Coronavirus: are we at the beginning of a major pandemic?

The origin of the current coronavirus epidemic has been linked to illegally traded wildlife at Wuhan’s ‘wet’ seafood market, which sells live animals including bats, rabbits and marmots. However, the exact source of the outbreak has not been identified, although it has been suggested that pangolins, one of the most trafficked animals in the world and sometimes consumed in China, may have been an intermediary.

The basic reproductive number for the illness is estimated at 2.2, meaning that on average each sufferer will infect more than two other people.  The viruses’s potential to spread while the patient is asymptomatic is very worrying as its mean the incubation period is five days. When symptoms do appear they include fever, cough, and shortness of breath leading (in some cases) to acute respiratory distress and bilateral pneumonia. Men who have or do smoke, or suffer from underlying chronic condition appear to be most susceptible.

At the time of writing, coronavirus has killed 813 people, with all but two victims in mainland China: one death occurred in the Philippines and another in Hong Kong. So far, the 2019-nCoV coronavirus epidemic has affected 24 countries. According to a cruise ship spokesperson, confirmed cases on a cruise ship in Japan rose by six to 70, making the vessel the biggest centre of infection outside of China. 

Reported cases in China alone have now climbed to 37 198, less than two months after the virus surfaced in late December in Wuhan. The Government there has sent more than 11 900 medical workers to Hubei province to fight the epidemic and built new hospitals with quite extraordinary celerity.

Over eight months, the 2002-2003 outbreak of severe acute respiratory syndrome, or SARS, killed 774 people and badly afflicted almost 8100 others in 26 countries. Mainland China accounted for about 45% of SARS deaths.

The World Health Organization has warned of a chronic shortage of gowns, masks, gloves and other protective equipment in the fight against the spreading epidemic.

A British man on board a cruise ship has been diagnosed with the coronavirus and is now hospitalised. Another patient has tested positive for coronavirus in England, bringing the total number of UK cases to eight, the chief medical officer has said. In Europe, five Britons, including a nine-year-old child, who were staying in a chalet at a French ski resort, have been diagnosed with coronavirus. They tested positive after sharing lodgings with a man who is believed to have contracted the disease in Singapore, said France’s health ministry. Singapore has just confirmed seven new cases, pushing its total to 40.

Anyone returning in the past fortnight from the Far East who has symptoms like a cough, fever, or shortness of breath should stay indoors and call the NHS 111 service. The Department of Health said they should do so ‘even if symptoms are mild’, adding: ‘In addition to China, a number of countries higher risk, including Singapore, a major stopover location for flights to Australia, have been identified because of the volume of air travel from affected areas, understanding of other travel routes and number of reported cases.’

The situation seems to be deteriorating rather rapidly. Are we on at the start of a major pandemic? What further steps should the authorities in the UK and elsewhere be taking?

Comments (135) Add yours ↓
  1. Roger Kirby Professor of Urology

    Coronavirus poses a “serious and imminent threat” in the UK, the government has declared as it moved to forcibly quaratine victims.

    The Department of Health has introduced new powers which will allow it to forcibly quarantine people with the virus, send them to isolation and force them not to leave if they pose a threat to public health.

    February 10, 2020 Reply
  2. Nicola Stingelin Ethicist

    Many experts have long said that zoonotic disease & how we interact we animals is a ticking time bomb – quite possibly an area of neglected public health. Thanks for reminding us of this.

    I appreciate of course that coronavirus deserves to be taken seriously and should not be trivialized (particularly for population segments rendered vulnerable by health or life situation bad fortune).

    For me the coronavirus situation gives me important food-for-thought to reflect again on the powers we grant the State – and the powers we want and need our public health agencies to hold to override our hard won liberties by imposing compulsory quarantine.

    In spite of political turmoil, police shortages and NHS woes, I feel that I am in pretty good hands in trusting those taking these decisions in the UK – a post Brexit reason-to-be- happy – or am I naïve?

    However parallel to the facts and concerns so lucidly and importantly expressed in this blog, and to my reflection added above, I cannot help but also feel sad that the attention and resources being given to coronavirus are not matched regarding public health scandals such as homeless on our own streets.

    Arriving back home late yesterday evening after speaking at an RSM event, and popping-in to the Sainsbury’s Express to biblically buy milk and a bottle of red wine – and a box of chocolates to leave by the sleeping bag of one on my homeless friends sleeping outside the shop – does make we wonder what kind of a world we are living in.

    Am I being a bit bleak; am I a bit odd to feel rather confused?

    February 11, 2020 Reply
  3. Roger Kirby Professor of Urology

    The number of British cases of coronavirus has doubled to eight – with two healthcare workers among those testing positive – while a GP surgery in Brighton was closed yesteray amid fears of the infection spreading.
    Brighton’s County Oak medical centre yesterday posted a warning notice on its door telling patients it was “closed due to operational difficulties”.
    According to reports, one of those infected was a GP, who was at work for one day but did not see any patients. Workers wearing protective suits were pictured cleaning the surgery and pharmacy yesterday afternoon.
    Yesterday became the deadliest day for the virus – the death toll has now risen above 1,000, and more than 40,000 people have tested positive in China.

    February 11, 2020 Reply
  4. Eric J Webb Retired GP

    Worldwide – on WHO figures:

    Malaria – circa 450,000 deaths / year
    ‘Flu’ – circa 80,000 deaths 2017-18
    TB – 1.5 million deaths in 2018 (including 250,000 with HIV)
    HIV – 770,000 deaths in 2018
    RTAs – 1.25 million deaths / year

    Let’s keep a sense of proportion shall we!

    February 11, 2020 Reply
    • nicola stingelin Ethicist

      Tks for reminding us of this important perspective

      February 12, 2020 Reply
    • Nicholas Wade Technical Author

      I think this kind of argument “Let’s keep a sense of proportion shall we!” is highly misleading. Death is by definition – the end. For each individual this is the final step and ultimately – personal. Having a “sense of proportion” is irrelevant. When I die, the World is for me extinguished – that is the sense of proportion. We use the same “sense of proportion” to define our actions in situations such as wars in the middle east and it really does not make any sense. Perhaps when we are talking about “a sense of proportion”, we should be referencing the “proportion” to the difficulty and cost of the incident?

      March 15, 2020 Reply
  5. Roger Kirby Professor of Urology

    Situation in the UK:
    Eight patients in England have tested positive for coronavirus. Chief Medical Officer for England Professor Chris Whitty, has shared a statement. If more cases are confirmed in the UK, it will be announced as soon as possible by the Chief Medical Officer of the affected country.

    Based on the World Health Organization’s declaration that this is a public health emergency of international concern, the UK Chief Medical Officers have raised the risk to the public from low to moderate. This permits the government to plan for all eventualities. The risk to individuals remains low.

    Based on the scientific advice of SAGE the UK Chief Medical Officers are advising anyone who has travelled to the UK from mainland China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia or Macau in the last 14 days and is experiencing cough or fever or shortness of breath, to stay indoors and call NHS 111, even if symptoms are mild.

    These areas have been identified because of the volume of air travel from affected areas, understanding of other travel routes and number of reported cases. This list will be kept under review. Our advice for travellers from Wuhan and Hubei Province remains unchanged from the below.

    The Secretary of State for Health and Social Care, Matt Hancock, has announced strengthened legal powers to bolster public health protections against coronavirus. The regulations have been put in place to reduce the risk of further human-to-human transmission in this country by keeping individuals in isolation where public health professionals believe there is a reasonable risk an individual may have the virus.

    As of 11 February, a total of 1,358 people have been tested, of which 1,350 were confirmed negative and 8 positive.

    The DoH has been working in close collaboration with international colleagues and the World Health Organization to monitor the situation in China and around the world.

    February 11, 2020 Reply
  6. Roger Kirby Professor of Urology

    Two prisoners at HMP Bullingdon in Oxfordshire are being tested for infection, with both reportedly in isolation while Public Health England conduct tests.
    The virus – now officially called Covid-19 – has so far killed 1,068 people in China according to the World Health Organisation (WHO), with 43,000 people in the country infected.
    An additional 358 instances of the virus have been confirmed in 24 other countries outside of mainland China, with the only deaths confirmed in Hong Kong and the Philippines.
    Speaking in an update, WHO chief Tedros Adhanom Ghebreyesus said any vaccine would be at least 18 months away.

    February 12, 2020 Reply
  7. Patricia GP

    Thank you for your interesting blog and for raising your concerns about a new pandemic. Predicting the extent and lethality of the 2019-nCov outbreak, which originated in China as you highlighted, still proves challenging at present. The rapid spread of information online including via social media has, on one hand, allowed us to follow emerging cases in real-time. On the other hand, it can lead to difficulties differentiating reliable sources of information from fake news, leaving the public and experts at times confused and overwhelmed.
    Public Health England has been quick and efficient in providing us with clear advice, which is updated on a regular basis- this holds for the general population, as well as health care professionals who deal with symptomatic and/or concerned patients. As a researcher and health care professional, I am impressed by how quick the viral sequence was published, and new scientific data/tests developed and shared across the globe. However, many questions about the virus remain at present e.g. duration of incubation period, how long viral shedding persists, and true case and fatality rate etc. To predict outbreak dynamics, and to tailor preventative measures in a socioeconomic way, we require these answers soon. In the meantime, public health authorities need to guide the public and healthcare professionals on next steps. They have the difficult task not to frighten the population, whilst not underreacting and putting lives at risk. Whilst it remains crucial to try and halt the virus’ spread, we need to simultaneously continue to prepare ourselves to cope with the virus.

    February 12, 2020 Reply
  8. John Ashton Former lecturer and Professor of Public Health

    At the moment, while COVID 19 has become a pandemic and been declared a Global Public Health Emergency by the WHO, it still has the characteristics of an outbreak here in the UK. As such, the efforts at the moment are in containment by identifying those people who may have been exposed to the virus and ensuring that they either self-isolate or are formally quarantined under new powers taken by the government this week. This measure has all the appearance of having been taken in the hoof and highlights the fact that we haven’t had a comprehensive review of Public Health legislation with a Public Health Act since 1936.

    Recent cases in Brighton relating to a Dr who had been skiing in France and come in contact with a so-called ‘super spreader’ who had come to the same resort from Singapore illustrates the naivety of a focus principally on people flying from China to Heathrow. There are many ways of travelling to the U.K. that might bring infection and Port Health must be strong in all land, sea and airports. This week the Port Health community has drawn attention to the cuts in budgets and understaffing that has affected them too.

    Whilst we undoubtedly have some of the strongest laboratory and clinical services in the world these are only one part of a robust, resilient and effective service. Since 2013, with the creation of Public Health England, the central public health function has been protected at the expense of the local and regional system where budgets have been cut by 30%, staffing levels dramatically reduced and the position of Directors of Public Health reduced to that of second tier Officer with no automatic access to Chief Executives or leaders of council, and prevented from having active relationships with the media. This is something that is essential now when there is rumour and anxiety bordering on panic brought about by, for example, sending travellers to be quarantined at Arrowe Park hospital in the Wirral at very short notice, with no public preparation, and then the bringing in of a quarantine order in the same way.
    To avoid rumour, trusted local voices of the local public health director, medical director and other clinicians should be played in freely.

    Similarly, at the national level there is confusion as to who is the public face of the response. Several ministers have appeared courting the limelight (a dangerous hostage to fortune, remember Edwina Currie!). The new CMO Chris Whitty is not well known yet, but should be fronting up alongside the prime minister supported by the prime minister not accounting to him. PHE is almost invisible.

    Each day brings new insights:

    The closure of the health centre in Brighton should alert everybody to have business continuity plans in the public and private sectors . Each family should have a domestic plan.

    If the outbreak is not contained then the public will be the main weapon against the epidemic. It will not be possible to hospitalise our way out of it

    The public must be treated as adults and not as children. There needs to be open and transparent information from trusted voices and faces. The time is short.

    We are not a totalitarian country but, at the moment, we are behaving paternalistically and this is in the verge of totalitarianism. It won’t work in the age of the internet and social media, as is being shown in China.

    February 13, 2020 Reply
  9. Roger Kirby Professor of Urology

    Some 242 deaths from the new coronavirus were recorded in the Chinese province of Hubei on Wednesday – the deadliest day of the outbreak.
    There was also a huge increase in the number of cases, with 14,840 people diagnosed with Covid-19.
    Hubei has started using a broader definition to diagnose people – which accounts for most of the rise in cases.
    China sacked two top officials in Hubei province hours after the new figures were revealed.
    Until Wednesday’s increases, the number of people with the virus in Hubei, where the outbreak emerged, was stabilising.
    But the new cases and deaths in the province have pushed the national death toll above 1,350 – with almost 60,000 infections in total.

