Development of COVID-19
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|31 march 2020.
The pace of the COVID-19 epidemic may be slowing down in
In addition to a second wave, what is happening this fall in the Southern hemisphere is important to prepare for a possible surge of the disease next year. Following the situation in Australia (4,557), New Zeland (647), Argentina (966), Chile (2,449) and Uruguay (320) could help us prepare for the worst. Genetic studies confirm that blood group O patients are less likely to get a severe infection. Studies investigating fucosyltransferases of the Lewis system should also be undertaken. The HLA cell markers may also have an influence on susceptibility. Other markers such as variants of angiotensin converting enzyme 2 (ACE2), which acts as a receptor of the virus are investigated.
|30 march 2020.
A new cluster of cases appears at another sectarian church in
The lessons from the recent past are not taken seriously. The controversial Manmin Central Church in Seoul, whose pastor Lee Jae-rok is in prison for rape, is behind 22 Covid-19 cases after sunday services resumed, despite obligation for social distancing. More than 100,000 citizens have returned to Hong Kong before compulsory quarantine was implemented and their health status was not monitored. This is beginning to start new chains of transmission of COVID-19 in the city. Epidemics are extremely interesting in the way they reveal the hidden agenda of individuals. Gurus are legions, but many people who wish to be visible also try by all means to get involved in activities that make them seen by the largest number. There is a hidden competition for visibility, at the cost of proper communication of really important knowledge. We are, once again, in the time of the « perfect crime » described by Edogawa Ranpo. This explain the explosion of the number of committees dealing with the disease. Who would dare ask the motivation of this or that person who generously uses their time for the benefit of mankind?
|29 march 2020.
Schools reopen in several Chinese provinces.
A study of patients in Wuhan evaluated the case fatality ratio to 1.4%, in line with the figure presented by the Inartis Foundation on march 12th. In perspective: if half of the world population were infected (this seems unlikely) this would imply that the yearly death count would have doubled this year. The large bias towards a high fatality rate for people older that 60 years is confirmed. George Gao, the director-general of the Chinese Center for Disease Control, gives a highly relevant summary of what we know about the epidemic and its containment. Wearing masks seems to be an essential component for success. The USS Theodore Roosevelt warship in confined in Guam after COVID-19 cases have been discovered on board.
|28 march 2020.
In times of epidemics the superstitious behaviour of animals
Mammals are superstitious (and perhaps many other animals too). Here is a rat in a cage separated from another cage by a long corridor, and which contains food. These cages allow food to be seen and smelled. The corridor is closed by sliding doors, controllable by the experimenter, at the entrance of each cage. We leave the hungry animal, letting it smell and see the food. Then we open both doors simultaneously. The rat rushes down the corridor, but just when it arrives at the food cage its door closes, and the rat cannot eat. It then returns to its original cage, and the process is repeated. Rats are intelligent. They get caught once, twice, and then go find if there is no other way to get access to this food. Instead of rushing down the hall to the food, they will go slowly, carefully, spinning around, maybe peeing in a corner, etc. It takes time, and the experiment is made so that if this time is significantly longer than going straight to the food cage, its door does not close. In this case the rat can eat. We then repeat the experiment. This time the rat, instead of rushing, will repeat all the moves he made when he had access to food. It is a superstitious act, which has nothing to do with being able to eat, but simply introduced a long delay between leaving the home cage and accessing food. We understand the selective interest of superstition. When you do not know the chain of causes, and you have a favorable outcome after a series of actions, the best is to strictly repeat this series of actions. We are mammals and therefore built with this constraint. This means that since superstition is natural to us, it is painful for us not to succumb to it, even if we do not believe it rationally. This is why I allow myself to touch wood, even if I know that it does not make sense: it is psychologically more comfortable to do so. This principle is at the root of miracle cures and the reason for the passion they trigger. In India sacred cow urine alleviates SARS-CoV-2 symptoms. Here, all kinds of dietary supplements or ancient drugs play the same role, srpeading like fire because superstition is a very contagious disease. When these remedies are harmless, there is no reason not to succumb to superstition, even if one does not believe in it. But beware of the hidden effects of the treatments offered, which are all the more hidden since the gurus who offer them often use mixtures, which has the advantage for them of not allowing statistically validated studies, quite simply because of the huge number of cases that should be tested to demonstrate their effectiveness. While a first train arrived in Wuhan's central station, witnessing the beginning of return to normal, several restrictions were reintroduced in Zhejiang province as new local cases emerge. A certain confusion resulted in conflict between state forces at the border between Hubei and Jiangxi provinces.
|27 march 2020.
A common cause must be found to explain why the letality
onset (not range) is the same in all but a few countries.
The USA are now the country with the more identified cases. A trick with spurious treatments is to combine several ingredients together. This allows their promoters to prevent clinical studies, which would require many more patients to be statistically significant: for example a rule of thumb would tell that with two ingredients you need four times more patients, with three, eight times etc. This predicts a dire future for the validation of proper antivirals, unless some are clearly efficient, as a single molecule.
|26 march 2020.
The situation of the epidemic in Germany should be used as a
model for prevention and perhaps treatment.
