Most European governments completely misread the epidemic although they had time to learn from the Chinese experience.
First they misunderstood exponentials, (it starts slowly then goes up fast) and did nothing. Then they over-reacted looking at models saying half the population would get sick with 3% dying and finally settled on the only option left: "Flatten the curve!" The result is that in a month or two, a large chunk of the economy will be gone. There will be hell to pay. Confinement and the dictatorial measures which come together will not be tolerated very long in many countries. The 4th turning is upon us!
But for now, that is indeed the only option left.
Here is a good brief
https://phys.org/news/2020-03-endgame-restart-coronavirus.html
Here is the complete original statistical work from the Imperial College in London:
(The link seems to be broken so I insert a copy of the summary, pdf below)
Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand
Neil M Ferguson, Daniel Laydon, Gemma Nedjati-Gilani, Natsuko Imai, Kylie Ainslie, Marc Baguelin, Sangeeta Bhatia, Adhiratha Boonyasiri, Zulma Cucunubá, Gina Cuomo-Dannenburg, Amy Dighe, Ilaria Dorigatti, Han Fu, Katy Gaythorpe, Will Green, Arran Hamlet, Wes Hinsley, Lucy C Okell, Sabine van Elsland, Hayley Thompson, Robert Verity, Erik Volz, Haowei Wang, Yuanrong Wang, Patrick GT Walker, Peter Winskill, Charles Whittaker, Christl A Donnelly, Steven Riley, Azra C Ghani.
On behalf of the Imperial College COVID-19 Response Team
WHO Collaborating Centre for Infectious Disease Modelling MRC Centre for Global Infectious Disease Analysis Abdul Latif Jameel Institute for Disease and Emergency Analytics Imperial College London
Correspondence: neil.ferguson@imperial.ac.uk
Summary
The global impact of COVID-19 has been profound, and the public health threat it represents is the most serious seen in a respiratory virus since the 1918 H1N1 influenza pandemic. Here we present the results of epidemiological modelling which has informed policymaking in the UK and other countries in recent weeks. In the absence of a COVID-19 vaccine, we assess the potential role of a number of public health measures – so-called non-pharmaceutical interventions (NPIs) – aimed at reducing contact rates in the population and thereby reducing transmission of the virus. In the results presented here, we apply a previously published microsimulation model to two countries: the UK (Great Britain specifically) and the US. We conclude that the effectiveness of any one intervention in isolation is likely to be limited, requiring multiple interventions to be combined to have a substantial impact on transmission.
Two fundamental strategies are possible: (a) mitigation, which focuses on slowing but not necessarily stopping epidemic spread – reducing peak healthcare demand while protecting those most at risk of severe disease from infection, and (b) suppression, which aims to reverse epidemic growth, reducing case numbers to low levels and maintaining that situation indefinitely. Each policy has major challenges. We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over. For countries able to achieve it, this leaves suppression as the preferred policy option.
We show that in the UK and US context, suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members. This may need to be supplemented by school and university closures, though it should be recognised that such closures may have negative impacts on health systems due to increased
16 March 2020 Imperial College COVID-19 Response Team
absenteeism. The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed. We show that intermittent social distancing – triggered by trends in disease surveillance – may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound. Last, while experience in China and now South Korea show that suppression is possible in the short term, it remains to be seen whether it is possible long-term, and whether the social and economic costs of the interventions adopted thus far can be reduced.
16 March 2020 Imperial College COVID-19 Response Team
Introduction
The COVID-19 pandemic is now a major global health threat. As of 16th March 2020, there have been 164,837 cases and 6,470 deaths confirmed worldwide. Global spread has been rapid, with 146 countries now having reported at least one case.
The last time the world responded to a global emerging disease epidemic of the scale of the current COVID-19 pandemic with no access to vaccines was the 1918-19 H1N1 influenza pandemic. In that pandemic, some communities, notably in the United States (US), responded with a variety of non-pharmaceutical interventions (NPIs) - measures intended to reduce transmission by reducing contact rates in the general population1. Examples of the measures adopted during this time included closing schools, churches, bars and other social venues. Cities in which these interventions were implemented early in the epidemic were successful at reducing case numbers while the interventions remained in place and experienced lower mortality overall1. However, transmission rebounded once controls were lifted.
Whilst our understanding of infectious diseases and their prevention is now very different compared to in 1918, most of the countries across the world face the same challenge today with COVID-19, a virus with comparable lethality to H1N1 influenza in 1918. Two fundamental strategies are possible2:
(a) Suppression. Here the aim is to reduce the reproduction number (the average number of secondary cases each case generates), R, to below 1 and hence to reduce case numbers to low levels or (as for SARS or Ebola) eliminate human-to-human transmission. The main challenge of this approach is that NPIs (and drugs, if available) need to be maintained – at least intermittently - for as long as the virus is circulating in the human population, or until a vaccine becomes available. In the case of COVID-19, it will be at least a 12-18 months before a vaccine is available3. Furthermore, there is no guarantee that initial vaccines will have high efficacy.
(b) Mitigation. Here the aim is to use NPIs (and vaccines or drugs, if available) not to interrupt transmission completely, but to reduce the health impact of an epidemic, akin to the strategy adopted by some US cities in 1918, and by the world more generally in the 1957, 1968 and 2009 influenza pandemics. In the 2009 pandemic, for instance, early supplies of vaccine were targeted at individuals with pre-existing medical conditions which put them at risk of more severe disease4. In this scenario, population immunity builds up through the epidemic, leading to an eventual rapid decline in case numbers and transmission dropping to low levels.
The strategies differ in whether they aim to reduce the reproduction number, R, to below 1 (suppression) – and thus cause case numbers to decline – or to merely slow spread by reducing R, but not to below 1.
In this report, we consider the feasibility and implications of both strategies for COVID-19, looking at a range of NPI measures. It is important to note at the outset that given SARS-CoV-2 is a newly emergent virus, much remains to be understood about its transmission. In addition, the impact of many of the NPIs detailed here depends critically on how people respond to their introduction, which is highly likely to vary between countries and even communities. Last, it is highly likely that there would be significant spontaneous changes in population behaviour even in the absence of government-mandated interventions.
16 March 2020 Imperial College COVID-19 Response Team