    February 13, 2020 Reply
  10. Mike Kirby Professor

    BMA is providing useful advice and a contact number for queries

    BMA advisers are on hand to answer any questions you have and are available on 0300 123 1233 and support@bma.org.uk
    For NHS 111 a process has been established whereby when a patient calls the service seeking further information about the virus, they will receive a pre-recorded message.
    – If the patient has any concerns, they will be put through directly to PHE helpline to help make decisions.
    – If the patient is unwell or has recently visited affected areas, they will be triaged to an NHS clinician.
    – Hospitals in England were asked a week ago to put in place an NHS 111 pod – a facility, preferably outside the emergency department and very close to the entrance. This is a dedicated room/space with a direct line to NHS 111. Patients who suspect they have symptoms of the virus are directed to the pod and will be put through to NHS 111 where they will discuss their symptoms with a clinician. The majority will be advised to return home, but those that need testing will be provided with further instructions via 111.
    Hospitals are being asked to identify a separate space, outside an Emergency Department, where testing can take place. The only patients being tested in emergency departments are those who are very ill. This will be rolled out across the system.

    A home diagnostic swab testing service will be rolled out very soon, rather than patients presenting to emergency departments.

    All this sounds very sensible

    February 13, 2020 Reply
  11. Roger Kirby Professor of Urology

    A ninth case of coronavirus has been confirmed in the UK as warnings the disease is likely to spread further in the country and international agencies warn of global complacency. Believed to have been the first case of a carrier being detected in London, the patient has since been taken to a specialist centre at Guy’s and St Thomas’.
    Officials confirmed the ninth victim of the virus – which has been named Covid-19 by the World Health Organisation (WHO) – contracted the pneumonia-like illness in China. Officials are now working to identify those the patient had contact with. It comes after Professor Paul Cosford of Public Health England told the BBC more cases of coronavirus in the UK are “highly likely”.

    February 13, 2020 Reply
  12. Roger Kirby Professor of Urology

    China didn’t release key genetic data on the coronavirus until about two weeks after it emerged that a new SARS-like illness may be sickening people, highlighting the need for outbreak detection systems to incorporate modern scientific tools.

    Insufficient attention was paid to the information doctors had gathered about the genetic sequence of the novel coronavirus, scientists said in a commentary paper in the Lancet medical journal Tuesday. The authors, who include two members of the World Health Organization’s emergency committee, said this wasn’t the result of a cover-up or deliberate delay, but rather the absence of mechanisms to inform outbreak warning systems.

    February 13, 2020 Reply
  13. Roger Kirby Professor of Urology

    There are now a total of 64,441 suspected and confirmed cases of COVID-19, worldwide.
    Of these cases, 63,859 are in mainland China. There have been 1,383 deaths from COVID-19.
    The figures have been collated by Johns Hopkins University’s Center for Systems Science and Engineering.
    Adam Kamradt-Scott, an infectious diseases expert at the University of Sydney, said the figures show drastic measures implemented by China to stop the spread of the coronavirus “appear to have been too little, too late”.

    February 14, 2020 Reply
  14. Roger Kirby Professor of Urology

    Chinese officials have given figures for health workers infected with the new coronavirus, amid concerns about shortages of protective equipment.
    Six health workers have died and 1,716 have been infected since the outbreak, they said.
    The death a week ago of Doctor Li Wenliang, who tried to warn authorities early on about the virus, provoked a burst of public anger and grief.

    February 14, 2020 Reply
  15. Roger Kirby Professor of Urology

    A Chinese tourist has died in France, marking the first death in Europe from the disease caused by the coronavirus, France’s health ministry said.
    There were 2,641 new confirmed infections in China, the National Health Commission said in a statement Saturday, bringing the total to almost 66,500. In Wuhan, the Chinese city where the coronavirus outbreak is centered, authorities further tightened the already-strict quarantine on residents.
    The State Department will evacuate American citizens and their families on board the Diamond Princess cruise ship, the largest infection cluster outside China and which is being quarantined in Japan.
    The virus is showing no signs of abating outside of China too. Japan, Thailand and Malaysia on Saturday confirmed new cases.

    February 15, 2020 Reply
  16. Roger Kirby Professor of Urology

    China has threatened to punish anyone who returns to Beijing without entering quarantine for 14 days, as authorities stepped up efforts to stop the spread of coronavirus. The new measure was announced in the capital’s state-run newspaper after the death toll rose to nearly 1,400 and the number of confirmed cases approached 65,000.
    However, it remains unclear how the regulation will be enforced or whether it applies to foreigners and people not normally resident in Beijing. Authorities also revealed that 1,760 healthcare workers had been diagnosed with coronavirus and six had died since the start of the outbreak.
    It came as the virus spread to Africa for the first time, with Egypt confirming yesterday the case of a foreigner who has been put into isolation in hospital.

    February 15, 2020 Reply
  17. Roger Kirby Professor of Urology

    China has reported a drop in new coronavirus cases for the third day in a row, as it became clear the country’s leadership was aware of the outbreak’s potential before the dangers were made public.

    There were 2,009 new cases in mainland China on Saturday, bringing its total to 68,500, according to the country’s National Health Commission.

    The fatality rate remained stable at 142 deaths.

    The figures have emerged after a 80-year-old Chinese tourist in Paris became the first person to die from the virus in Europe.

    February 17, 2020 Reply
  18. Roger Kirby Professor of Urology

    An interesting blog on quarantine: https://blogs.bmj.com/bmj/2020/02/17/coronavirus-and-the-ethics-of-quarantine-why-information-matters/?utm_source=twitter&utm_medium=social&utm_term=hootsuite&utm_content=sme&utm_campaign=usage

    February 17, 2020 Reply
  19. Roger Kirby Professor of Urology

    Legal blog questioning new regulations:

    https://ukhumanrightsblog.com/2020/02/13/corona-vires-has-the-government-exceeded-its-powers/#more-139789

    February 17, 2020 Reply
    • Nicola Stingelin Ethicist

      Thanks Roger
      This link provides an important insight.
      It connects to the points made above that all of us involved in medicine/the medical sciences might be advised to take the coronavirus as motivation to (re)consider the status quo globally and nationally regarding the powers we grant out government in health emergencies to forceably put temporarily aside basic liberties in order to protect public interests.

      February 22, 2020 Reply
  20. Roger Kirby Professor of Urology

    The head of the World Health Organization (WHO) has expressed concern at the number of coronavirus cases with no clear link to China or other confirmed cases.
    Dr Tedros Adhanom Ghebreyesus’s comments follow Iran’s announcement of two more deaths, bringing the total there to four.
    The window of opportunity to contain the virus was “narrowing”, he said.
    Iranian health officials said the virus may already be in “all Iran’s cities”.
    Outside China 1,152 cases of the virus have been confirmed in 26 countries and there have now been eight deaths.
    They include two deaths in South Korea, which has the biggest cluster of confirmed cases apart from China and a cruise ship quarantined in Japan.
    Italy on Friday announced 16 more cases and its health minister said schools and offices would be closed and sports events cancelled in the affected regions.
    China has so far reported 75,567 cases including 2,239 deaths

    February 21, 2020 Reply
  21. Roger Kirby Professor of Urology

    A coronavirus patient initially discharged after recovering in southwestern Sichuan province’s Chengdu city has been readmitted after testing positive during a quarantine period at home, the city’s public health clinical center said on Friday.

    The patient tested positive during a check-up 10 days after being discharged, the center said in a statement. Similar cases have been reported in other regions.

    February 22, 2020 Reply
  22. Roger Kirby Professor of Urology

    Italy has introduced “extraordinary measures” to tackle the spread of the biggest outbreak of the new coronavirus in Europe.
    Prime Minister Giuseppe Conte announced the emergency plan late as the number of cases rose to more than 100.
    The measures were imposed after two Italian citizens were confirmed to have died from the virus.
    A dozen towns in the northern regions of Lombardy and Veneto have been effectively quarantined under the plan.
    Around 50,000 people from towns in two northern regions have been asked to stay at home by authorities.

    February 23, 2020 Reply
  23. Roger Kirby Professor of Urology

    The Chinese Center for Disease Control and Prevention released clinical details on the first 72,314 patients diagnosed through February 11. The report shows that COVID-19 killed 2.3 percent of patients, meaning it is currently 23 times more fatal than the seasonal flu. Severe disease and deaths were reported in every age group including children.

    February 24, 2020 Reply
  24. Roger Kirby Professor of Urology

    Officials said on Saturday that 229 new cases had been confirmed since Friday, raising the total to 433.
    In a televised address, Prime Minister Chung Sye-kyun described the situation as “grave”.
    Many of the new cases are linked to a hospital and to a religious group near the south-eastern city of Daegu, authorities have said.
    Two patients in South Korea have died so far and there are fears the number will rise.
    Daegu and nearby Cheongdo – where the hospital is situated – have been declared “special care zones” and the streets of Daegu are reported to be largely abandoned.

    February 24, 2020 Reply
  25. Mike Kirby Professor

    MOH Italy;
    Case count in Italy soars to 219, including 5 deaths, seems likely they will be less effective at controlling the spread.
    Roll on spring & summer when the virus activity will drop off!!! hopefully

    February 25, 2020 Reply
  26. Roger Kirby Professor of Urology

    The number of cases in Spain has now reached five with the first cases reported on the mainland. Switzerland has also confirmed its first case of coronavirus, while France announced two additional cases.
    In Italy – Europe’s worst-hit nation – the death toll has increased to 11, while the number of people infected grew by 45 per cent to 322 – 100 more than the previous day.

    February 26, 2020 Reply
  27. Roger Kirby Professor of Urology

    Summary of current WHO, CDC and PHE advice to the public aimed at reducing COVID-19 transmission and its impact on public health.

    Group of behaviours

    Hand hygiene:
    1. Wash hands regularly with soap and water for at least 20 seconds
    2. Always wash hands:
    • after coughing and sneezing
    • after touching nose or mouth
    • after caring for the sick
    • before, during and after food preparation
    • before eating
    • after using the toilet
    • after handling animals or animal waste
    3. If soap and water are not available, use an alcohol-based hand sanitiser. This is particularly important after taking public transport.

    Surface hygiene:
    4. Clean and disinfect frequently touched objects and surfaces
    in the home and work environment.
    Respiratory
    5. Cough or sneeze into crook of elbow or tissue. Stifle sneeze as much as possible.
    6. Immediately dispose of tissue into closed bin after coughing or sneezing.
    Touching
    7. Do not touch mouth, eyes or nose with unwashed hands.

    Self-isolation:
    8. If symptomatic or otherwise advised to, stay at home for 14 days.
    Social distancing
    9. If not caring for a symptomatic person, avoid contact and proximity. Maintain distance between yourself and other people, particularly those who are coughing, sneezing or have a fever.

    Health care:
    10. If experiencing a fever, cough and difficulty breathing seek medical advice early and describe previous travel history to the healthcare professional.
    11. If recently arrived from specified countries within the last 14 days, call a telephone helpline.
    Personal protective equipment
    12. If caring for someone who has been diagnosed, wear facemasks, eye protection and gloves.

    Food safety:
    13. Avoid eating raw or undercooked animal products. Handle raw meat, milk or animal organs in such a way as to avoid cross-contamination with other foods.

    February 26, 2020 Reply
  28. Roger Kirby Professor of Urology

    https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/85320e2ea5424dfaaa75ae62e5c06e61

    February 27, 2020 Reply
  29. Roger Kirby Professor of Urology

    Rates of the Covid-19 coronavirus have continued to spike across Europe with new instances confirmed in France, Italy and Germany as the number of cases outside China outstripped those within the east Asian nation for the first time since the virus’s emergence.
    The flu-like illness gained a further foothold in Europe with France reporting an additional death and Germany announcing new cases without clear origins in China, which is believed to have been the point of origin for the virus.
    Meanwhile in Italy, where the virus has quickly spread following infections in 10 towns in the north, health officials confirmed 400 people had been infected in total while 12 people had died.
    Today marked the first day in which there were more cases in the rest of the world than were announced in China, fuelling concerns the spread of the disease may teeter into a pandemic.

    February 27, 2020 Reply
  30. Roger Kirby Professor of Urology

    New York’s Dow Jones has recorded its biggest one-day points fall in history as the coronavirus stock market sell-off gathered pace.
    The Wall Street index fell by 1,191 points, or 4.4%, as share indices across the globe entered “correction” territory amid heightening worries about the economic impact of the outbreak.
    It put US markets on course for their worst week since October 2008 – at the height of the financial crisis.
    Earlier on Thursday, the FTSE-100 suffered its biggest one day fall in percentage terms since August 2015.
    Markets in London, Europe, and the US were in so-called “correction” territory after the latest declines – meaning they have lost more than 10% of values off their most recent highs.

    February 27, 2020 Reply
  31. Roger Kirby Professor of Urology

    The first case of coronavirus has been confirmed in Wales and two more in England have taken the UK total to 19.