While the course of contamination in Germany looks similar to that in other countries, the death rate there is considerably lower than elsewhere. It seems that widespread testing of people allows the authorities to quarantine people most at risk to transmit the disease as well as those who would be most at risk to die from it. This has an extremely positive role in containing the epidemic while keeping deaths at a minimum level. Japan has set up a COVID-19 task force, preliminary to declaring state of emergency. Russia has suspended all international flights except those intended to repatriate its citizens. The epidemic behaves asif it were two diseases: mild in people younger than approximately 65 years, it is extremely severe beyond that age. Crisis management should take explicit account of this situation and widespread testing appears to be the way to go. More than 500,000 cases in the world. Global growth of the disease remains exponential. Ougadougou (Burkina Faso) will enter lockdown.
|25 march 2020.
The Hubei province (except for Wuhan, still for some time)
reestablish freedom of movements.
47 imported cases from overseas Chinese citizen have reintroduced COVID-19 in China, but they are under strict quarantine. In the Southern Hemisphere the number of cases follows the course of the disease in the Northern Hemisphere: Australia 2,431, New Zealand 205, South Africa 709, Argentina 387, Uruguay 189, Chile 1,142. Singapore, which has 200,000 expatriate citizens expect a surge in cases (to 631) as many return (1,200 daily from the US). While the virus keeps mutating (an isolate with more than 40 mutations has been identified in Iceland), it becomes important to see when and where its proofreading gene will be inactivated, as this would interfere with vaccine development.
|24 march 2020.
The Ruby Princess cruise ship becomes a major source of
COVID-19 in Australia.
130 passengers of the ship are positive for SARS-CoV-2, but it seems difficult to trace their contacts as 2,700 passengers disembarked in Sydney on March 19th. In the Southern Hemisphere the number of cases follows the course of the disease in the Northern Hemisphere: Australia 2,144, New Zealand 155, South Africa 554, Argentina 301, Uruguay 162, Chile 922. It would be a mistake to think that the present epidemic is just an unlucky accident. Many animal viruses have the potential to trigger very severe epidemics. For example morbilliviruses (the measles virus belongs to this family) such as PPRV (peste des petits ruminants) are close to the canine distemper virus (CDV) a virus of global distribution capable of causing diseases in many animal species, including non-human primates. Worse, CDV can adapt, in vitro, to the human morbillivirus receptor form. Let us hope that the present epidemic will serve as a lesson and trigger relevant research in all domains affected today.
|23 march 2020.
The exact origin of the SARS-CoV-2 virus remains unknown.
This question is also open at many places where the virus suddenly appeared. A strong correlation is with proselytic cult clusters (in particular in South Korea, in Mulhouse in France and in Malaysia), often associated to secret practices (meaning that it is difficult to trace back the travels and origins of participants). Another correlation is with large gathering of people that remained close together for some time (cruise ships, celebration dinners, such as in Singapore). Prisons are also cases in point (multiple examples: China, Iran in particular) and should be monitored carefully. This may explain the sudden apparently « explosive » beginning of the disease at a variety of places. As such this type of scenario is reminiscent of infection by Legionella bacteria, which as individual entities are not very dangerous, but when present within amoebas as clusters of a thousand bacteria and reaching the lung, they trigger a very virulent disease. In this context it could be interesting to understand the role of the « multiplicity of infection » (MOI) in the onset of COVID-19. An important MOI might explain the severity of the disease for some medical doctors. South Korea has the lowest number of new cases, suggesting that it may escape a second phase of the epidemic. In the Southern Hemisphere the number of cases is not under control: Australia 1,717, New Zealand 102, South Africa 402, Argentina 266, Uruguay 158.
|22 march 2020.
As it ended there, a second wave of the epidemic hits the
countries where it appeared.
Remember, however, that during the past period, the virus has evolved and that the characteristics of the new strains in terms of contagion, incubation and virulence are certainly modified. This should be taken into account when comparing the epidemic at different places. An epidemic involves contact with people other than the infected person, and for the simplest model, the average infection number per person, called R0, has already briefly discussed on March 14. If R0 is greater than 1, we understand that the epidemic is spreading. A large fraction of the population will therefore be contaminated. At some point, an infected person will interact with people who are already infected, and will only spread the disease to a number lower than R0. There comes a point when the number of people infected is such that a patient will no longer be able to infect anyone who has not had the disease, and the epidemic will therefore gradually end. Basically, again for the simplest models, one finds that the proportion of the population that must be reached for the disease to die out is 1 - 1 / R0. For an R0 of 2 (close to what we think is the case at the moment) we see that this proportion is 50% of the population (therefore a very high number and very far from being reached already). A slightly more optimistic view notes that in the Diamond Princess situation it is only about a quarter of the population that has been infected (provided that the diagnosis has been complete). One way to fight this effect is to decrease R0, and this is the reason for lockdown, for example. However it is a necessarily temporary action and, because the disease cannot really disappear, if the circulation of people is restored, it will resume, until reaching the magic number 1 - 1 / R0 corresponding to the previous social structure of contact between people. This is what is beginning to be seen in China (45 new infections among which one local case in Guangdong province), Hong Kong (317 with 29 new imported cases from America and Europe), Korea (8897) and Singapore (455). Yet, during the lockdown time the number of affected people will have been diluted out, which avoids congestion in hospitals. The WHO initially stated that asymptomatic cases were extremely rare, while they are at least 30%, explaining why countries that implemented tests for everybody instead of only for people with symptoms were able to contain the disease. With the surge of imported cases Singapore and Taiwan close their borders and air arrivals in Beijing are diverted to airports specializing in the detection of COVID-19.
|21 march 2020.
COVID-19 is not a surprise: outbreaks of this type are
commonplace with domestic animals.
