oldguy I wouldn't worry too much about India, they seem to have the common sense to use anti virus treatment when the scientific/clinical/biochemical evidence suggests it. Unlike the 'developed nations'. So this advisory was issued 22 March? Lets see how the statistics develop from then on. (my suspicion is there was already widespread use in India unofficially before this because of widespread availabilty for malaria treatment-accounting for 0.2 deaths per million)

India’s use of chloroquine to prevent Covid-19 based on data from Chinese studies

Niti Aayog member V.K Paul, head of national task force set up to fight Covid-19, says suggested dosage of hydroxychloroquine was “well thought expert opinion”.

HIMANI CHANDNA 27 March, 2020 8:00 am IST

A pharmacy in Jammu (representational image) | Dhiraj Singh | Bloomberg

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New Delhi: The government’s recommendation to consume anti-malaria drug chloroquine for the prevention of Covid-19 infection is a “well thought expert opinion”, said V.K. Paul, member of government’s policy think tank NITI Aayog.

An advisory, released on 22 March by the national task force set up by the government to fight Covid-19, has recommended that the healthcare workers and high-risk individuals can use anti-malarial drug “hydroxychloroquine” to prevent Covid-19 infection.

Time for Mass Drug Administration (MDA)? Still worried about 1 in 100,000 fatal heart attacks when the 100,000 will die of COVD-19.?

Quote from Roseland67

If you asked the same group of doctors about lifting the stay at home rules on

December 31st, their response would be the same. “It MAY cause a rebound in February”.

Now, if this group of doctors said,

“It WILL cause a rebound and it will be worse than it is now”, we might get a better response.

But since no one, including

Group Think Blue or Group Think Red

knows, many will assume it’s another media made “Crisis”.

Planet earth simply will not stay homebound for the better part of a year because of a virus strain, it’s not realistic and will not happen.

Many, if not most, will eventually take to the streets again, (I suspect Monday, May 4th),

and take their chances. Let’s wait and see.

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There are two separate issues here: the science and the politics.

The science. This is a very virulent (more so than flu) epidemic, where no area in the world (except Wuhan) has any decent level of immune resistance because not enough people have yet caught it.

Every scientist will tell you that without measures to suppress it (R < 1) it will come back, exponentially. That is just fact. I guess there is a small small chance that it will mutate to a more virulent but milder form. In that case the mild form is a nature-generated vaccine and we are saved. So a careful scientist would point out that possibility, but give it low probability.

There will then be some disagreement about what rules you need to keep R < 1. Obviously, they must be more than what happened when the virus (this time) was spreading exponentially. But perhaps some set of social distancing and technological track and trace measures would serve. No scientist is going to be sure about what measures will work or not work, because they depend on human behaviour. Maybe, even, everyone is so scared that they stay at home anyway. Maybe those more at risk (> 60, etc) will stay at home anyway under strict biosecurity and without any other measures, although the virus lets rip, health systems will cope. All these maybes depend on human behaviour in an unprecedented situation, so no scientist will be certain, though I think most people will agree what is more and what less likely.

The politics. Finally, there is leadership. I agree it is very tough to ask people to live under constraints for 12 months, and, as Shane and others here have articulated, the cost to the economy and the future well being of our children is arguably even higher than the cost of lives lost to a dreadful disease now. Given the right leadership and communication, people will bear many things. I think most western governments will prefer an exit strategy with restrictions, but which has a relatively high rate of transmission still continuing, even though that is bad in terms of lives lost. Why? (a) it offers herd immunity sooner, and more surely, than some vaccine prospect. 12 months of a sustainable rate of death, with health systems beefed up to manage this, would give this (I have not done the exact sums but more of less). Effective shielding of those at most risk (tough when people live in slum conditions) would give that with a much lower overall death toll. (b) It is less harmful to the economy - though that is arguable. (c) With a continuing health emergency everyone can see that unpopular restrictions are still needed and compliance is more easily achieved.

It is a dreadful equation for anyone in power. I feel for them, even Trump. I guess his "group of brilliant advisers" will be skewed to wards his politics and a "let the deaths continue for the sake of the economy" solution. It is then a matter of how to manage that gracefully.

For myself? I think the best solution would be very highly interventionist.

(1) Wait another month or two so that treatment options have improved, medical supply lines ramped up, and IFR for whole population would go down from 0.66% to 0.3%.

(2) Lock up safely those at more risk - say:

• Anyone retired and over 50
• Anyone over 60 who wants to be locked up, with suitable guarantees on jobs

Put some of those trillions of dollars of resources into supporting the locked up people in a decent manner, keeping their jobs, whatever. There is a balance here between compulsion and reward. Also about cost to the economy (which is why those retired are the absolute priority to lock up). And there are immense problems with those now in sub-standard housing.