    February 28, 2020 Reply
  32. Roger Kirby Professor of Urology

    A British man has died after being infected with coronavirus while in quarantine in Japan on the Diamond Princess cruise ship, Japanese media reports.
    He is the first Briton to die from the virus.
    Asahi News, Kyodo News and NHK cited Japan’s Ministry of Health, Labour and Welfare in announcing the man’s death.
    The man was one of four Britons who had to remain in Japan after dozens more, who had tested negative for COVID-19, were evacuated to the UK last week following a fortnight on the coronavirus-stricken ship in Yokohama.
    Two of the group of four were David and Sally Abel, from Northamptonshire, who were being treated for the virus in a Japanese hospital.

    February 28, 2020 Reply
  33. Roger Kirby Professor of Urology

    A British man infected with coronavirus has died after becoming ill onboard the Diamond Princess cruise liner in Japan, as the World Health Organisation raised the global risk to “very high”.
    The Japanese Ministry of Health said the man was the sixth person from the ship to have died. A Foreign Office spokesperson said it was supporting the family and was in contact with Japanese authorities.
    The death comes as the UK yesterday confirmed the first case of the virus to be passed on inside the country, with the government reported to be mulling emergency laws to help public services cope with the potential impact of further coronavirus cases.
    The uncertainty around the outbreak has sent stock markets plummeting – the worst week since the 2008 financial crash.

    February 29, 2020 Reply
  34. Roger Kirby Professor of Urology

    Across the UK, 20 people have now tested positive for the virus, with one new case in Wales, one in Northern Ireland and three in England, one of the cases having been confirmed last night as the first patient to be infected in the UK.
    The UK’s chief medical officer Professor Chris Whitty said on Thursday it was “just a matter of time” before the virus began to spread within the UK. Commenting on the most recent case, he said yesterday: “The virus was passed on in the UK. It is not yet clear whether they contracted it directly or indirectly from an individual who had recently returned from abroad. This is being investigated and contact tracing has begun. The patient has been transferred to a specialist NHS infection centre at Guy’s and St Thomas’.”

    February 29, 2020 Reply
  35. Roger Kirby Professor of Urology

    China has reported nearly 80,000 cases of coronavirus and almost 3,000 deaths, while the virus has reached nearly 60 countries and with more than 80 deaths.
    “The outbreak is getting bigger,” WHO spokesperson Christian Lindmeier told a Geneva news briefing yesterday. “The scenario of the coronavirus reaching multiple countries, if not all countries around the world, is something we have been looking at and warning against.”
    A dog in Hong Kong whose owner was infected with coronavirus also tested “weak positive” for the infection, the government said yesterday.
    The Agriculture, Fisheries and Conservation Department (AFCD) said it was not yet clear that domestic pets could catch the virus or pass it on to their owners.

    February 29, 2020 Reply
  36. Roger Kirby Professor of Urology

    France has banned all public gatherings with more than 5,000 people in a confined space, as the number of coronavirus cases there rises and the list of countries hit by the illness climbs.

    Sporting events and music concerts could be affected as France raised the number of confirmed cases to 100.

    Five Serie A football games, which were going to be played without fans, have been postponed in Italy, which is struggling to contain a rapid spread in cases.

    Officials have now confirmed the death toll from the virus has risen to 29 with more than 1,000 others infected.

    In Washington state a person has died of COVID-19, the first such death in the US with another 22 cases of the virus reported.

    February 29, 2020 Reply
  37. Roger Kirby

    The number of coronavirus cases in the UK dramatically increased yesterday with 13 new confirmed infections as ministers outlined their “battle plan” for a possible pandemic outbreak.
    As the virus reached Scotland and 12 others tested positive in England, health officials scrambled to identify who the infected people had contact with amid fears Covid-19 is now spreading freely within the UK.
    Health secretary Matt Hancock has not ruled out putting whole cities on lockdown to quarantine parts of the country should the virus get out of hand.
    Reacting to the new cases – which represented the country’s largest daily leap so far – Boris Johnson said the virus was “now likely to spread a bit more” during a visit to a public health facility in north London, ahead of a Cobra meeting today. As part of the PM’s so-called “battle plan”, recently-retired doctors and nurses could be asked to return to work in the NHS if the coronavirus outbreak worsens, while emergency powers could be employed to close schools and ban large events.

    March 2, 2020 Reply
  38. Geoff Scott Consultant Microbiologist

    There is no doubt that’s there will be an increase of cases of COVID19 in UK, but detected cases lag behind transmission events. The strategies which the Public Health Authorities are putting in place revolve around rapid diagnosis in ill people, who have been to places where there is an outbreak, and exclusion of infection in well contacts of confirmed cases. This is all retrospective and given that there is a vast inter communicating network of individuals on public transport, further transmission is inevitable. The epidemiology of common cold viruses is that they circulate between kids in schools and are then brought home to their parents. ‘Flu’, like measles, mumps and chicken pox, is spread by aerosol droplet generated by coughing, laughing or singing! If inhaled, these viruses infect the alveolar cells in the lung. It is not certain how COVID19 infects people without some volunteer studies. You will remember the experiment at the Common Cold Unit where a bunch of volunteers with a cold shared a room with susceptibles separated only by a bed-sheet hanging from the ceiling. There was no transmission. That leads us to think that colds are directly inoculated into the nose by fingers contaminated from the environment. If that is the case with COVID19, it would be quite easy to protect oneself. But if it is spread by aerosol, that would be far more difficult. This virus will spread and no simple strategy will be able to significantly interfere with its spread. Major interference with our lives by authoritarian action will not work. Then it will fade away and the reasons for this will be quite unknown (although the authorities will take credit!).

    March 2, 2020 Reply
  39. Roger Kirby Professor of Urology

    Number of deaths worldwide now more than 3,000
    More than 90% are in Hubei, China, but there have been deaths in 10 other countries
    European Union disease prevention agency raises risk level to “moderate to high”
    South Korea reports 476 new cases, a total of 4,212, and a death toll of 28
    The leader of a South Korean church linked to the outbreak gets on his knees to apologise
    Indonesia, Iceland, Portugal, Armenia, the Czech Republic and Andorra confirm their first cases

    March 2, 2020 Reply
  40. Roger Kirby Professor of Urology

    The latest analysis from the World Health Organisation said among a sample of 44,672 patients in China with confirmed Covid-19 infection, most patients (80 per cent) experienced mild illness, while approximately 14 per cent experienced severe disease and 5 per cent were critically ill.
    Severe illness is associated with being over 60 and having other underlying illnesses. Death rates are estimated to be 1 to 2 per cent.

    March 3, 2020 Reply
  41. Roger Kirby Professor of Urology

    Ministers have warned a widespread outbreak of coronavirus in the UK could lead to an increase in deaths among the vulnerable and elderly, as officials were instructed to find extra mortuary spaces.
    A 27-page government document outlining the potential scale of disruption revealed that a fifth of workers in the UK could be off sick during the peak of the virus. And in the worst-case scenario, up to 80 per cent of the population could be infected. It also says in the event of mass sickness, police services would focus on responding only to serious crimes and maintaining public order while the NHS would be forced to discharge patients and cancel operations. The army could also be called in to support civil authorities.

    March 4, 2020 Reply
  42. Roger Kirby Professor of Urology

    The NHS yesterday declared a major national incident over the coronavirus outbreak and ordered all hospitals to review their numbers of intensive care beds and how they could be increased to cope with a surge in patients.
    A letter sent to health chiefs yesterday by NHS England reveals patients infected with the virus could soon start to be treated on hospital wards instead of specialist units as the numbers affected grow. Hospitals have been told all patients in intensive care who have signs of a lung infection should now be tested for coronavirus, amid fears the virus could already be in hospitals and could spread between patients.
    NHS chiefs have been told to work up plans to segregate wards such as A&E departments, critical care and diagnostic areas in the event of a “significant escalation” in cases of coronavirus.

    March 4, 2020 Reply
  43. Roger Kirby Professor of Urology

    More than 90,000 people have been infected with the deadly Covid-19 coronavirus, the chief of the World Health Organisation (WHO) has confirmed as nations turn to increasingly drastic measures to halt the spread of the virus.
    The coronavirus, which has continued its spread into more than 70 countries after emerging in China in December, has led to the deaths of 3.4 per cent of those confirmed to have contracted it – according to the WHO’s Tedros Adhanom Ghebreyesus.
    However, while warning the virus was deadlier than the flu, which carries a fatality rate of less than 1 per cent, he told reporters in Geneva he believed the virus could still be contained.
    “To summarise, Covid-19 spreads less efficiently than flu, transmission does not appear to be driven by people who are not sick, it causes more severe illness than flu, there are not yet any vaccines or therapeutics, and it can be contained”, he said.

    March 4, 2020 Reply
  44. Roger Kirby Professor of Urology

    A patient with underlying health conditions has become the first person in the UK to die after testing positive for coronavirus.
    The Royal Berkshire NHS Trust said the person was an “older patient” who had been “in and out of hospital for non-coronavirus reasons”.
    The patient was admitted and tested positive for coronavirus on Wednesday.
    It comes as the number of UK people diagnosed with the virus reached 116, a rise of more than 30 in 24 hours.

    March 5, 2020 Reply
  45. Roger Kirby Professor of Urology

    Globally the virus has continued its spread – with Italy, the worst afflicted region in Europe, announcing an additional 31 deaths and almost 800 cases in a 24-hour period.
    In Iran, which has been accused of covering up the scale of the issue within its borders, 107 people have died, prompting a limit on inter-city travel and a push from the government for citizens to reduce their use of paper bank notes.
    Meanwhile South Koreans, who have seen the highest infection rates outside of the disease’s epicentre in China, have been inundated with mobile phone alerts announcing where infected people had been and when. According to the European Centre for Disease Control, 35 people have died in that country while 5,766 have been infected.

    March 6, 2020 Reply
  46. Roger Kirby Professor of Urology

    The global tally of people diagnosed with coronavirus passed 100,000 yesterday, while the number of coronavirus cases in the UK saw its biggest jump to date.
    Matt Hancock, the health secretary, confirmed a second person with Covid-19 had now died in Britain, as the number of patients in the country rose to 164 – up from 116 the day before.
    – More than 4,000 people have been placed in quarantine across New York State, where 33 people have been diagnosed with Covid-19, according to governor Andrew Cuomo
    – Italy’s death toll rose by nearly 50 on Friday to 197, while the number of confirmed cases surpassed 4,000
    – Boris Johnson announced £46m extra funding for research into developing a coronavirus vaccine, saying he hopes one would be ready to use in around a year

    March 7, 2020 Reply
  47. Roger Kirby Professor of Urology

    Read our article in Trends based on a discussion held at the Royal Society of Medicine recently on the issue and impact of quarantine in response to the Covid-19 epidemic. It is now online at https://trendsinmenshealth.com/article/coronavirus-reducing-the-impact-of-quarantine/.

    March 7, 2020 Reply
  48. Culley Carson Professor of Urollogy

    On the other side of the Atlantic, the situation is similar to the UK. There is rising hysteria and much mis information. Some by our president! The number of cases continues to rise and the deaths are rising as well. There have been 70 deaths to date compared with over 8000 for the flu this season. The difference is that there is, to date, no treatment for COVID-19. None of the antivirals are effective and there is as yet no vaccine. The deaths and serious illnesses are predominantly in the elderly and those with preexisting illness. A nursing home in Seattle has had 8 deaths among their patients.

    Our hospital is putting in place a screening for all who enter and there have been cancellations. The Division III college basketball tournament starting this weekend will be without spectators.

    Unfortunately, there are more unknowns than knowns. How does it spread? How long are people at risk? Is there immunity after infection? Is isolation or quarantine effective in stopping spread? What should I do if I have symptoms? Many others.

    An abundance of caution is prudent but how much and for how long. I think that the unknowns coupled with the press hype is causing more panic than is necessary at this time and only time will tell the whole story.

    March 7, 2020 Reply
  49. Roger Kirby Professor of Urology

    Many governments and health officials have released guidance for health-care professionals, but published advice alone is insufficient. Guidance on how to manage patients with COVID-19 must be delivered urgently to health-care workers in the form of workshops, online teaching, smart phone engagement, and peer-to-peer education. Equipment such as personal protective equipment, ventilators, oxygen, and testing kits must be made available and supply chains strengthened. The European Centre for Disease Prevention and Control recommends that hospitals set up a core team including hospital management, an infection control team member, an infectious disease expert, and specialists representing the intensive care unit and accident and emergency departments.

    March 7, 2020 Reply
  50. Roger Kirby Professor of Urology

    Italy last night placed a quarter of its population under mandatory quarantine after a new spike in coronavirus cases yesterday took the total number of people infected to 5,883 — the largest figure outside Asia.
    The prime minister, Giuseppe Conte, signed the decree shortly after midnight, banning movement in and out of Lombardy, Italy’s most populous and wealthy region. The ban also applies to parts of the northern regions of Emilia-Romagna, Piedmont, Veneto and the Marches, affecting the lives of around 16 million people.

    March 8, 2020 Reply
  51. Roger Kirby Professor of Urology

    Italian deaths surged more than 50% and are the highest outside China while France banned large gatherings to limit the spread of the coronavirus. Apple is letting some employees work from home.