Epidemics in domestic animals are favoured by crowding in massive flocks and widespead worldwide travel of live or slaughtered animals, as well as fresh meat. The importance of understanding this as a model of what will happen to human communities was highlighted at the beginning of the 2000s by the « One Health » program. This could have aroused more interest in order to avoid the classic solution in the event of an animal epidemic, the culling of all infected flocks. Yet another outbreak on the cruise ship Costa Luminosa now in Marseilles just substantiates the view that large concentrations of people and mass travels unavoidably result in epidemics. While autumn begins, the number of cases in the southern hemisphere is now, for South Africa 240, Argentina 158, Uruguay 110, Chile 537, Australia 1,071, New Zealand 52. The epidemic develops in India (330 cases and 4 deaths) and Pakistan has 666 cases. 53,578 cases and 4,825 deaths in Italy. In Hong Kong, there are 273 cases, and the new cases are all from overseas travel while demonstrations against the government resume. To enforce the application of the 14 confinement days, Hong Kong authorities require everyone arriving to wear a wristband that tracks their movements. Singapore has its first fatalities (432 cases and 2 deaths). 22,738 cases and 288 fatalities in the USA and 20% of the population is locked down. Checkpoints are taken down in Wuhan and fireworks celebrate the end of lockdown.
|20 march 2020.
The difficulty to contain resurgence of outbreaks comes from multiple
routes of ingress.
Citizens of countries on the verge of totally containing the disease come back and initiate new local outbreaks. In addition, because of the high number of asymptomatic contaminations, it cannot be considered that a country is free from the disease for at least two weeks without new local cases. The number of cases in the southern hemisphere is now, for South Africa 202, Argentina 128, Uruguay 94, Chile 434, Australia 791, New Zealand 39. The new president of Argentina, Alberto Fernandez, has implemented a complete lockdown of the population. The epidemic develops in India (244 cases and 4 deaths) and Pakistan has 501 cases. The situation in Russia is far from clear. 41,035 cases and 3,405 deaths in Italy. In a strange development, Germany and France, which have a somewhat similar number of cases (15,320 vs 11,010) have a 8-fold difference in fatalities (44 against 372). In Hong Kong, there is a jump of 48 new cases to 256, most of which with a travel history. Because these new patients had local contacts it can be predicted that there will be a surge in cases in the next couple of weeks. A similar situation is developing in Korea (8,652) and in Singapore (385). Combined with widespread testing of the population, for some time Hong Kong authorities have monitored quarantined people with tracking bracelets. Malaysia now enforces a partial lockdown supervised by the army. Figures giving the number of cases are considerably underestimated as, when the number of severe cases increases it is no longer to identify mild cases. 17,402 cases and 231 fatalities in the USA where the disease seems to propagate at an extremely high rate. California locks down all its inhabitants. In China factories gradually but slowly resume production, and this is matched by increase in energy consumption, harbour traffic and travels.
|19 march 2020.
At a time when panic is gripping the rest of the world China
appears to have contained the epidemic.
China reports no new local case. However new imported cases keep growing (34) forcing authorities to impose quarantine for all arrivals. This is true also for Hong Kong which will benefit from the hotels offer to provide 1,000 rooms to quarantine arrivals. The number of cases in the southern hemisphere is now, for South Africa 116, Argentina 97, Uruguay 79, Chile 238, Australia 681, New Zealand 28. The epidemic develops in India (169 cases and three deaths) and Pakistan has 335 cases. 35,713 cases and 3,000 deaths in Italy. In Hong Kong, there is 208 cases, with the new cases coming from abroad. Hongkongers are massively leaving UK for their home city, posing problem to the authorities to organise quarantine. A second pet dog is infected in the city and placed in quarantine. Singapore faces the same problem of return of infected people with 345 cases, with 33 newly imported cases. South Korea reported 8,565 cases and 91 deaths. An islamic proselytic gathering in Malaysia (900 cases), the "tabligh", which brought together 16,000 people has already infected several hundred participants. The state of emergency on Hokkaido Island is suspended, and Japanese schools are about to reopen. Getting out of lockdown may look nice. Unfortunately people coming from locked down regions meet prejudice and a lot of red tape. Public reactions are irrational, as anybody could have been directly affected. The New York Times reports incidence in real time, and we will now stop reporting figures, except for special situations.
|18 march 2020.
The SARS-CoV-2 virus is likely to become endemic.
China reports just one new case (but 12 imported cases). The number of cases in the southern hemisphere keeps increasing (South Africa 116, Argentina 79, Australia 568, New Zealand 20, Chile 201). It will be interesting to see how the epidemic develops in India, where folk medicine is rife (151 cases and three deaths). Pakistan has 257 cases, mostly coming from Iran. As could be expected, the epidemic on the Diamond Princess cruise ship propagated through crew members, in particular those involved in feeding the passengers. 35,713 cases and 3,000 deaths in Italy. In Hong Kong, there is 181 cases, with the new cases coming from abroad. Singapore faces the same problem with 313 cases. South Korea reported 8,413 cases and 84 deaths, but new clusters appeared. The main challenge with the disease is the combination of many asymptomatic cases associated to local clusters with a significant number of serious cases requiring ICU treatment. This creates a logistic hurdle extremely difficult to tackle. UK is changing its policy, resorting to more stringent rules for social distancing. Epidemiologist Neil Ferguson, who initiated the UK policy change, quarantined himself due to symptoms of COVID-19.
|17 march 2020.
The simultaneous presence of a large
number of asymptomatic cases and severe cases drives
Europe into lockdown, except for UK.
