but he says he will be “watching with interest” how Australia and New Zealand come out of lockdown. https://www.youtube.com/watch?v=H2TEOnOnHVM&feature=youtu.be&t=261 Personally I don't believe in face masks in public, instead, hopefully governments will from now on financially support people with an active infection to stay at home! Facemasks, imagine yourself working in a dusty environment with such a public facemask and when you take it off after a while and look in the mirror, your nose area will be full of dust (and viruses) anyway. @wouterhavinga On Mon, May 25, 2020 at 7:55 PM Baijayanta Mukhopadhyay < [log in to unmask]> wrote: > I think other considerations other than public health measures alone > certainly have a lot to do with the success/failure of containment > measures. > > Comparing within Canada, as David mentions, allows us to use some > easily-contrasted markers. Quebec imposed the strongest lockdown in the > country, and also had daily briefings with a very popular chief officer of > public health, not unlike British Columbia. But clearly those interventions > cannot explain everything. The initial viral load is a critical factor: > jurisdictions with few cases could manage more. Quebec's long peak might > relate to things that have nothing to do with public health leadership: it > had the earliest spring break in the country the first week of March, and > thousands and thousands of people returned from the United States and > France (the two biggest source countries for travel-related COVID-19 here) > just as those countries grappled with exploding cases. I myself returned > from a Paris that weekend that - it now seems incredible - was running > largely normally, as Italy expanded its lockdown from regional to national > on the 8th/9th. The returning asymptomatic carriers (perhaps even me) went > to see their elders in long-term care for at least a few days before those > visits ended with Quebec's lockdown, which began to to ramp up from the > 13th onwards, but by then those residents had infected the vulnerable, > low-wage, racialised workers in that sector who lived in cramped, crowded > quarters in a dense city and who often worked more than one job -- all of > which overwhelmed the province's burgeoning test-and-trace capacity. > > While there's much to be said for where things went wrong, at least some > of the outcomes point to things that went wrong decades or centuries ago, > some things that were still being figured out -- I think the lack of > masking as a practice in the West was a huge contributor. And some other > factors point to things that were down to unfortunate timing/luck: > Montrealers historically have close ties to both Paris and New York, had a > holiday just as those cities spiralled into the abyss, and unfortunately, > we're all only just resurfacing now, good leadership or not. > > -B. > > On Mon, 25 May 2020 at 13:52, Birnbaum, David <[log in to unmask]> > wrote: > >> My disagreement in this thread relates to implication in the YouTube >> video, and to occasional paragraphs throughout that use the wording "virus >> can be *eliminated*" (rather than a word like "contained"). I've >> generally agreed with all your points, Rod, and for many reasons have >> long admired the leadership of New Zealand's government. BTW, in addition >> to places like South Korea & New Zealand, the approach taken here in >> British Columbia (which wasn't a full "lockdown" order per se but is >> comprehensive, thoughtful, started early, adapted as it learned and has >> been delivered consistently via joint daily public briefings from our very >> credible Provincial Health Officer and Minister of Health) and its >> success are noteworthy but often not mentioned in these international >> discussion forums (details & data available at >> http://www.bccdc.ca/health-info/diseases-conditions/covid-19). Our >> experience here contrasts sharply with that of Quebec and Ontario in >> Canada, and of course with the United States immediately to our south, >> which all took different approaches than British Columbia. >> >> >> Regards, >> >> David >> >> ------------------------------- >> >> David Birnbaum, PhD, MPH >> >> Adjunct Professor >> >> School of Population and Public Health >> >> University of British Columbia >> >> Principal >> >> Applied Epidemiology >> >> British Columbia, Canada >> >> >> ------------------------------ >> *From:* Evidence based health (EBH) <[log in to unmask]> >> on behalf of David Richard Leslie Cawthorpe <[log in to unmask]> >> *Sent:* Sunday, May 24, 2020 7:51 PM >> *To:* [log in to unmask] >> *Subject:* Re: Where did COVID19 cases go? >> >> Agreed... >> >> On May 24, 2020, at 8:01 PM, Rod Jackson <[log in to unmask]> >> wrote: >> >> >> [△EXTERNAL] >> >> Hi David - could I check who you beg to differ with. Me or Michael >> Lewitt, whose YouTube presentation is referred to by Wouter? >> >> What you outline below is basically what I stated. >> I agree with your first point. I think the change in slope is all about >> the interventions. I dont think the virus is changing or just disappearing. >> Also, as you say, if restrictions are relaxed before it is eliminated, >> there will be new spikes. >> >> I also agree with your second point(s). Elimination requires closure of >> borders with populations that still have the virus and/or quarantine of >> those who enter. Herd immunity is