    Seattle said two more nursing home residents died, bring the local toll to 17. The Grand Princess cruise ship with ill passengers and crew will dock Monday in Oakland, California.

    March 8, 2020 Reply
  52. Roger Kirby Professor of Urology

    The number of coronavirus-related deaths in Italy has leapt by more than half in just 24 hours, with 133 new fatalities announced yesterday as UK officials warned against all but essential travel to the north of the country.
    Italy, the worst affected nation in Europe, confirmed the death toll related to the Covid-19 virus within its borders had risen to a total of 366, 37 days after it was first observed in the country. Infections across the nation stood at 7,375 – up by almost 1,500 in a 24-hour period. The increase makes the country the second-worst afflicted worldwide, with only China confirming more cases so far.

    March 9, 2020 Reply
  53. Roger Kirby Professor of Urology

    Deaths from coronavirus in Italy have jumped from 233 to 366 – a 57% increase – as the country’s prime minister said he will use “massive shock therapy” to battle the outbreak.
    The rise was by far the largest daily rise in fatalities since the start of the crisis there last month.

    March 9, 2020 Reply
  54. Roger Kirby Professor of Urology

    The decision to delay closing schools and introduce other strict measures to combat coronavirus has been defended by England’s deputy chief medical officer.
    Dr Jenny Harries said experts are assessing new cases on an hourly basis to achieve a “balanced response”.
    She told BBC Breakfast new measures could follow as UK cases begin to rise rapidly over the next two weeks.
    In the UK, five people with the virus have died. There were 319 confirmed cases as of 09:00 GMT on Monday.
    Dr Harries said the vast majority of those diagnosed with coronavirus in Britain are “pretty well” but that they may “feel a bit rough for a few days”.
    She added that people with flu-like symptoms will be advised to self-isolate within 10 to 14 days and, at the same time, significant increases in the number of cases are likely to begin.
    Dr Harries said cancelling big outdoor events like football matches would not necessarily be a decision supported by science.

    March 10, 2020 Reply
  55. Roger Kirby Professor of Urology

    The number of people infected nationwide in the UK has increased to 382, the second largest day-on-day increase since the outbreak began
    Junior health minister and MP Nadine Dorries has confirmed she has contracted the virus. She is believed to have attended an event with the prime minister Boris Johnson before testing positive
    A man in his early 80s at Watford General Hospital has died after contracting the virus. Officials confirmed he had suffered with an underlying health condition
    The deputy chief medical officer for England has warned the peak of the epidemic will likely hit in the next 10-14 days

    March 11, 2020 Reply
  56. Roger Kirby Professor of Urology

    Dr Jenny Harries, England’s deputy chief medical officer, has said the start of the UK peak of the coronavirus epidemic is expected within the next fortnight
    “Within 10 to 14 days we will be likely to advise people with symptoms to self-isolate and we are expecting that start of the peak to come within that period,” she said.

    March 11, 2020 Reply
  57. Roger Kirby Professor of Urology

    Boris Johnson will chair an emergency Cobra meeting today during which he is expected to approve moving to the “delay phase” of the coronavirus response, after the outbreak was declared a pandemic by the World Health Organisation (WHO).
    Moving from the containment to the delay stage would mean social distancing measures would be enacted, including restricting public gatherings and issuing more widespread advice to stay at home.
    It comes after eight people with Covid-19 were confirmed to have died in the UK, as the total number of positive cases rose to 460.

    March 12, 2020 Reply
  58. Roger Kirby Professor of Urology

    At least 631 people have now died from coronavirus in Italy – an increase of 168 in a single day.

    The 36% rise is the biggest since the COVID-19 contagion first came to light there on 21 February.

    Almost a thousand extra cases of coronavirus were recorded in 24 hours – reaching 10,149.

    The head of the country’s civil protection agency said 877 people were in intensive care – up from 733 on Monday.

    Just over 1,000 have now fully recovered.

    March 12, 2020 Reply
  59. Roger Kirby Professor of Urology

    Ireland will close all schools and cancel all public gatherings amid the coronavirus outbreak, according to the Irish premier.
    The effective lockdown will start from tonight and remain in place for two weeks, Leo Varadkar has said.
    Teaching will be done online or remotely until 29 March as schools and colleges shut temporarily as Ireland battles the spread of Covid-19.
    Childcare facilities will also be temporarily shut, and people will be encouraged to work from home, the taoiseach said.
    Indoor gatherings of more than 100 people and outdoor meetings of more than 500 will be cancelled.

    March 12, 2020 Reply
    • Nicola Stingelin Ethicist

      Quote from the venerable Prof John Ashton on the UK response to Covid-19:

      Ministers ‘behaving like 19th-century colonialists playing a five-day game of cricket’.

      March 12, 2020 Reply
  60. Roger Kirby

    Up to 10,000 people in the UK probably have coronavirus, officials have said, as they announced they were stepping up Britain’s response to the outbreak with new actions designed to delay its spread.
    From today, anyone showing cold or flu-like symptoms is being told to isolate themselves for seven days – a measure brought forward by at least a week. They should then stay at least two metres, or “about three steps”, away from anyone else, sleep alone and ask for help “to get the things you need”.
    “Stay away from vulnerable individuals such as the elderly and those with underlying health conditions as much as possible,” the new advice reads.
    Schools have been ordered to cancel all foreign trips, and over-70s or those with underlying health conditions are advised not to go on cruise ships.
    Premier League and Champions League football games have just suspended until 2nd April.

    March 13, 2020 Reply
  61. Roger Kirby Professor of Urology

    Cases in the UK have risen to 798, up from 590 on Thursday
    Spain has announced a steep rise in the number of coronavirus victims
    English Premier League suspends all matches until 3 April – Uefa Champions League and Europa League also affected
    Belgium, France, parts of Germany, India and some US states become the latest places to close schools
    Czech Republic and Slovakia close borders to foreigners except those with residence permits and Malta announces mandatory quarantines for new arrivals
    Just eight new cases are reported in China
    Majority of people in the UK need to get a mild dose of coronavirus for “herd immunity”, chief scientific adviser says

    March 13, 2020 Reply
  62. Roger Kirby Professor of Urology

    Jeremy Hunt has said it is ‘surprising and concerning’ that large gatherings have not been cancelled
    Speaking to BBC Newsnight, former health secretary Jeremy Hunt described the coronavirus outbreak as a “national emergency” – adding he was “personally surprised that we’re still allowing external visits to care homes”.

    He said: “I think it is surprising and concerning that we’re not doing any of it at all when we have just four weeks before we get to the stage that Italy is at.

    “You would have thought that every single thing we do in that four weeks would be designed to slow the spread of people catching the virus.”

    March 13, 2020 Reply
  63. Roger Kirby Professor of Urology

    In response to the challenge of COVID-19, the four surgical Royal Colleges of the UK and Ireland have created a joint policy statement to provide guidance to surgeons and surgical trainees.

    From Monday 16 March, conferences, educational and training courses, assessment panels, accreditation visits and examinations that require travel will be postponed. Where possible, activities will continue if these can be delivered by video call or webinar. Events within hospitals may continue if local circumstances allow this. These arrangements will remain in place until at least the end of the summer.

    March 13, 2020 Reply
  64. Roger Kirby Professor of Urology

    The U.K. government’s strategy to tackle the outbreak will need almost 40 million Britons to catch the disease to work, according to the country’s top scientific adviser. “Sixty percent is the sort of figure you need to get herd immunity,” the government’s Chief Scientific Adviser Patrick Vallance told Sky News.

    He was referring to the point where a high enough proportion of the population has had an illness — and gained immunity to it — that it won’t be transmitted to those who haven’t had it. The government wants to achieve this over the summer months, before the next winter sets in.

    The figure is likely to be controversial, and comes a day after Johnson told reporters many families can expect to lose their loved ones and that the nation is facing the greatest public health crisis in a generation. His approach has been criticized by other medical experts because measures announced so far are relatively restrained compared to other countries.

    March 13, 2020 Reply
  65. Roger Kirby Professor of Urology

    The number of confirmed UK coronavirus cases has risen to 798, the government has said.

    More than 200 people have been tested positive in a day, according to official figures. That jump, up 35 per cent in a day, is by far the biggest rise in cases of Covid-19 in one day.

    One week ago, on 6 March, the total number of cases stood at 163.

    Today’s total of 798 is almost five times greater than the equivalent figure one week ago.

    In total, 32,771 people have been tested for the disease, the Department of Health said. The relatively low number of people being tested for coronavirus has been criticised, but NHS England has committed to increase those numbers rapidly.

    March 13, 2020 Reply
  66. Roger Kirby

    In Italy, the number of infections has soared by more than 2,500 in 24 hours, while virus-related deaths made the largest single-day jump of 250. It took the total number of cases in the country to 17,660, and the number of related deaths to 1,266.
    In the hardest-hit Lombardy region, hospitals were overflowing with both the sick and the dead. The country’s restaurants, cafes and retail shops closed. Grocery stores, pharmacies and markets were allowed to operate, with orderly lines of evenly spaced customers forming outside to avoid crowds inside.
    France, Spain and Germany all exceeded 2,000 cases each. Panic buying was seen around the continent. Health chiefs in Germany and Italy scrambled for ventilators as manufacturers warned yesterday that hospitals faced a lack of vital equipment.

    March 14, 2020 Reply
  67. Roger Kirby Professor of Urology

    Community Action Response – five things you can do:

    Think of others, consider your actions & be kind: People in every community will face the challenges of Covid-19 in some way – from needing basic provisions to help while they are unwell.
    Connect and reach out to your neighbours: as self-isolation increases, we need to find new ways to stay connected and check in on one another for our physical and mental wellbeing. Share phone numbers and stay in touch.
    Make the most of local online groups: Keep up to date, share information and be a positive part of your local community conversations using platforms like Nextdoor.
    Support vulnerable or isolated people: different groups in our communities are at increased risk and social isolation and loneliness are key concerns for all ages. There are things you can do like volunteering for local support services or donating to food banks to help.
    Share accurate information and advice: Support anyone who may be anxious about Covid-19. Sign post them to the correct advice from Public Health England and encourage people to follow the correct hygiene practices.

    March 14, 2020 Reply
  68. Roger Kirby Professor of Urology

    Iran’s armed forces will clear all cities within 24 hours to contain the spread of coronavirus that has killed more than 500 people, the official IRNA news agency has reported.
    The extraordinary measure was announced by Iran’s military chief of staff Major General Mohammad Baqeri, who said: “Clearing shops, streets and roads will be carried out in the next 24 hours as a national decision.”
    He added that this would be carried out in coordination with the Interior Ministry and provincial governor general.
    The Basij – the paramilitary branch of the feared Islamic Revolution Guards Cops (IRGC) – medical students, conscripts with medical expertise and retired health workers, meanwhile, will be drafted in to the efforts to combat the coronavirus outbreak, which has so far killed 514 people and infected nearly 12,000 more.

    March 14, 2020 Reply
  69. Roger Kirby Professor of Urology

    Number of deaths in the UK rises from 11 to 21
    Spain announces 1,500 new cases, bringing the total there to 5,700
    British low-cost airline Jet2 cancels flights to mainland Spain and the Canary Islands
    Death toll from coronavirus in hotspot Iran jumps by 97 to reach total of 611
    New Zealand imposes 14-day quarantine on anyone entering the country from Sunday
    A ban on non-Americans travelling from 26 European countries comes into force in the US

    March 14, 2020 Reply
  70. Roger Kirby Professor of Urology

    Ten more people have died after being diagnosed with coronavirus, with 1,140 cases now confirmed in the UK.
    It is the largest number of deaths announced on a single day since the start of the outbreak and brings the total number of fatalities to 21.
    The number of people testing positive for the infection was up by 342 from 798 at the same time on Friday.
    Health officials say 37,746 people have so far been tested.
    The ten patients who died were all aged over 60 and were in “the at-risk groups”, said Professor Chris Whitty, chief medical officer for England.

    March 14, 2020 Reply
  71. Hannah Warren Urology Registrar

    There is a sombre feeling on the front line. It is eerily quiet as patients stay away from A&E for fear of catching the virus, but we all know that it is likely just days until this situation changes dramatically and preparations are gathering pace. NHS hospitals are declaring ‘Major Incidents’ to be able to implement the changes they need to meet the impending demand. In my own hospital all elective surgery is cancelled, including most cancer surgery that can afford to be deferred. Routine clinic appointments are being cancelled or are to be done by phone. Trainees from all specialities have been informed they will be drafted in to areas of need when required. The stories coming out of Italy from health care workers are alarming. It is going to be a difficult time for the population, but particularly awful for health care workers. Let’s look out for each other.