If this is confirmed, it becomes important to wear a mask even without signs in order to protect the community. Because health authorities are unable to rapidly test whether a person in infected by the virus, new cases appear more or less at random places. This forced most countries, in order to prevent saturation of intensive care units in hospitals, to prohibit individual travel, keeping the population at home. 31,500 cases in Italy. Several new provinces in China no longer have cases (like the Tianjin conurbation), but Yunnan has discovered two new patients. Malaysia (673 cases, 2 deaths) closes its border to Singapore despite the fact that 10% of the city's population cross the border every day, getting 90% of its food supply from the country. Because of the superstitious "salt" incident at a church in South Korea, the authorities threaten to close churches in the country. In Hong Kong, there is 162 cases (the 5 new cases are cases imported from Europe) and 266 in Singapore. 20 people arrived from different flights at Hong Kong airport with fever and were immediately sent to hospitals. The number of cases in the southern hemisphere keeps increasing (South Africa 62, Argentina 68, Australia 452, New Zealand 12). South Korea reported 8,320 and 81 deaths. It seems that people with the O group blood marker are more resistant and group A more sensitive to SARS-CoV-2. This observation fits well with the maintenance of the recessive O group in regions where viruses are stabilized by low temperatures. The fecal transmission of the virus is experimentally confirmed and may be used for diagnostic tests. It seems that a downtrend in R began before lockdown measures were implemented in Italy or in France.
|16 march 2020.
The SARS-CoV-2 virus keeps evolving.
This means that its propagation and virulence varies at different places. The South Korea approach which sampled people near clusters to monitor the size of the presence of the virus and quarantined those who were next to dangerous clusters while leaving the other travel freely seems the way to go. It seems clear that some viral strains display much less worrying symptoms than others. It would be good politics to let these strains propagate as a barrier against the more dangerous forms. However, in contrast to what seems to be the approach in UK, this way to reach herd immunity should be strictly based on local evaluation of the severity of the disease. Letting complete freedom of movement without assessing local virulence may allow the virulent forms of the virus to spread. It must be remembered that, at this time, there are many forms spreading concurrent disease development. Also, it is important to remember that fake news and other creeds have dangerous consequences: salt water used as spray in a South Korea church has infected 46 persons. Japan identifies 15 infection clusters—the largest one with more than 50 cases near Osaka—with a sudden increase of the total number of cases in the country (839). This happens right at the moment where the country was about to reopen schools. In Hong Kong, there is 157 cases with 33 out of the 46 new cases being recent travelers, and 243 in Singapore. The number of cases in the southern hemisphere keeps increasing (South Africa 62, Argentina 56, Australia 377, New Zealand 8). South Korea reported 8,236 and 75 deaths, suggesting that the epidemic will soon be under control. The large variation of death rates throughout Europe suggests that there is environmental factors increasing the severity of the disease. They should be urgently identified. We got an information from the USA, where it seems that glucocorticoids are still used, despite the fact that this family of drugs was likely responsible for the doubling of mortality in Hong Kong (and Toronto as well) during the SARS episode. Apparently lessons of the past are difficult to be understood. It is true that, to our knowledge, no retrospective study has been correctly performed to analyze that unfortunate situation.
|15 march 2020.
With a completely different management of the disease South
Korea appears to begin to contain COVID-19.
This is quite remarkable as there was no compulsory confinment in the country, in contrast to what happened in China or in Italy. Our diseases reflect the organization of our societies. For example at this time Malaysia has almost doubled its cases, to 428, following a previous religious event at a mosque near Kuala Lumpur. Events with large crowds are also keys to the creation of clusters of infections. It is interesting to see how the perception of the importance of uniting around a « common good » will affect the outcome of the present epidemic. It is unfortunately likely that in countries where people call for mass demonstrations while the government imposed restrictions in the number of people present together at any place—such as in France—demonstrating their lack of interest for their country, the disease will develop into a fairly worrying course. The disease also reveals important features of societies where bureaucracy tried to hide its severity (this happened both in China and in the USA). A possible development (to be confirmed) is the worrying disappearance of the tycoon Zhiqiang Ren who had widely criticized the way China—where activity is slowly going back to normal—tackled the epidemic. As the number of COVID-19 cases keeps increasing we will only provide what we think are significant figures. Again we must remember that seasonal flu results year after year in up to 650,000 deaths per year. The total number of cases is now the double of Chinese cases. In Hong Kong, a housing block is again the site of multiple infections, probably due to contamination via the sewage system and this will likely cause an increase of the total number of cases in the city (148 cases). There are 226 cases in Singapore. Ten Chinese provinces no longer have any active cases (Tibet, Qinghai, Yunnan, Fujian, Jiangsu, Anhui, Jiangxi, Hunan, Chongqing city, Shanxi). The number of cases in the southern hemisphere keeps increasing (South Africa 38, Argentina 34, Australia 250, New Zealand 6). For those who are interested in figures GitHub is providing a regular update.
As reported by the South China Morning Post (SCMP) South Korea reported 76 new cases (8162) and 3 more deaths (75), this is down from the time when it reported 909 new cases in a day. Again, a majority (41) cases came from Daegu where a large cluster of cases triggered the explosion of the epidemic. The number of recovered patients in a day is now significantly higher that that of new contaminations. In an interesting development the management of the disease did not involve strict confinement measures but rested on a highly coordinated government response to manage the behaviour of the public and rapid detection of cases in a fully transparent way. The idea is that proper behaviour of individuals can get the R0 of the disease progressively smaller, resulting in the control of the epidemic.
|14 march 2020.