unlikely given the low seroprevalence in >> hard hit cities. I didn’t mention non-human reservoirs, but that’s a likely >> cause of a new pandemic as it appears to have caused this one. >> >> So I assume your disagreement was with Michael Lewitt. What was >> interesting about Michael Lewitt’s YouTube presentation is that he chose >> South Korea and New Zealand as his examples to demonstrate how quickly the >> virus disappears, but didn’t mention how these countries had responded. >> Both responded with major nationwide interventions, albeit quite different >> ones, so I am not surprised the virus cases plummeted in both countries. >> >> Reading other reports from Lewitt suggests he may have ignored or just >> missed this point. I thought his presentation supported my statement that >> the virus can be eliminated without a vaccine. But unlike him, I dont think >> it is due to some natural characteristic of the virus. It is achieved by >> simply keeping infected people away from others so they dont become >> infected, and on average, there is a 4-5 day window between infection and >> infectiousness. It will be hard work for most countries but it is not >> rocket science and it needs to be done in the absence of an effective >> vaccine. >> >> Cheers Rod >> >> On 25/05/2020, at 7:07 AM, Birnbaum, David <[log in to unmask]> wrote: >> >> >> >> I beg to differ. Having watched some outbreaks burn themselves out, IMHO >> this one cannot be assumed to do so based on the data at hand because: >> >> 1. Change in slope may be due to a stabilization from the >> interventions introduced (case identification & contact tracing, social >> distancing, etc.) rather than disappearance of (or changes in) the virus >> per se. Several countries seem to have succeeded in driving down the >> weekly number of new cases using this strategy. However, note recent >> spikes in several places that seemed to have had the situation in control, >> which could be due to unrecognized infections seeding expanding unprotected >> social networks as interventions are relaxed. >> 2. Terminating this pandemic without a vaccine assumes not only that >> it has burned itself out in a population but also: >> 1. no new introductions of the virus (as from travelers within or >> between regions), >> 2. sufficient herd immunity (but note relatively low antibody >> prevalence rates reported thus far even in hard hit cities), and >> 3. no non-human reservoirs (perhaps unlikely given presumed origin >> of the virus). >> >> >> I do believe the evidence thus far shows that shape of the curve can be >> flattened, and health systems not overwhelmed, without an >> effective vaccine. However, until more is known about antibodies (both >> from natural infection and from immunization), given what has been >> experienced in morbidity & mortality and is being learned about the virus >> makes me still doubt that an end without a vaccine would be acceptable or >> successful. >> >> >> David >> >> ------------------------------- >> >> David Birnbaum, PhD, MPH >> >> Adjunct Professor >> >> School of Population and Public Health >> >> University of British Columbia >> >> Principal >> >> Applied Epidemiology >> >> British Columbia, Canada >> >> >> ------------------------------ >> *From:* Evidence based health (EBH) <[log in to unmask]> >> on behalf of Wouter Havinga <[log in to unmask]> >> *Sent:* Sunday, May 24, 2020 12:15 AM >> *To:* [log in to unmask] >> *Subject:* Re: Where did COVID19 cases go? >> >> Apart from the discussion of social isolation or lockdown but supporting >> Rod’s opinion that a vaccine is not needed: >> >> Prof Michael Levitt’s approach, with fitting data by using machine >> learning, suggests that the virus outbreak seems to limit itself? >> >> https://youtu.be/8aHrx68IT7o >> >> Via >> https://twitter.com/mlevitt_np2013/status/1264122360753512449?s=12 >> >> >> Wouter >> @wouterhavinga >> >> >> ------------------------------ >> >> To unsubscribe from the EVIDENCE-BASED-HEALTH list, click the following >> link: >> >> https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=EVIDENCE-BASED-HEALTH&A=1 >> >> >> ------------------------------ >> >> To unsubscribe from the EVIDENCE-BASED-HEALTH list, click the following >> link: >> >> https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=EVIDENCE-BASED-HEALTH&A=1 >> >> >> ------------------------------ >> >> To unsubscribe from the EVIDENCE-BASED-HEALTH list, click the following >> link: >> >> https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=EVIDENCE-BASED-HEALTH&A=1 >> >> ------------------------------ >> >> To unsubscribe from the EVIDENCE-BASED-HEALTH list, click the following >> link: >> >> https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=EVIDENCE-BASED-HEALTH&A=1 >> > > ------------------------------ > > To unsubscribe from the EVIDENCE-BASED-HEALTH list, click the following > link: > > https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=EVIDENCE-BASED-HEALTH&A=1 > ######################################################################## To unsubscribe from the EVIDENCE-BASED-HEALTH list, click the following link: https://www.jiscmail.ac.uk/cgi-bin/webadmin?SUBED1=EVIDENCE-BASED-HEALTH&A=1 This message was issued to members of www.jiscmail.ac.uk/EVIDENCE-BASED-HEALTH, a mailing list hosted by www.jiscmail.ac.uk, terms & conditions are available at https://www.jiscmail.ac.uk/policyandsecurity/