    March 15, 2020 Reply
    • Dr Nicola Stingelin Ethicist

      Good luck Hannah to you and your team

      March 16, 2020 Reply
  72. Roger Kirby Professor of Urology

    The number of people who have died after testing positive for coronavirus in the UK has risen by 14 – the largest increase in a 24-hour period.
    There are now a total of 35 fatalities.
    There have been 1,372 confirmed infections, a rise of 232 in a day.
    It comes as the health secretary told Sky News that over-70s would be asked to self-isolate “in the coming weeks” and America added Britons to a ban on travellers from Europe.
    Bristol Royal Infirmary said one of the deaths was a patient there in his late-50s who had underlying health conditions.

    March 15, 2020 Reply
  73. Roger Kirby Professor of Urology

    Cases topped 152,000 worldwide, with deaths at 5,700
    China has 80,824 confirmed cases, 3,189 deaths
    In the U.S., nine new deaths and 520 new cases were reported
    France’s prime minister says people ignore warnings
    Schools in Jakarta will close for two weeks
    African nations from Rwanda to Mauritania reported first cases

    March 15, 2020 Reply
  74. Roger Kirby Professor of Urology

    Every Briton over the age of 70 will be told “within the coming weeks” to stay at home for an extended period to shield them from coronavirus, Health Secretary Matt Hancock has said.
    He told the BBC the advice will not come into force just yet but when it does it will last “a very long time”.
    It comes as 14 more people have died in the UK after testing positive for the virus, bringing total deaths to 35.
    Manufacturers will be asked to make extra NHS ventilators, Mr Hancock said.
    The total number of confirmed UK cases of the virus has reached 1,372, with a total of 40,279 people being tested, according to the latest figures released by the Department of Health and Social Care.
    Of the 14 patients that died, all were aged between 60 and 90, and most had underlying health conditions, according to the latest information released by hospital trusts.
    It comes after 34 new cases were announced in Wales, 32 in Scotland and 11 in Northern Ireland.

    March 15, 2020 Reply
  75. Brian Dye Lawyer

    This has been a very good blog by the OP. If I may, as a lawyer, I’d like diffidently to make some additional comments about UK government policy re Covid-19 and see if any readers agree or disagree:

    1) The Chief Medical and Chief Scientific Officers have not yet published at all still less in auditable form the data and the economic and mathematical models on which they rely so that these can be critiqued, but they will do so shortly, and this is a good development.

    2) It is very understandable that, hit by an unexpected crisis, government policy may be for a time in disarray. However, since our government’s policy is not at present in accordance with WHO recommendations, I’m hoping that, when the Chief Medical and Chief Scientific Officers publish their models and data, those in the medical profession take care of us by using their expertise to at a high level what we need to do as a people to protect our fellow citizens.

    3) One of the critiques should be, I hope, be this: statistically, Covid-19 is a “Black Swan” event. We learned about these in the financial crisis of 2008. They are events for which there is no reliable body evidence as to the extent of the harm that they can do. Plainly, there is no past data for this particular disease. Given the extreme degree of harm now being manifested (see the fatality rate in Italy in particular) statisticians would call Covid-19 a “fat tailed process”.

    4) Since there is no reliable data or modelling that the authorities can draw in order to make reasonable predictions of “likelihoods”, it is very highly arguable that the intellectual approach of the Chief Medical and Scientific Officers in giving policy recommendations to Government based on what they advise is the “likely” course of the disease is systemically flawed – because of that very fact there is no reliable data from past events of Covid-19 which any conclusion as to likelihoods can be drawn.

    5) Statistically, therefore, a correct intellectual approach is therefore – not to base policy on Covid-19 on estimates of “likelihood”, but – to base policy on choices that minimise the “risk of ruin”; the so called “precautionary approach” – this approach should be taken because in the case of Covid-19 there are no statistical averages that are valid since the risks of Covid-19 are not ergodic.

    6) Indeed, estimates of Covid-19’s reproductive ratio have a downward bias, because they are averages that are vulnerable to superspreader, and/or maybe asymptomatic, spread events. The reproductive ratio is itself a endogenous variable.

    7) Moreover, the uncertainty characteristics of the virus, eg such as whether there is (i) asymptomatic spread (ii) spread through the womb (iii) re-infection by Covid-19 or a mutation thereof, raise the risks and uncertainties of the course the virus may take, and undermine the ability to predict the likelihood of outcomes on estimates of which the advice given to the Government is apparently based.

    8) The fatalistic thesis propounded in the advice to the Government – that large swathes of the population will contract Covid-19 in any event – fails to recognise the proven favourable impact that dramatic interventions have made in other Far Eastern countries, as to which there is modelling that suggests such an approach can crush the disease at least for the time being. Dramatic reductions in connectivity have in those countries, with a short lag, produced dramatic reductions in new infections.

    9) The WHO approach of testing, tracing, quarantining and isolating is not being adopted in the UK, apparently in preference to some sort of economic behavioural theory. However, unempirical nudge theory and behavioural economics – based on analysis of data for other diseases, some of those diseases less infective, some less harmful, some less uncertain, some less novel, than Covid-19 – may be as flawed as the pre 2008 macroeconomic modelling that failed to predict the Black Swan events of the 2008 financial crisis. Economists do not have a good record in fortune-telling!

    10) The fact that the public have already led the charge towards self-isolation gives us valuable information which at least embodies the wisdom of the crowd, and is suggestive that the economic modellers lag the public and may have got their evaluations wrong. Are economists any more reliable now in 2019 than they were pre-2008?

    11) The fatalistic thesis that there will be a second wave of Covid-19 will be rapid and overtake the pubic before a vaccine is available is not evidence based – there being no evidence for this particular disease. There are many reasons to try to crush or heavily stunt the progress of the disease now: see below.

    12) If (which is now denied by the Government to be its policy) the Government’s policy were to seek to bring about herd immunity, otherwise than by vaccination, that would involve an untried experiment of infecting about 47 million Britons, with a ill-understood disease which is presently manifesting itself with a high fatality ratio. We have not been told what the Government estimate is of the top and bottom end of the range of fatalities, but even if we were told, how could we know the estimate was reliable when reliable data on which the estimates could be based is lacking? The fatality ratio estimates plainly need to be very large to match the current experience.

    13) If alternatively (which has not yet been clearly articulated by the Government) their policy is to have bureaucrats try to manage the “attack rate” of the disease by bringing in regulations at times to slow the attack rate or keep regulation looser at other times to let the disease progress to help develop immunity, there is overwhelming evidence – in many fields – that governments rarely “pick winners”. How can they know the time to press the brake, or let go of it, given the very significant uncertainties of the properties of Covid-19 as set out above?

    14) Taking into account also the great uncertainties of collection of data, the failure of the Government to choose to introduce a massive self-testing programme for Covid-19 on demand, and the uncertainties inherent in Covid-19, it is a matter of luck whether a policy of picking the right time to intervene works or not. The policy is in reality a “game of hazard” with the public.

    15) Test it this way: Russian roulette is a game of hazard where one is invited to put a six chamber gun with a bullet in only one chamber to one’s forehead. The “likely” outcome, if one does it is that one does not come to harm: there is a 5/6 chance of no harm. But no-one plays Russian roulette for real, relying on what is “likely”, because, inherently, we all recognise that the right way of dealing with processes than can cause extreme harm is to operate on the precautionary principle of avoiding the risk of ruin. But that is not what the government advice is to do here: the advice has been to date (and to this extent the Government can make no denial) to leave the public exposed to the harm.

    16) Test it another way, too. I understand there are about 6.6 ICU beds per 100,000 of the UK’s population – about 4,500 beds. Let’s also suppose that private hospitals are commandeered and that ventilators in operating theatres too: suppose then that the UK has 9,000 respirators right now. Each case in Italy is taking an average of 18-21 days to resolve to discharge or death in ICU beds. Suppose then that 47 million UK citizens are infected at an even rate over 1 year and that just 10% of them are critical, needing ventilation. Then calculated ventilator turnover rate is about 17 times a year. So we have right now ventilator capacity of 9000 times 17 – enough to treat 153,000 people – but we will have 4.7 million people needing ventilation. In these circumstances, it is obvious that, even if we commandeer manufacturers to turn to production of ventilators, the fatality rate may well be higher than Hubei or in Italy, because not enough ventilators will be available for everyone who needs them. The Government needs to tells us what its estimates of the ventilator deficiency are and how production of them will be ramped, whist taking steps now to crush the disease by dramatic isolation measures until the ramped up production of ventilators is well under way. By my calculation, a huge ramp up of ventilator production is needed – on my calculation about 263,000 ventilators are needed, each turning over 17 times, to deal with 4.7 million ventilator patients over the next 12 months. But even if we have that, those numbers far exceed how many beds in the NHS or the private sector we have put together. So: we will need field hospitals. We should certainly start producing the ventilators now, but we need to ramp up the field hospitals. And then the staff? What we are going to need to do is train people like the Battle of Britain spitfire trainees, give them a few hours training in the cockpit and are send them into battle. So: we had better start organising this right now. We’ll need 130,000 such people at rate of 1 carer for 2 patients.

    17) A third aspect (which may or may not be an aspect of Government policy, I sincerely hope not, but I do not know) might be that a there is in the background some sort of cost reckoning afoot, bearing in mind the massive economic recessionary and social cost of the dramatic connectivity reduction measures needed now to stem the disease. There may be those who consider that it is fair to evaluate those costs in terms of lost GDP in the light of the economic value of the lives that will lost if those connectivity measures are not taken. NICE evaluates years of life gained by estimating the value of Qalys and, while these values may be controversial, the same type of calculations can theoretically be made for the economic value of lives lost. With Covid-19, it appears that the fatality rate is quite high for those of age 70+, and lower for people of younger age than that. So, some might say that there is an intergenerational issue of equity if a very large economic costs need to be borne by the whole UK population, the main benefit of which may be in age groups with a lower Qaly values (as economists might calculate them), and perhaps it may be said that the aggregare aggregate lost Qaly value in terms of lost lives is below the massive costs of the social isolation measure to combat Covid-19. As I say, I very much do hope that the foregoing is not part of the Government’s thinking at all. For two reasons.

    18) First, if we apply the criteria of a theory such as John Rawls “Theory of Justice” to the policy choice and hypothetically ask each individual the question of whether, before being born and not knowing what age he/she would be if and when Covid-19 struck, he/she would choose a policy of not taking connectivity reduction measures to save economic cost, thereby exposing people of 70+ to a higher chance of earlier death, I reckon most people would answer “Certainly, not”. In principle, therefore, under standard Rawlsian theory, I say such a policy would be deeply unjust.

    19) Secondly, the policy would be wrong for another reason. This is simply that the uncertainties of Covid-19 are so great that one simply cannot rule out that a large swathe of younger people will die from it, if it is allowed to infect a substantial proportion of the UK population. The precautionary principle of acting to prevent ruin does not justify any belief that in the long run younger people will not experience significant death rates. Indeed, already in Italy there is evidence of more and more younger victims. Trying to stop the thing in its tracks until at least we can ramp up field hospitals, staffing and ventilators and are close to a vaccine seems to be a reasonable precautionary approach, combined with self testing. A major major flaw of policy at the moment is that we are not rolling out mass public availability of testing and until we have that we won’t be capable of fighting back effectively, It was Intelligence that was critical in winning the Second World War, as any visitor to Bletchley Park will know. Knowledge is power. Testing is knowledge.

    20) So as the Government’s data and modelling are published in due course, I say we need the leaders in Medicine and Statistics to look at it and evaluate and critique the policy being implemented to help protect us all. Conceptually, same happened in the Second World War during 1940. Chamberlin’s war policy, if we recall, was critiqued. After the disaster in Norway, it lost the confidence of the House of Commons, and was replaced.

    March 16, 2020 Reply
    • Nicola Stingelin PhD medical ethics

      Thank you. The voice of an ethicist / data ethics specialist:

      I agree that with ‘Black Swans’ the principles of transparency and accountability are important, needing to be balanced with public health duties of responsibility & protecting from panic reactions.
      Therefore it is essential to have all (synthetic) data sets and the economic and mathematical modelling assumptions and scenario- building made available to a wide panel of top experts who may hold different but informed/justifiable views and approaches.

      Such work must be multidisplinary – humanities as well as natural sciences

      A problem I often refer to in my work is that of confusing ‘risk’ and ‘uncertainty’: by definition, risk implies being able to make an estimation based on known factors; risk is rational, calculable, scientific (= probability, dimension of consequences, vulnerability, exposure)

      Modelling based on uncertainty (to a large extent our situation now) is another ball game where transparency, accountability, research ethics principles, discourse (incl Rawls) are vital.

      Agree that data & stats people must be now fully involved (perhaps they are already?).

      There are interesting parallels in this discussion with the work underway in the area of big data, real world data, synthetic data governance and ethics.

      March 17, 2020 Reply
  76. Roger Kirby Professor of Urology

    Now is the time for everyone to stop non-essential contact with others and to stop all unnecessary travel,” the prime minister says.