The large difference between the virulence of the infection at
different places is extremely puzzling.
This is true not only in Europe but also between different provinces in China: for example in two provinces that are not very far from each other: Henan 1,273 and 22 deaths, and Zhejiang 1,227 cases one death. Two major reasons may account for this observation: the initial virus strain(s) may differ in their virulence and contagiosity, and, cases happen in clusters, resulting in seeds that may be large. The rule of thumb used by epidemiologists to predict the course of diseases is based on R0, the initial average number of persons contaminated by an infected patient. The size of the population which will be infected before the disease dies out spontaneously is 1-1/R0, which means 50% with an R0 of 2. We have one case of a confined population that had to live together for a significant period of time, the passengers of the Diamond Princess cruise ship. The outcome of the epidemic in this setting is that approximately one quarter of the passengers and staff got infected, suggesting a R0 of 1.33. By contrast a single british patient that had come from Singapore contaminated more than 5 persons. This is what has to be taken into account to prepare for the future development of the disease and its associated logistics, noting that when the healthcare system is overwhelmed R increases fast. In Hong Kong the number of cases is 141 (4 deaths) and in Singapore 212 (no death). The number of cases begins to be under control in South Korea to 8,086 with 72 deaths. The South Korean model, based on prompt and accurate diagnostic, education of the population, but no restriction of movements appears to be working well. Iran reports 12,729 cases and 611 deaths. In Italy, the number of cases is 21,157 cases and 1,441 deaths. Japan has published 725 cases and 21 deaths. France has 4,499 cases and 91 deaths, Germany has 4,174 cases and 8 deaths, and Spain 6,023 and 191 deaths. Switzerland now has 1,359 cases and 11 deaths. The United States have recorded 2,488 cases and 49 deaths and they restrict travels from Europe. The number of cases in the southern hemisphere keeps increasing (South Africa 38, Argentina 31, Australia 250, New Zealand 5). It seems more and more obvious that different strains of the virus have different virulence and propensity to propagate. Another cruise ship, the Silver Shadow, is struck with possible cases of COVID-19 and docked in isolation in Brazil. As in the case of SARS—and we repeatedly emphasized this at the time—using anti-inflammatory drugs early aggravates the severity of the disease. The history of the disease begins to be understood. After an initiation period still not exactly understood, the number of infections on december 15 was at least of 27 patients and by december 20 it reached 60. On december 27 this figure passed 180 and as did Wenliang Li, Jixian Zhang doctor from the from Hubei Provincial Hospital of Integrated Chinese and Western Medicine informed authorities but was told not to make this publicso that the number of patients on january 1st had reached 381.
|13 march 2020.
The number of SARS-Cov-2 asymptomatic infection is probably at
least of 30%.
A possible index patient is a Hubei 55 years old resident diagnosed with atypical pneumonia on november 17th 2019. The number of cases is less and less accurate as the proportion of people with an exact diagnostic does not improve. Furthermore the number of fake news explodes, even at the level of the highest governmental authorities. In Hong Kong the number of cases is 134 (4 deaths) and in Singapore 200 (no death). The number of cases begins to be under control in South Korea to 7,979 with 67 deaths. Iran reports 11,364 cases and 514 deaths. In Italy, the number of cases is 17,660 cases and 1,266 deaths. Japan has published 620 cases and 17 deaths. France has 3,661 cases and 79 deaths, Germany has 3,062 cases and 3 deaths, and Spain 4,209 and 120 deaths. Switzerland now has 858 cases and 6 deaths. The United States have recorded 1,663 cases and 41 deaths and they restrict travels from Europe. The number of cases in the southern hemisphere keeps increasing (South Africa 17, Argentina 19, Australia 156, New Zealand 5). It seems more and more obvious that different strains of the virus have different virulence and propensity to propagate. Unfortunately government epidemiological models have not understood this evidence. While it now seems unavoidable that at least 50% of the world population will be infected (at least in non equatorial regions), the outcome of the epidemic should not have created the massive economic collapse that we are witnessing, reflecting a hugely irrational behaviour of mankind. Perspective: note that as of past week the total number of deaths in France linked to seasonal flu is 83, most of which among the 809 people who were placed in intensive care because of that disease. AI approaches are now used to diagnose COVID-19 by X-rays chest scan image analysis in Wuhan, monitoring 30 images per second.
|12 march 2020.
If we are alive today this is because our ancestors escaped
being killed by epidemics.
This has considerable consequences on our genetic build up, based on homeostasis of many processes (i.e. keeping the process stable by restoring it correctly when it is perturbed). The present disease however, with its mortality rate heavily biased towards old age would not have had a considerable importance. Today we keep altering this homeostasis when using drugs and all kinds of supplements. Monitoring how people fare during COVID-19 as a function of the way they listen to all kind of fake and real medicine will be very important. It could well be that the reason of the huge difference in mortality between young and old people is not age, but the way people are supplemented by drugs or supplements, widely available worldwide. Of course, smoking is an obvious cause of increased mortality. Almost 70,000 patients were cured of the disease allowing authorities to involve them in activities helping economy. The Inartis Foundation provided an interesting view of the COVID-19 epidemic.
