Learning Lessons On The Use Of Models During COVID19

Greg Clark is the Chair of the Science and Technology Committee which has, along with the Health and Social Care Committee, been hearing oral evidence in their joint inquiry into lessons to be learned from the response to the coronavirus pandemic.

He made the following observation during one of his questions yesterday to Matt Hancock, the UK Secretary of State for Health and Social Care:

[…]It seems to me that everyone—certainly most people in the system—got bogged down in the modelling and the complexity, and did not step back to see the crude maths of it, if you like […]

Full transcript here.

Compare and Contrast: Boil-Water Advisory Edition

About 390,000 Texans are still under boil water advisories from the winter storm (March 2nd, 2021)

About 390,000 Texas residents were still under boil water advisories as of midday Monday, almost two weeks after a winter storm slammed large swaths of the South.

The Texas Commission of Environmental Quality (TCEQ) website shows there are 399 active boil water notices in effect on Monday, while 1,780 notices have already been lifted.

Members of Neskantaga come home today to boil water advisory (Dec 18, 2020)

After two months of living in hotel rooms, members of a remote First Nation will begin returning home today to clean tap water for the first time in 25 years.

But the community’s public health officer says the boil-water advisory, which has been in place since 1995, will remain in place because of lingering problems with the water plant’s performance — problems the community warns could grow worse without more help from the federal government.

Neskantaga, a Northern Ontario community of about 300 people, has been under a boil-water advisory for longer than any other First Nation in Canada.

Also, for your consideration, this passage from the article about Texas:

Pastor Marilyn Davis spent her Sunday picking up cases of water at the Mesquite Police Department to deliver to members. “It’s been very, very hard,” Davis told the affiliate.

“I live in an apartment complex and when we didn’t have any water it was very difficult for us to make it. So many people in one place.”

Now that she has her water back, she wants to make sure other people have what they need. [emphasis added]

Can Covid-19 Spread Via Building Pipes?

As I explained a couple of weeks ago, it seems plausible that the 2019 Coronavirus (now officially designated as Covid-19) may spread e.g. vertically through a building of flats via the various piping systems. This is based on a theory of what happened in a cluster of SARS cases in Hong Kong in 2003.

CNN and others are discussing this today after officials in Hong Kong partially evacuated a building where this is again a possibility.

The Role of Sanitation in Slowing the 2019-nCov Coronavirus

While most media reports have been focusing on the respiratory side and pneumonia-like symptoms — the fevers, and coughs, and protective measures like face-masks, it may be that toilets, latrines, and sanitation are an important part of the story of the 2019-nCov outbreak.

This paper by Chan et. al examines a familial cluster in Shenzhen, and monitored gastrointestinal (GI) symptoms as well as respiratory ones. As they point out:

“Diarrhoea and gastrointestinal involvement are well known in coronavirus
infections of animals and humans.”

Indeed, as summarised in a recent story from Bloomberg:

A virus-laden aerosol plume emanating from a SARS patient with diarrhea was implicated in possibly hundreds of cases at Hong Kong’s Amoy Gardens housing complex in 2003. That led the city’s researchers to understand the importance of the virus’s spread through the gastrointestinal tract, and to recognize both the limitation of face masks and importance of cleanliness and hygiene, [John Nicholls, a clinical professor of pathology at the University of Hong Kong,] said in an interview. […]

Many of the emerging coronaviruses are so-called pneumoenteric viruses, meaning they can replicate both in the respiratory tract and the gastrointestinal system, said Ralph Baric, professor of microbiology and immunology at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, who has studied coronaviruses for decades. Overwhelmed by hundreds of severely sick pneumonia patients, doctors in Wuhan might not have focused on any gastric signs, Baric said in a phone interview.

The Bloomberg story also links to this paper from Li et al. on early transmission dynamics of the virus

“Confirmed cases could more easily be identified after the PCR diagnostic reagents were made available to Wuhan on January 11, which helped us shorten the time for case confirmation. Furthermore, the initial focus of case detection was on patients with pneumonia, but we now understand that some patients can present with gastrointestinal symptoms, and an asymptomatic infection in a child has also been reported. Early infections with atypical presentations may have been missed, and it is likely that infections of mild clinical severity have been under-ascertained among the confirmed cases. We did not have detailed information on disease severity for inclusion in this analysis.” (emphasis added)

If a GI-associated route is part of the story and the sanitation arrangements (pit latrines, squat latrines, toilets, covers, hand washing with soap and water, etc.) are very different between locations then this may well play a part in the story as it continues to develop.