    Here are some key points:

    Anyone who lives with someone who has a cough or a temperature should stay at home for 14 days
    People should start working from home where they possibly can
    Avoid pubs, clubs, theatres and other such social venues
    Only use the NHS when we really need to
    From tomorrow government will no longer be “supporting” mass gatherings using emergency workers

    March 16, 2020 Reply
  77. Roger Kirby Professor of Urology

    The UK government will unveil more financial plans to help the economy during the coronavirus outbreak, after the prime minister announced unprecedented peacetime measures.
    Boris Johnson has urged everyone to avoid unnecessary social contacts, to work from home where possible, and to stay away from pubs and restaurants.
    People in at-risk groups will be asked within days to stay home for 12 weeks.
    Firms warned the virus restrictions could put them out of business.
    The number of people who have died with the virus in the UK has reached 55.
    More than 1,500 people have tested positive for the virus in the UK – but the actual number of cases is estimated to be between 35,000 and 50,000.

    March 17, 2020 Reply
  78. Roger Kirby Professor of Urology

    The government is facing rising anger over Boris Johnson’s decision to keep schools open amid the coronavirus pandemic.
    The prime minister’s spokesperson said the scientific advice was that school closures were not a step the government should be taking at this time.
    However, concerned parents have been keeping their children at home and complaining other countries were doing more to stop the spread of Covid-19.
    The hashtags #Covid19Walkout and #CloseTheSchoolsNow were both trending on Twitter yesterday, with pupils posting photos of densely packed school corridors and saying it was impossible for follow guidance on social distancing. A petition on parliament’s website calling on the government to close schools and colleges has been signed more than 590,000 times

    March 17, 2020 Reply
  79. Roger Kirby Professor of Urology

    SOME RELIABLE WEBSITES ON COVID-19, which are continuously updated (useful only if relevant for a specific decision):
    LSHTM Covid-19 updates. Available at: https://www.lshtm.ac.uk/newsevents/news/2020/covid-19-updates-lshtm
    PHE guidance (updated regularly): https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance
    PHE guidance (stay at home guidance): https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance
    WHO Novel coronavirus (2019-cCov). Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
    WHO Technical interim guidance for novel coronavirus. Available at: https://www.who.int/health-topics/coronavirus
    WHO travel advice for international travel and trade in relation to the outbreak of pneumonia caused by a new coronavirus in China. Available at: https://www.who.int/ith/2020-0901_outbreak_of_Pneumonia_caused_by_a_new_coronavirus_in_C/en/
    WHO Novel Coronavirus (COVID-19) situation reports. Available at : https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
    WHO Dashboard for Novel coronavirus (COVID-19). Available at: https://experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b9125cd
    WHO European dashboard for COVID-19. Available at: http://who.maps.arcgis.com/apps/opsdashboard/index.html#/ead3c6475654481ca51c248d52ab9c61
    ECDC daily risk assessments: https://www.ecdc.europa.eu/en/current-risk-assessment-novel-coronavirus-situation
    UK totals updated circa. 14:00 daily: https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public#number-of-cases

    March 17, 2020 Reply
    • Nicola Stingelin Ethicist

      better late than never
      Tks for this. Really useful
      Virtual hug – Missing all my profesional friends in London

      March 25, 2020 Reply
  80. Brian Dye Lawyer

    There has been short, but an extremely important, statistical Note published today by Taleb et al critiquing the also very important paper just published last night by a team at Imperial College, the latter paper being one which is apparently now informing Government policy since the last few days.

    Nassim Nicholas Taleb is acknowledged as one of the most brilliant statisticians and mathematicians at this time in the field of risk and decision analysis. His reputation has grown over the years as a result of his analysis of Black Swan events; in particular, the 2008 financial crisis. Here is a link to the Taleb et al Note published today:

    https://www.academia.edu/42242357/Review_of_Ferguson_et_al_Impact_of_non-pharmaceutical_interventions…_

    The case that Taleb et al advance in this Note is that Imperial’s conclusion that suppression, not merely mitigation, of Covid-19 is essential because merely to mitigate the disease inevitably results within a very short time in a massive overload of the UK’s health resources and many fatalities, for which we are completely unprepared. That’s good that Imperial’s conclusion in that respect is approved by such an authority.

    However, and this is what is especially important about the Taleb et al paper, the authors’ view is that not only are a number of the assumptions employed by Imperial wide of the mark, but also that the modelling used by Imperial is weak in several important respects and, indeed, that the actual type of mathematical model used by Imperial is “not well suited for incorporating real world conditions on a fine or large scale and that Imperial’s model is in fact “several degrees of abstraction away from what is warranted.”

    Taleb et al conclude that, adopting a more correct approach, it can be shown that a suppression strategy can, contrary to the present conclusions of Imperial, actually achieve the following:

    (i) “The outbreak can be stopped completely with no resurgence as in China, where new cases were down to one yesterday, after excluding imported travellers who were quarantined”; and

    (ii) “Since lockdowns result in exponentially decreasing numbers of cases, a comparatively short amount of time can be sufficient to achieve pathogen extinction, after which restrictions can be relaxed without resurgence.”

    This would be very good news, if true. It would mean that Imperial are right, but too pessimistic about the degree of success that suppression can achieve. Taleb is a very distinguished man, with a good track record in the field of analysing extreme risk and uncertainty. If this is his Opinion, and if it is right, this is certainly something of potentially great importance that the press, the Medical profession and the Government should know. I am very much hoping that those readers who may know or have access to the Chief Medical and Scientific Officers could draw this paper to their attention and give the Taleb et al Note the widest possible publicity through social media and other means. If Taleb et al are right in asserting that there is a way out of this crisis even now by taking what are dramatic by comparatively simple measures that they describe, why would we not take those measures now, given what we now know about the extent of harm uncertainly and risk inherent in Covid-19, at present running amok.

    Apologies for writing to this Blog twice – in one day – but I felt the Taleb et al paper, published in an area that might be less familiar to some doctors, was too important to ignore, when many lives are at stake. Hope this helps.

    March 17, 2020 Reply
    • Nicola Stingelin Ethicist

      Better late than never: thks this input. It has never been more Important to carry on learning.

      March 25, 2020 Reply
  81. Roger Kirby Professor of Urology

    Chancellor Rishi Sunak has unveiled an “unprecedented” set of financial measures to support the UK economy through the coronavirus pandemic.
    They include mortgage “holidays” for those in financial difficulty as well as £330bn in loans to protect businesses facing losses as a result of the virus.
    Meanwhile all non-urgent operations in England and Scotland will be postponed to free up beds for virus patients.
    It comes as the UK death toll hit 71.
    The government’s chief scientific adviser Sir Patrick Vallance said it would be a “good outcome” for the UK if the number of deaths from the virus could be kept below 20,000.

    March 17, 2020 Reply
  82. Roger Kirby Professor of Urology

    NHS hospitals have been told to cancel operations in an effort to free up 30,000 beds to create space for an expected surge in coronavirus patients.
    In a letter to NHS bosses yesterday NHS England said hospitals should look to cancel all non-urgent surgeries for at least three months starting from 15 April.
    Hospitals were given discretion to begin winding down activity immediately to help train staff and begin work setting up makeshift intensive care wards. Any cancer operations and patients needing emergency treatment will not be affected.
    The measures come as the UK death toll rose to 71 as the Department of Health and Social Care said there were now 1,950 confirmed cases. The chief scientific adviser Sir Patrick Vallance told MPs on Tuesday as many as 55,000 people could have been infected by the virus.

    March 18, 2020 Reply
  83. Roger Kirby Professor of Urology

    The European Union will ban all travellers from outside the bloc for 30 days
    The US is working on an $850bn stimulus package
    UK government faces calls to do more to help renters and those in the gig economy
    Nevada will shutter all non-essential businesses, including Las Vegas casinos
    WHO says South East Asian countries must “act now” to tackle the virus
    More than 198,000 people have contracted the new coronavirus worldwide
    China, Italy and Iran have been the worst hit countries

    March 18, 2020 Reply
  84. Roger Kirby Professor of Urology

    A further 14 people have died after being diagnosed with coronavirus in England, bringing the UK’s total to 71.

    NHS England said those who died were aged between 45 and 93 and all had underlying health conditions.

    Sixty-seven have now died in England after testing positive for COVID-19.

    Earlier, it was revealed the number of confirmed coronavirus cases in the UK has reached 1,950 – up 407 in the past 24 hours and a rise of 26%.

    March 18, 2020 Reply
  85. Mike Kirby Professor

    Helpful to know that CT findings of COVID-19 overlap with the CT findings of diseases caused by viruses from a different family, such as adenovirus, and have differences as well as similarities with viruses within the same family, such as SARS-CoV and MERS-CoV.”

    Reference: https://www.ajronline.org/doi/10.2214/AJR.20.22954

    Thanks for your thoughtful piece John.

    In mitigation the research information arrived also a bit late.(16 March 2020)

    Imperial College COVID-19 Response Team

    Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand
    :DOI: https://doi.org/10.25561/77482 (20 pages)

    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.
    . 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.

    March 18, 2020 Reply
  86. Michael Kirby Professor

    I keep getting asked about children and the impact on them and risk to grandparents etc.
    Text below summarizes what the current knowledge is:
    Preliminary evidence suggests children are just as likely as adults to become infected with SARS-CoV-2 but are less likely to be symptomatic or develop severe symptoms. However, the importance of children in transmitting the virus remains uncertain. Children more often have gastrointestinal symptoms compared with adults. Most children with SARS-CoV present with fever, but this is not the case for the other novel CoVs. Many children affected by MERS-CoV are asymptomatic.
    The majority of children infected by novel CoVs have a documented household contact, often showing symptoms before them.
    Therefore children with COVID-19 have fewer symptoms and less severe disease, according to a review published in The Pediatric Infectious Disease Journal. Ref below
    The news comes from data reported by the Chinese Centers for Disease Control and Prevention showing that of the 72,314 cases as of February 11, 2020, only 2% were in individuals aged younger than 19 years.
    A case series with 34 children from the Province of Shenzhen showed that none of the children diagnosed between January 19, 2020, and February 7, 2020, had an underlying disease, 65% had common respiratory symptoms, 26% had mild disease, and 9% were asymptomatic. The most common symptoms were fever (50%) and cough (38%). Most infected children recovered 1 to 2 weeks after the onset of symptoms and no deaths from SARS-CoV-2 has been reported by February 2020.
    “From these series, it appears that children have milder clinical symptoms than adults, “It has therefore been suggested that asymptomatic or mildly symptomatic children might transmit the disease. However, the majority of children infected with SARS-CoV-2 thus far have been part of a family cluster outbreak. The importance of children in transmitting the virus remains uncertain.”

    Ref
    Coronavirus Infections in Children Including COVID-19
    An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children
    Zimmermann, Petra MD, PhD*,†,‡; Curtis, Nigel FRCPCH, PhD†
    The Pediatric Infectious Disease Journal: March 12, 2020 – Volume Online First – Issue –
    doi: 10.1097/INF.0000000000002660

    March 18, 2020 Reply
  87. Roger Kirby Professor of Urology

    Italy registers 475 new deaths – the highest one-day rise since it was hit by the virus
    The UK is to shut schools – but they will still need to look after children of key workers
    Prime Minister Boris Johnson tells news conference “we need to apply further downward pressure” on cases
    Tougher restrictions in London not ruled out by PM
    Canada and US closing border to non-essential transit
    Confirmed cases worldwide pass 200,000, more than 8,000 people have died
    EU countries have begun turning away travellers from outside the bloc
    Share prices across global markets fall as stimulus packages fail to reassure markets
    Glastonbury festival and Eurovison Song Contest cancelled

    March 18, 2020 Reply
  88. Roger Kirby Professor of Urology

    Italy has just surpassed China for the most number of deaths related to coronavirus.
    The total number of cases in the country rose to 41,035 on Thursday, which includes 5,322 new cases, the Italian Civil Protection Agency said at a news conference.
    The number of deaths in Italy has reached 3,405, making Italy the world’s deadliest center of the Covid-19 outbreak.
    The current number of deaths in China stands at 3,242, according to the World Health Organization.

    March 19, 2020 Reply
  89. Roger Kirby Professor of Urology

    The UK can “turn the tide” on the coronavirus crisis within 12 weeks, Prime Minister Boris Johnson has said.
    But pressed on what he meant by the three-month timescale, he said he did not know how long it would go on for.
    He said trials on a vaccine were expected to begin within a month and warned he would “enforce” Londoners to be kept apart “if necessary”.

    March 19, 2020 Reply
  90. Roger Kirby Professor of Urology

    UK PM Boris Johnson says bars, pubs, restaurants will close on Friday evening
    His chancellor says Britain will be helping pay wages for the first time in its history
    UK policies to limit the spread of coronavirus would be needed for “at least most of a year”
    Death toll passes 10,000, confirmed cases near 250,000, more than 80,000 recovered
    Spain becomes fourth country to register more than 1,000 deaths, after China, Italy and Iran
    Data from Italy indicates the death rate for men is double that for women, US says
    China again reports no new domestic cases

    March 20, 2020 Reply
  91. Roger Kirby Professor of Urology

    PM orders pubs, restaurants and gyms to close across the UK

    Biggest rise in deaths in a day as UK total hits 177

    Govt to cover 80% of pay for people unable to work due to #COVID19

    March 20, 2020 Reply
  92. Roger Kirby Professor of Urology

    Social distancing restrictions need to be in place for “at least most of a year” to control the spread of coronavirus, according to experts advising the government about the pandemic.