In Hong Kong the number of cases is 129 and in Singapore 178. The number of cases slows down in South Korea to 7,869 with 66 deaths. Iran reports 10,075 cases and 429 deaths. In Italy, the number of cases is 12,662 cases and 827 deaths. Japan has published 620 cases and 17 deaths. France has 2,876 cases and 61 deaths, Germany has 2,078 cases and two deaths, and Spain 2,950 and 84 deaths. Switzerland now has 652 cases and 4 deaths. The United States have recorded 1,323 cases and 30 deaths and they restrict travels from Europe. The number of cases in the southern hemisphere is increasing (South Africa 17, Argentina 19, Australia 128, New Zealand 5). A study from Wuhan shows that quarantine has favoured local competition between different strains of the virus. In general different strains have different outcomes in terms of severity, propensity for contagion and incubation time. In a situation highly reminiscent to what happened in Wuhan at the beginning of the epidemic, where authorities tried to suppress information indicating community spread of a severe pneumonia, authorities in Seattle, in the USA, blocked scientists publicizing their observation of the first community spread in the region! As in Wuhan this is now resolved.
|11 march 2020.
The twenty-fold difference between mortality rates in Germany
and Italy requires an explanation.
This may be due to a huge difference because of the way deaths are recorded in these countries. An overestimation would indicate a complete collapse of the health system. Furthermore, the fact that older people are particularly affected is not unexpected, but could reveal a negative role of the polypharmacy to which these people are subjected. 66,239 patients were cured of the disease. In Hong Kong, the number of cases swelled to 129 after Cathay Pacific flight attendants were found to be positive after a return from Madrid. In Singapore the number of cases is now 178. The number of cases increases in South Korea to 7,775 with 60 deaths. Iran reports 9,000 cases and 354 deaths. In Italy, the number of cases is 12,662 cases and 827 deaths. Japan has published 581 cases and 17 deaths. France has 2,281 cases and 48 deaths, Germany has 1,629 cases and two deaths now, and Spain 2,174 and 49 deaths. Switzerland now has 613 cases and 3 deaths. The United States have recorded 1,050 cases and 29 deaths (19 from a same nursing home). The number of cases in the southern hemisphere is increasing (South Africa 13, Argentina 19, Australia 112, New Zealand 5). Undergraduate students in Harvard are given five days notice to leave their campus. In an interview in the official magazine People—later deleted—another doctor in Wuhan, director of the emergency department states that she was forbidden by local authorities to signal on dec 30 that a patient had died from a SARS-like pneumonia. This article was deleted and allusions to it are censored on social networks but this triggered an extraordinary inventiveness with « translation » of the article via emojis, ancient Chinese characters, Morse code, flash codes etc. It is likely that this inventiveness will have long term consequences.
|10 march 2020.
Behind a wealth of figures, often contradictory, a
It always takes a while at the start of a new disease to characterize the symptoms and diagnose it. This is particularly the case of pulmonary diseases in winter, because the causes are many. For COVID-19 the identification rules are now well established (in particular the “signature” of the genome), and the reported cases can be attributed to it with confidence. The health authorities give each day the number of new cases (daily incidence) but also all the existing cases (prevalence). In fact the authorities give the number of cases since the beginning of the disease not its exact prevalence. Note that as people begin to be cured prevalence should decrease and become zero when the epidemic has been contained. Otherwise this means that the disease has become « endemic ». Then comes the number of deaths, where the disease is directly implicated because a doctor had to note the death and give it a cause. What is comparable for two diseases is prevalence and duly recorded deaths. This is only true, however, for clearly visible cases. There is also, because the patient's defenses are weakened, the appearance of secondary diseases which will sometimes be identified as causes of death. It follows, a general excess of mortality compared to an average year, and this gives the highest figures for mortality attributed to a disease, but this is only an estimate, which superimposes other possible causes in excess. For influenza, which is generally the only disease really present on the territory, the figures are therefore very reliable, including direct and indirect causes of death.
64,166 patients were cured of the disease. In Hong Kong, the number of cases is 115 and in Singapore of 160. The number of cases increases in South Korea to 7,513 with 54 deaths. Iran reports 8,042 cases and 291 deaths. In Italy, the number of cases is 10,149 cases and 631 deaths. Japan has published 581 cases and 17 deaths. France has 1,784 cases and 33 deaths, Germany has 1,281 cases and two deaths now, and Spain 1,646 and 30 deaths. Switzerland now has 374 cases and 3 deaths. The United States has recorded 804 cases and 22 deaths. The number of cases in the southern hemisphere is increasing (South Africa 7, Argentina 17, Australia 107, New Zealand 5). 70,000 prisoners have been temporarily released from jail in Iran, to control the spread of COVID-19 in prisons. The epidemic is now largely in control in China, even in Wuhan.
|9 march 2020.
The increase of the number of cases in South Korea slows down
to 69 new cases in 24 hours and China to 40.
It is important to see how the epidemic will evolve in different countries which manage the crisis differently. 62,496 patients have been cured from the disease. In Hong Kong the number of cases remained at 115 and in Singapore it reached 160. The number of cases increases in South Korea to 7,478 with 53 deaths. Iran declares 7,161 cases and 237 fatalities. In this country a fake rumour about the use of alcohols to cure the disease killed at least 27 people. In Italy the number of cases is 9,172 cases and 463 deaths. Japan has published 511 cases and 17 deaths. France has 1,412 cases and 25 deaths, Germany, 1,176 cases and two deaths, and Spain 1,204 with 28 fatalities. Switzerland has now 337 cases and two deaths. The United States have recorded 604 cases and 21 deaths.
It has long been known that coronaviruses can stay infectious for a long time on a variety of surfaces (door handles, elevator buttons, computer keyboards, cell phones etc). However touch surfaces containing copper appear to inactivate the viruses rapidly.
|8 march 2020.