    Evidence from the Scientific Advisory Group for Emergencies (SAGE), which is advising ministers on the UK’s response to the coronavirus pandemic, has been published by the government.

    It comes after Prime Minister Boris Johnson said on Thursday that the UK could “turn the tide” against COVID-19, the disease caused by the coronavirus, in 12 weeks.

    March 20, 2020 Reply
  93. Roger Kirby Professor of Urology

    Background and scope of guidance
    This guidance is for everyone, including children. It advises on social distancing measures we should all be taking to reduce social interaction between people in order to reduce the transmission of coronavirus (COVID-19). It is intended for use in situations where people are living in their own homes, with or without additional support from friends, family and carers. If you live in a residential care setting guidance is available.

    We are advising those who are at increased risk of severe illness from coronavirus (COVID-19) to be particularly stringent in following social distancing measures.
    This group includes those who are:

    aged 70 or older (regardless of medical conditions)
    under 70 with an underlying health condition listed below (ie anyone instructed to get a flu jab as an adult each year on medical grounds):
    chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
    chronic heart disease, such as heart failure
    chronic kidney disease
    chronic liver disease, such as hepatitis
    chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy
    diabetes
    problems with your spleen – for example, sickle cell disease or if you have had your spleen removed
    a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy
    being seriously overweight (a body mass index (BMI) of 40 or above)
    those who are pregnant
    Note: there are some clinical conditions which put people at even higher risk of severe illness from COVID-19. If you are in this category, next week the NHS in England will directly contact you with advice about the more stringent measures you should take in order to keep yourself and others safe. For now, you should rigorously follow the social distancing advice in full, outlined below.

    People falling into this group are those who may be at particular risk due to complex health problems such as:

    people who have received an organ transplant and remain on ongoing immunosuppression medication
    people with cancer who are undergoing active chemotherapy or radiotherapy
    people with cancers of the blood or bone marrow such as leukaemia who are at any stage of treatment
    people with severe chest conditions such as cystic fibrosis or severe asthma (requiring hospital admissions or courses of steroid tablets)
    people with severe diseases of body systems, such as severe kidney disease (dialysis)
    What is social distancing?
    Social distancing measures are steps you can take to reduce social interaction between people. This will help reduce the transmission of coronavirus (COVID-19).

    They are to:

    Avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough
    Avoid non-essential use of public transport when possible
    Work from home, where possible. Your employer should support you to do this. Please refer to employer guidance for more information
    Avoid large and small gatherings in public spaces, noting that pubs, restaurants, leisure centres and similar venues are currently shut as infections spread easily in closed spaces where people gather together.
    Avoid gatherings with friends and family. Keep in touch using remote technology such as phone, internet, and social media
    Use telephone or online services to contact your GP or other essential services
    Everyone should be trying to follow these measures as much as is practicable.

    We strongly advise you to follow the above measures as much as you can and to significantly limit your face-to-face interaction with friends and family if possible, particularly if you:

    are over 70
    have an underlying health condition
    are pregnant
    This advice is likely to be in place for some weeks.

    Handwashing and respiratory hygiene
    There are general principles you can follow to help prevent the spread of respiratory viruses, including:

    washing your hands more often – with soap and water for at least 20 seconds or use a hand sanitiser when you get home or into work, when you blow your nose, sneeze or cough, eat or handle food
    avoid touching your eyes, nose, and mouth with unwashed hands
    avoid close contact with people who have symptoms
    cover your cough or sneeze with a tissue, then throw the tissue in a bin and wash your hands
    clean and disinfect frequently touched objects and surfaces in the home

    March 21, 2020 Reply
  94. Roger Kirby Professor of Urology

    Italy saw its death toll from the coronavirus surpass 5,400 yesterday, while the number of fatalities in Spain rose by 30 per cent in its largest single-day increase. The number of people who have died in Italy rose by 651 — an increase of 13.5 per cent but down on the figure from Saturday, when 793 people died. The hardest-hit region, Lombardy, remained in a critical situation, with 3,456 deaths as of yesterday.
    Meanwhile, the number of deaths from Covid-19 in Spain rose by nearly 400 in its largest one-day jump to date. More than 1,700 people diagnosed with the coronavirus have now died in Europe’s second worst-hit country, according to the Spanish health ministry. France – where the death toll stood at 562 on Saturday – reported its first known death of a doctor from the coronavirus.

    March 23, 2020 Reply
    • Nicola Stingelin Ethicist

      More COVID Action Notes from Practical Ethics Perspective

      1 Work is needed to encourage the commercial pharma sector to re-access their particular duties in a
      pandemic situation (I am active in trying to move one molecule of the mountain)

      2 It is sad but not surprising to observe that countries with totalitarian-style political regimes have best chance control a pandemic. A price to be paid for freedoms? I am surely not the only blog reader engaged in looking at draft Coronavirus Bill and discussing with our legal friends.

      3 New research was published yesterday based on data collected in China that I am sharing with the team I am working with who are planning to start clinical trials in April in the drug repurposing field; particular focus: comparing vulnerability of infants versus children versus teenagers.

      March 23, 2020 Reply
  95. Roger Kirby Professor of Urology

    Thanks for your comments Nicola.
    Another 46 people died in England alongside four in Scotland and four in Wales yesterday, taking the number who have died in British hospitals after testing positive to 335. Those who have died in England range in age from 18 to 105.
    From last night, people will only be allowed to leave their homes for:
    * Shopping for basic necessities “as infrequently as possible”;
    * One exercise outing a day – for example a run, walk or cycle;
    * Medical needs or caring for a vulnerable person;
    * Travelling to and from work, but only if this is absolutely necessary and cannot be done from home.
    The UK is in lockdown – but was this introduced early enough? And how long is this going to last?

    March 24, 2020 Reply
  96. Roger Kirby Professor of Urology

    Boris Johnson and his health secretary Matt Hancock have tested positive for coronavirus, they revealed today.
    The two men in charge of the government’s efforts to tackle the virus both said that they had mild symptoms and were continuing to work while self-isolating.
    However, their diagnoses will lead to concerns that the virus is spreading in Downing Street among those who are critical to coordinating the national response. Chris Whitty, the chief medical officer, has also said he is self-isolating after experiencing symptoms.
    It is believed that Mr Johnson is the first leader of a G7 country to have contracted the infection.
    Dominic Raab, the foreign secretary, will take over if the prime minister becomes too ill to carry on at the head of the government’s response.
    Neither Rishi Sunak, the chancellor, or Michael Gove, the cabinet office minister, who have both been in contact with Mr Johnson in recent days are understood to have been tested.
    Professor Whitty, 53, tweeted: “After experiencing symptoms compatible with COVID-19 last night, in line with the guidance, I will be self-isolating at home for the next seven days.

    March 27, 2020 Reply
  97. Roger Kirby Professor of Urology

    At least 1,019 people have now died in the UK after contracting coronavirus, the most recent government figures have revealed – an increase of 260 in 24 hours.
    The latest figures, accurate as of 5pm on Friday, mark by far the most significant increase in deaths since the start of the outbreak.  
    It means the total number of deaths is 34% higher than the equivalent figure yesterday. This is the largest day-on-day percentage increase since March 18, when the total rose from 71 to 104 (a 46% jump).
    It took 13 days for the number of deaths in the UK to go from one to just over 100. It has taken a further 10 days for the total to go from just over 100 to just over 1,000.
    Meanwhile the number of people tested in the UK for coronavirus has now passed 120,000. The total as of 9am on March 28 was 120,776.
    Just under 50,000 tests (47,958) were carried out in the seven days to 9am March 28.
    In the previous seven days the number was 35,072.
    The total number of confirmed cases of coronavirus in the UK now stands at 17,089, as of 9am March 28.

    March 28, 2020 Reply
  98. Roger Kirby Professor of Urology

    Michael Gove has admitted the UK needs to go “further and faster” on testing NHS staff for coronavirus, amid a growing backlash over the failure to meet the target of 10,000 tests a day.
    The cabinet minister revealed that just 8,240 people were tested on Monday – days after he incorrectly claimed that the 10,000 milestone had been met by a target of the end of last week. The UK still lags well behind countries like Germany, where 70,000 are being tested every day.
    In an apparent sign of frustration at the failure to use the UK’s full capacity, which now stands at 12,700 a day, ministers and Public Health England have ordered NHS trusts to ensure that any tests not needed for patients should be used on staff.
    A further 393 people who tested positive for coronavirus have died, the highest UK daily total yet, bringing the death toll to 1,808. In England, NHS Trusts recorded the deaths of 367 patients, including a 19-year-old with no underlying health conditions. Another seven new deaths were reported in Wales, with a further 13 in Scotland and six in Northern Ireland.

    April 1, 2020 Reply
  99. Dr Eric Webb GP -retired

    That ‘a further 393 people who tested positive for coronavirus have died’ does NOT confirm that these primarily – or at all – died of coronavirus. Yes, we have a crisis! No, it it is nor primarily an epidemic crisis – although we certainly face a significant epidemic – but a crisis of confidence – and of pure media driven hysteria.

    April 1, 2020 Reply
  100. Roger Kirby Professor of Urology

    Yes Eric but France’s coronavirus death toll has risen by more than 1,000 to around 6,500 – as another 160,000 police officers were deployed to enforce the country’s strict confinement laws.

    The head of the country’s national health agency said the steep rise in fatalities was because the figures included deaths from around 3,000 care homes for the elderly.

    Worldwide, confirmed infections surged past one million and deaths topped 54,000, according to a tally by Johns Hopkins University.

    April 4, 2020 Reply
  101. Roger Kirby Professor of Urology

    Worldwide cases have passed 1.1 million, and at least 60,000 people have died
    UK sees 708 deaths in a day, with public urged to stay at home as weather turns warmer
    A five-year-old child with underlying health conditions is believed to be the youngest UK victim
    NHS England Medical director Stephen Powis says UK’s high death rate is likely to continue for next week or two
    New York state sees a record 630 virus deaths in a single day
    US President Trump rejects his own experts’ advice on wearing a face mask
    Spain reports another 809 deaths, but there are signs its infection rate is slowing
    Hopeful news in Italy as the country sees its first drop in patients receiving intensive care for the coronavirus
    A day of remembrance is held in China to honour those who died of Covid-19
    The IMF says the pandemic has stalled the global economy, causing a recession worse than 2008

    April 4, 2020 Reply
  102. Roger Kirby Professor of Urology

    A 5year old child was among a further 708 people to have died in UK hospitals in the past 24-hour period after contracting coronavirus, bringing the country’s death toll to 4,313. The latest figure, which covers 5pm on Thursday to 5pm on Friday, is just the latest record daily rise in fatalities, in line with a continuing upward trend. A total of 684 people died over 24 hours between Wednesday and Thursday.

    April 5, 2020 Reply
  103. Geoff Scott Retired Microbiologist

    I have written a polemic about this epidemic which may or may not be published. This is all driven by fear. Reporting daily death rates is a way of creating more fear and personifying risk: it is coming MY way. There are 1600 deaths in the UK from things other than coronaviruses. It is my opinion that the lock down was not a very effective way of stopping infections. The main reason for this is that people are still going shopping for food (most of the other shops having elected to close). SARS entered Hong Kong via the lift buttons in the Metropole Hotel. People continually put their fingers in their nose and mouth. If the virus is transmitted on hands via fomites, then it will continue to be transmitted via numeric keypads at the ATM or on card readers. One person puts virus on the numbers and the next hundred can pick up an infectious dose. Of course, not all those will catch the infection! So the way to stop transmission is, yes, stay away from people in case they cough in your face, and clean your hands with alcohol (in any form) after you have touched a « common item (numeric keypad, lift button, door handle etc). There is no way that an aerosol generated outside can infect anyone. Aérosols will be diluted to uninfectious infinity in the open air. Closing the beaches in France was barmy. So all travel, particularly in private cars to beauty spots, should be encouraged! We need to get the country back to work. Remember the alcohol on your hands.