The SARS-CoV-2 is sensitive to high temperature but this will
not be enough to stop the epidemic.
The optimal spread temperature is approximately 9°C. This implies that good practice is to refrain from having air conditioning of public spaces set at temperatures lower than 23-25°C. 60,660 patients have been cured from the disease and only 99 new cases (74 in Hubei) have been recorded last night in China. Three new provinces, Anhui, Xinjiang and Fujian, have no active case. Part of the speed of contagion in the northern hemisphere may stem from weakened immune defenses of previously flu-infected persons at the end of the seasonal flu epidemic. In Hong Kong the number of cases reached 114. In Singapore the limit of 150 cases has been reached. 9 of the new cases come from participants at a dinner where 18 other cases had already been identified. The 111th Hong Kong case just returned from India and his first symptoms were diarrhoea, substantiating the oro-fecal route. China sends a team to Iraq to tackle the epidemic there. The number of cases increases in South Korea to 7,314 with 50 deaths. Iran declares 6,566 cases and 194 fatalities. In Italy the number of cases is 7,375 cases and deaths jump to 366 which suggests that the real number of infections has been underestimated. Japan has published 502 cases and 6 deaths. France has 1,126 cases and 19 deaths, Germany, 951 cases and Spain 613. Switzerland has now 330 cases and two deaths. The United States have recorded 465 cases and 21 deaths. The question now is to control the spread of the disease in the southern hemisphere so that it does not become endemic. Yet another infected cruise: 45 patients in Egypt.
|7 march 2020.
Cured patients do not seem to be reinfected by the SARS-CoV-2
virus. It is
important to remember that viral pneumonia usually lessens
immune defences so that recovering patients may have been
infected by bacteria that are also sources of pneumonia.
Travels associated to mass tourism and sects are major drivers
of the epidemic. 58,354 patients have been cured from the
To put the situation in perspective, note that for the seasonal flu considered as benign this year and that will end in France there has already been 55 deaths among the 654 cases admitted in intensive care. In Hong Kong, civil servants have returned to work and the danger now comes from outside. Travel alerts in China for people coming from Iran, Italy and South Korea. In Hong Kong the number of cases reached 108, where the 107th case is a businessman back from Europe, and Singapore now recorded 138 cases. The number of cases increases in South Korea to 7,041 with 44 deaths. Iran declares 5,823 cases and 145 fatalities. In Italy the number of cases is 5,883 cases and 233 deaths. Japan has published 420 cases and 6 deaths. France has 949 cases and 16 deaths, Germany, 799 cases and Spain 500. The United States have recorded 346 cases and 15 deaths. The New York state declares an emergency. 21 persons test positive on the Grand Princess cruise ship stuck near San Francisco. This again reflects the danger of confined structures with large numbers of people. With this high level of worldwide contamination it becomes important to monitor the Southern Hemisphere where, if the disease spread, it may subsequently multiply during winter (our summer in Northern Hemisphere) and come back next year.
|6 march 2020.
spreads mainly outside of China.
Children are as at risk as adults, while the severity
increases with age. New cases in Hubei are now confined to
Wuhan. The total number of identified cases passed 100,000.
This must be placed in the perspective of the multimillion
cases registered every year for the flu epidemic. 55,753
persons have been cured from the disease. The leveling off of
the epidemic seems confirmed in Hong Kong (106), where the 105th
case comes from London and Paris, suggesting an
Europe-acquired contamination, but there is an increase in
Singapore (130). In Hong Kong, a woman who showed diarrhoea
symptoms has been diagnosed with COVID-19. However, because
this was not recognized early on, she had been in contact of
many people in the city, which may start again the local
epidemic spread. In mainland China, the number of imported
cases keeps increasing. The number of cases still increases in
South Korea 6,593 with 42 deaths. Iran declares 4,747 cases
and 124 fatalities. In Italy the number of cases is 4,636
cases and 197 deaths. Japan has published 381 cases and 6
deaths. France has 613 cases and 9 deaths, Germany, 670 cases
and Spain 386. The United States have recorded 245 cases and
15 deaths. The mortality rate in South Korea seems to be 0.65%
while it would be 1.4% in Hong Kong. These figures assume that
all contamination cases have been taken into account. If there
were more of those the letality of the virus would be lower.
Using recovered patients immunoglobulins will be investigated
in the USA. In France, yet another cult seems to be at the
origin of a major cluster.
|5 march 2020.
Moving around people is a major cause of spread for the
has been a mistake, in general, to repatriate people from
contaminated regions, despite quarantine of the repatriated,
because all the persons involved, at whatever level, in the
process should also have been submitted to a strict
quarantine. It is important that the vehicles used for
transport are cleaned up carefully, in particular toilets and
toilet accesses. Yet another cruise ship immobilized with
possible cases of COVID-19: the Grand Princess waits near San
Francisco for an all clear signal. 53,457 persons have now
been cured from the disease. Stable conditions, possibly
reflecting the leveling off of the epidemic locally are in
Hong Kong (105) and in Singapore (117). The number of cases
increases more slowly in South Korea 6,088 with 40 deaths.
Iran declares 3,513 cases and 107 fatalities. In Italy the
number of cases is 3,858 cases and 148 deaths. The
major form of the virus that circulates in Italy seems
identical to the early forms in Wuhan, while
elsewhere other forms have replaced the original. Japan has
published 360 cases and 6 deaths. France has 377 cases and 6
deaths, Germany, 482 cases and Spain 259. The United States
have recorded 177 cases and 9 deaths and California declares
state of urgency. One case in South Africa (coming from
|4 march 2020.
Manufacturing work resumes in the Guangdong province.
A substantial fraction of this work is performed by migrant
workers coming from other provinces. In most provinces of
China the number of still active cases is less than 10% of
what it was. Qinghai
or Tibet are without active cases. In the rest of
the world official reactions are not concerted. While the
total number of cases is still growing it becomes difficult to
follow, as the way to report the disease is very variable
outside of China. From tomorrow we will report less details
about the number of cases of the disease. 94,718 cases
worldwide, 80,270 cases in China, 104 in Hong Kong, 112 in
Singapore and 3,246 deaths. The number of cases in South Korea
reaches 5,621 with 32 deaths. Iran declares 2,922 cases and 92
fatalities. In Italy the number of cases increased to 3,089
cases and 107 deaths and this is a matter of great concern if
people tend to move away from their present location. Japan
has published 304 cases and 6 deaths. France has 285 cases and
4 deaths, Germany, 244 cases and Spain 193. The United States
have recorded 128 cases and 9 deaths. Many cases keep
spreading via long range travellers. The pet dog of a person
in Hong Kong has now been confirmed to be infected with the
virus. It has no symptoms. The rate of evolution of the virus
is about 30 nucleotides per year. Mass media now suddenly
support the hypothesis that we have proposed at the beginning
of the epidemic, of a second
oro-fecal route of contamination by a variant of SARS-CoV-2.
|3 march 2020.
Infections in South Korea now dominate the evolution of the
Facing imported cases (8 from Italy in Zhejiang, where the
Qingtian county has 100,000 expatriates in Italy) China
introduces control measures and quarantine for people coming
from areas with an active epidemic. A significant number of
infections is undetected, worldwide, making assessment of the
presence (and letality) of the disease difficult. Symptoms in
younger people are usually quite mild. The number of infected
persons in the northern island of Hokkaido in Japan may be
considerably higher than the official number. This is the
result of cases with minor or undetected symptoms. 92,238
cases worldwide, 80,151 cases in China, 100 in Hong Kong, 110
in Singapore and 3,135 deaths. The number of recovered
patients is now well above half of the total number who have
been infected. The number of cases in South Korea reaches
5,186 with 31 deaths. Iran declares 2,336 cases and 77
fatalities, 23 of these cases are among members of the
parliament. The prisons in this country are probably massively
contaminated, and the Iranian state has just released tens of
thousands of prisoners in an attempt to fight the epidemic. In
Italy 2,502 cases and 79 deaths. As expected from its contacts
with Italy, Argentina has identified its first case. Japan has
published 284 cases and 6 deaths. France has 212 cases and 4
deaths, Germany, 196 cases and Spain 150. The United States
have recorded 118 cases and 9 deaths, mainly around Seattle.
|2 march 2020.
The sheer number of refugees massed at the border between
Turkey and Greece will prevent proper control of COVID-19 in
Europe if not properly managed.
Five imported cases in China: from Iran, UK, Italy. Zhejiang
province has downgraded its response to SARS-CoV-2 epidemic
after nine days without cases. Interestingly, for the time
being, the mortality rate there was 0.1%. A fairly large study
in China showed a large proportion (approximately 80%) of
person to person transmission occurs within households. In the
public space it will be important to monitor the impact of
cell phones on the propagation of the epidemic (repeated
contacts with hands and face). 90,181 cases worldwide, 80,026
cases in China, 100 in Hong Kong, 108 in Singapore and 3,080
deaths. The number of recovered patients is now half of the
total number who have been infected. The number of cases in
South Korea reaches now 4,335 with 26 deaths. Iran declares
1,501 cases and 66 fatalities. In Italy, 2,036 cases and 52
deaths. Japan has 275 cases and 6 deaths. France has 191 cases
and 3 deaths, Germany, 157 cases. The United States have
recorded 88 cases and two deaths.
The locust invasion is extremely alarming in the Horn of Africa, specifically Kenya, Ethiopia and Somalia.
|1 march 2020.
China will have to place under tight control its huge market
of wild animal consumption.
China introduced health-related control measures at the border
both for entry and exit. 88,207 cases worldwide, 79,824 cases
in China, 98 in Hong Kong, 106 in Singapore and 3,006 deaths.
Most of the cases in China still came from Wuhan where the
situation remains serious (565 cases, with only 3 cases
outside of Hubei province). The number of cases in South Korea
reaches now 3,736 with 20 deaths. The Korean society has long
been plagued with corruption linked to cults. A 61-year-old
member of SCJ in Daegu is believed to be behind the sudden
jump in coronavirus cases in South Korea. She had initially
refused to be tested for the virus and attended church
services after developing a sore throat initiating an
explosion of cases in the country. The 45 days baby of a
follower of the SCJ sect has been infected. More and more
clearly, the cult appears to be at the centre of the epidemic.
Iran declares 978 cases and 54 fatalities. In Italy, 1,694
cases and 34 deaths. Japan has 256 cases and 6 deaths. France
has 130 cases and two deaths. Sudden increase in Germany, with
129 cases. The United States have recorded 62 cases and one
death. Several cases of people apparently cured but infected
again were identified in several locations. The steady
progress of anti-Asian racism in North America—often triggered
by the academic and economic successes of people of Asian
descent—is fueled by the COVID-19 epidemic. This is doomed to
have considerable economic consequences.