    April 6, 2020 Reply
  104. Roger Kirby Professor of Urology

    UK PM Boris Johnson being taken to intensive care, Foreign Secretary Dominic Raab to deputise
    More than 10,000 people have died from coronavirus in the US, according to Johns Hopkins University
    France reports 833 deaths in 24 hours, its highest since the outbreak began.
    Medical experts believe the restrictions in the UK are working, but it is too early to tell when they might end
    New infections have fallen in Spain and Italy in recent days – suggesting lockdowns are working
    Nearly 1.3 million cases have now been confirmed worldwide with deaths over 70,000

    April 6, 2020 Reply
  105. Roger Kirby Professor of Urology

    PM Boris Johnson is breathing without help in intensive care – Foreign Secretary Dominic Raab
    Raab, deputising for the PM, says Boris Johnson is a “fighter’ and is confident he will recover
    UK has now suffered 6,169 deaths
    New York records 731 deaths, the largest single-day rise in the worst-hit state
    Voting in Democratic presidential primary election under way in Wisconsin after court battle
    Stock markets rise on hopes the spread of coronavirus is starting to slow
    Travel is shut down in Israel ahead of the Jewish Passover holiday.

    April 7, 2020 Reply
  106. Roger Kirby Professor of Urology

    The number of people to have died in hospital after contracting coronavirus has increased by 938 over the space of 24 hours, the government has confirmed.
    The UK death toll for coronavirus patients has risen to 7,097, the Department of Health and Social Care said yesterday.
    The total number of confirmed infections has jumped to 60,733 after a rise of more than 5,400.
    Around 232,700 people have been tested for the virus as yesterday morning, according to the latest figures.
    Nearly 13,000 people were tested in a day, the health ministry said.

    April 9, 2020 Reply
  107. Roger Kirby Professor of of Urology

    The global coronavirus pandemic has now infected more than 1.7 million people worldwide and an estimated 100,000 deaths have been recorded.
    In the UK nearly 80,000 people have been confirmed to have caught the disease and 9,875 people have died – the fifth highest national number globally.
    The US has surpassed Italy as the country with the greatest number of confirmed deaths from Covid-19, with more than 20,000 fatalities.
    Anyone willing to speculate when the lockdown will begin to be relaxed in the UK?

    April 12, 2020 Reply
  108. Roger Kirby Professor of Urology

    More than one in five deaths in England and Wales is linked to coronavirus, figures show.
    The Office for National Statistics data showed the virus was mentioned on 3,475 death certificates in the week ending 3 April.
    It helped push the total number of deaths in that week to more than 16,000 – a record high and 6,000 more than expected at this time of year.

    April 14, 2020 Reply
  109. Roger Kirby Professor of Urology

    The global death toll from coronavirus has passed 200,000, according to figures compiled by Johns Hopkins University. The grim milestone in the progress of the pandemic was announced last night, hours after Spain and Belgium became the latest countries to reveal plans to partially lift their lockdowns.
    It came on a day the UK was confirmed as the fifth country to record 20,000 deaths – meaning it now accounts for 10 per cent of the worldwide total. The US has the highest toll, with over 53,000, followed by Italy, Spain and France. However, the actual death toll is likely to be much higher.
    Many nations only report daily figures for hospital deaths and analysis of excess deaths in the UK suggests that its true figure may already be over 40,000.
    More than 100 days have passed since the first death was reported in Wuhan, China, on 10 January. It took 91 days for the global death toll to pass 100,000 and a further 16 days to reach 200,000. The worldwide total of confirmed cases is heading rapidly towards 3 million.

    April 26, 2020 Reply
  110. Roger Kirby Professor of Urology

    After almost 5 weeks of lockdown:
    * Mr Raab warns the public must accept “the new normal” of tough restrictions, saying: “Social distancing measures are going to be with us for some time.”
    * Mr Johnson prepares to return to his Downing Street desk today, three weeks after receiving oxygen while in intensive care in hospital.
    * A government minister suggests furloughed workers should help pick crops when the harvest comes, to stop them rotting in the fields.
    * The expert behind the smartphone app that ministers hope will track and trace potential coronavirus victims warns it required a 60 per cent take-up to be successful.
    * The number of hospital deaths from coronavirus rose yesterday by 413 to more than 20,700 – as an NHS chief argued a gradual decline showed the lockdown was working.

    April 27, 2020 Reply
  111. Roger Kirby Professor of Urology

    Dominic Raab has issued a plea for patience on lifting the coronavirus lockdown, warning that the UK stands at a “delicate and dangerous moment” with the risk of a second wave of infection inflicting more deaths and prolonged economic pain.
    The first secretary was speaking as new statistics showed the UK moving into third place for Covid-19 deaths globally with 26,097, behind only the US and Italy, as fatalities outside hospitals were included for the first time.

    April 30, 2020 Reply
  112. Roger Kirby Professor of Urology

    Black men and women are almost twice as likely to die from coronavirus when compared with white people, a new analysis by the Office for National Statistics has found.
    The study shows that after accounting for age, wealth and factors such as disability, the risk of death for black men and women who contract Covid-19 was 1.9 times more likely than white men and women.
    The ONS study shows similar results for men from Bangladeshi and Pakistani ethnic groups who were were 1.8 times more likely die than white males. For women from the same ethnic backgrounds, the risk of death was 1.6 times more likely.

    May 8, 2020 Reply
  113. Nicola Stingelin Medical Research Ethicist

    Indeed there are indications (not yet evidence?) suggesting that ethnic genetic/genomic factors may influence certain aspects of how an individual reacts to the COVID-19 virus – research is underway into this of course in the life and social sciences to understand and deliniate biological, BMI, socio/economic contributors factors etc.

    A question I am actively pursuing is that some aspects of COVID-19 research and decision making are informed by data coming from regions including China & South Korea. Citizens of these regions may be assumed to have some unique genetic characteristics, some of which may be relevant and specific to COVID-19.

    It seems important to look into if there are any ‘Asian’ genetic /genomic features relevant to COVID-19 so that false assumptions or extrapolations moving from one ethnic group to another are avoided as we all plan how to move forward in predominantly European populations.

    I have been unable to locate such projects until now.

    May 8, 2020 Reply
  114. Roger Kirby Professor of Urology

    The current total of Covid-19 deaths in the US stands at 77,788, with more than 1.3 million infections, according to tracking carried out by organisations such as Johns Hopkins University. That figure itself is likely an undercount, given the delay and difficulty in obtaining data.
    Health experts say such counts do not show the full devastation of the virus because they do not include deaths from conditions such as heart failure, strokes or cancer of people who failed to get treatment, either because they were too scared to go to hospital, or else their appointment was cancelled as health departments were obliged to halt non-urgent procedures.

    May 9, 2020 Reply
  115. Roger Kirby Professor of Urology

    The US Treasury secretary Steven Mnuchin and other White House advisers have warned of dire economic times ahead as the country continues to struggle to contain coronavirus.
    Nearly 80,000 Americans have died from Covid-19, with over 1.35 million confirmed cases. Health experts have warned that reopening businesses too early could lead to another spike in cases and put the economy back to square one.
    But Mr Mnuchin warned yesterday that if the US does not reopen businesses soon, despite the public health risks, there will be “permanent” ramifications for the economy.

    May 11, 2020 Reply
    • Nicola Stingelin Medical Research Ethicist

      Thanks Roger

      A timely reminder of the knotty question of when / how we in the UK need to be more transparent in weighting-up the population level risks to health on the longer term – poverty as determinant of health – and the shorter term risk to individual health resulting from our political decisions.

      May 11, 2020 Reply
  116. Roger Kirby Professor of Urology

    More than 300,000 people around the world have now died globally from the coronavirus, according to figures from Johns Hopkins University, as the pandemic passed yet another bleak milestone on Thursday.

    More than 4.4 million cases have also been recorded, according to the university’s count. Given the varied ways in which different countries report Covid-19 figures and the vast societal impact of the pandemic, the true number of infections and fatalities could be far higher.

    May 15, 2020 Reply
  117. Roger Kirby Professor of Urology

    More than 39,000 confirmed deaths involving the coronavirus have occurred in England and Wales, according to the Office for National Statistics.
    The latest ONS figures also showed there were a total of 9,980 coronavirus-related deaths in care homes in England and Wales up to 8 May. The ONS statisticians pointed out that the northwest saw the highest number of coronavirus-related deaths of any region for the first time since the pandemic began, after recording 576 deaths in a seven-day period.

    May 20, 2020 Reply
  118. Roger Kirby Professor of Urology

    Five million cases of coronavirus have now been recorded around the world, just over five months after the virus first emerged. The milestone comes as many countries begin to ease restrictions on populations which have been locked down for months.
    The disease, which emerged in China in late 2019, is known to have caused more than 325,000 deaths to date. Measures, including extensive controls on populations, in the country now mean it has the 13th highest number of total recorded cases to date with just under 83,000 cases and 4,634 deaths.
    The United States has recorded the highest number of cases anywhere in the world with more than 1.5 million. After America, the top worst affected nations are Russia (with more than 300,000 cases), Spain (more than 278,800), Brazil (more than 271,800) and the UK (more than 248,800).

    May 21, 2020 Reply
  119. Roger Kirby Professor of Urology

    The UK has suffered the second-highest rate of deaths from the coronavirus pandemic after Spain, according to excess mortality figures published in the Financial Times.

    The UK has registered 59,537 more deaths than usual since the week ending March 20, indicating that the virus has directly or indirectly killed 891 people per million.

    Until Thursday, the UK had a higher rate of death than in any country for which high-quality data exist. However, Spain made a revision to its mortality estimates, adding 12,000 to its toll of excess deaths from coronavirus in a one-off adjustment to 43,000. This increased its death rate to 921 per million.

    May 29, 2020 Reply
  120. Roger Kirby Professor of Urology

    New cases of the novel coronavirus are rising faster than ever worldwide, at a rate of more than 100,000 a day over a seven-day average.
    In April, new cases never topped 100,000 in one day, but since May 21, there have only been less than 100,000 on five days, according to data from Johns Hopkins University. Newly reported cases reached a high of 130,400 on June 3.
    The increase in case rates may be partially explained by increases in testing capacity, but there’s still not enough testing to capture an accurate picture in many countries.
    Different nations’ epidemics have followed different trajectories. The number of new cases has slowed in many of the countries that were hit hard earlier on in the pandemic, including China, the US, UK, Italy, Spain and France.
    But many countries, particularly in South America, the Middle East and Africa, the rate of transmission still appears to be accelerating, according to a CNN analysis of Johns Hopkins University data.
    In Libya, Iraq, Uganda, Mozambique and Haiti, the data shows the number of known cases is doubling every week. In Brazil, India, Chile, Colombia and South Africa, cases are doubling every two weeks.

    June 5, 2020 Reply
  121. Roger Kirby Professor of Urology

    The number of excess deaths in the UK since the beginning of the coronavirus outbreak has passed 63,500, according to the latest data.
    Figures from the Office for National Statistics (ONS) show that 57,961 excess deaths were recorded in England and Wales between 21 March and 29 May. Covid-19 was responsible for 45,748 of these fatalities, the ONS said.
    The remainder – deaths not directly linked to Covid-19 – might have been caused by factors connected with wider changes in England and Wales since the lockdown began: a reluctance on the part of some people to visit a doctor or a hospital, for instance, or the result of long-term health conditions being made worse by having to remain at home.

    June 10, 2020 Reply
  122. Roger Kirby Professor

    UK lockdown a week earlier could have halved COVID-19 death toll, scientist says reut.rs/3hhqtWP

    June 10, 2020 Reply
  123. Roger Kirby Professor of Urology

    The coronavirus pandemic is accelerating, with Thursday’s 150,000 new cases the highest in a single day and nearly half of those in the Americas, the World Health Organization (WHO) said.

    “The world is in a new and dangerous phase,” Director General Tedros Adhanom Ghebreyesus told a virtual briefing from WHO headquarters in Geneva. “The virus is still spreading fast, it is still deadly, and most people are still susceptible.”

    More than 8.53 million people have been reported infected by the novel coronavirus globally and 453,834​ have died, a Reuters tally showed as of 1326 GMT on Friday.

    June 19, 2020 Reply
  124. Roger Kirby Professor of Urology

    U.S. coronavirus cases now exceed 2.5 million, with over 125,000 reported fatalities — in both cases the world’s highest. The country’s inability to control the spread of the virus seems likely to result in U.S. citizens being banned from traveling to Europe, for example, where cases are down in some cases 90% from their peak.

    June 28, 2020 Reply
  125. Roger Kirby Professor of Urology

    Boris Johnson insists that Downing Street is learning lessons from the UK and around the world as it adapts its response to the coronavirus crisis. However, in the absence of an inquiry into the initial handling of the pandemic, critics warn that there is little independent oversight of the government.
    Many scientists believe that imposing the lockdown one week earlier could have halved the UK’s death toll, which is the highest in Europe. The initial response to the outbreak was hampered by a shortage of ventilators and personal protective equipment (PPE). A lack of testing capacity led to contact tracing being abandoned in March. With hindsight, the government’s scientific and medical advisers accept that it should have continued.
    Another failure was in protecting care homes. Despite ministers’ claims to have put a “protective ring” around them “at the start”, it happened only after painful lessons had been learnt. A tragedy unfolded as homes struggled to cope with patients discharged from hospitals, and without adequate PPE or testing for staff and residents.

    July 2, 2020 Reply

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