(3) Let the virus rip through the rest of the population. IFR now down to 0.15%, if the lock up measures work properly. The economy is missing only a relatively small part of its productive population.

(4) Herd immunity is hit within 4? months. Not reliably, of course. When those locked up are released the virus will still be around a bit, and will still have outbreaks, but the maybe 50% herd immunity achieved can handle that with selective local lock-ups of the at-risk group - and they are those who would be most motivated to be locked up.

There are a lot of variants here, trading life, dignity, future prosperity, freedom. Which option is a political decision and while I have every sympathy for any political leader making this decision I feel some are less fitted to make a wise decision and carry the county unified with them than others. (There Shane, that apolitical enough for you )

This least worst option loses many more lives than a Wuhan-style virus elimination. Arguably that is impossible now in a West with relatively porous borders, since not all countries will do it.

It is much worse for the future economy than a less interventionist option, allowing higher health system stress and many more lives lost

It is much tougher for individual autonomy than some policy relying on voluntary compliance, or relatively weak social distancing.

We need a new simulation game "Virus" which allows players to be leaders of different countries and manage these different levers, observing the course of the virus in their country with its cost on lives, economy, and the lack of compliance that comes from a population that does not believe you are acting in their best interests.

The differences

This is a peculiarly UK preoccupation, but every country has its version of the balance between doing right by those that have and those that have not. When locked in, those living in the country, with space around, are privileged. Those with strong friend and family support networks, and decent communications technology, are privileged. Those with enough money to order in supplies and manage emergencies easily are privileged. Personally I am all three. But many are not. Those living crammed 3 people per room in a tiny flat in a town without a nearby local park and with no money, nor helpful privileged friends, will find lock-in restrictions 100X more difficult. This virus hits the urban impoverished particularly, leaving less touched the rural impoverished. Live in the country and social distancing enough to keep R < 1 is a lot easier than when in a high-rise city centre.

THH

Quote from RobertBryant

The Chinese propaganda machine will attempt delay news of any rebound... but thanks to the net..Taiwan will let the world know ASAP

I find the prejudice against China here a bit extreme.

(1) China's government is opaque, an oligarchy, works by exercising high control over its citizens, will stifle dissent using extreme measures where it sees risk, yet still needs popular support to continue. A bit like many of the relatively well-liked right-wing dictatorships.

(2) China's poor biosecurity allowed the virus in, and innate capacity to cover things up at local (and national) level lost a few months early on.

(3) China's ability to mobilise the country and control its people made eradicating the virus there possible. As a result the death toll, and the economic hit, in China is much lower than it will be in most Western countries.

Now the idea that China is somehow hiding a virus rebound? I'm sure if there are local outbreaks they might be hidden. But the government knows to its recent cost that you cannot hide a virus unless you stamp on it locally. It will have intrusive systems in place to do this, and any local government that allows outbreaks to exist by ignoring them will (perhaps literally) be killed.

So China, I expect, has the will and capacity to keep the virus under control. As, by the way, does Taiwan.

Politically, China and the WHO will treat Taiwan appallingly (just as Spain treats the Catalans appallingly) in the interests of national unity. I know, in Taiwan only 30% thinks it would like to be part of China, and who can blame the 70%.

Politically, Taiwan will have equally strong propaganda against China. Every little local outbreak (of course they can exist, this is a virus) will be seen as the government having lied. And the government may well lie about such tiny outbreaks, I don't know.

Still, you can't hide from this Virus. Unless it is fully suppressed track and trace cannot keep it like that without much more extreme lockdown. So however the government lies, it cannot hide from this. The Chinese government, unlike a few Western leaders, listens to its scientists and is realistic about the future. That is why I think they will do what is needed to keep the virus suppressed. Not because I like them, think they are the world's best political system, or think they tell the truth.

Friends in China tell of rumours that because national conferences are still cancelled the government is not confident it has eradicated the virus, and fears its return. That I can believe, in fact anything else would be very stupid.

Sorry to bore you all with another boring statistic but if you look at the coronavirus worldometer all the countries with a number of deaths per million <0.5 like India either have malaria or malaria has been recently eradicated there. Correlating wiith the availability of quinine analogues to the populations. Venezuela is an interesting case, malaria cases have shot up since the political disaster there, but has far less COVID19 infections/deaths than other S. American countries. No shortage of testing with 188000 + tests (if any of these figures are to be believed). Despair not, there is hope for our Anti bat yet.

Duh? But they don't have a problem, we do! Money should be spent on the poor, starving UK citizens instead. Don't these idiots look at the Worldometer Coronavirus statistics? Or spend it on a container ship-full of anti-virus drugs. New hand-washing stations! That's really helped here hasn't it?

Coronavirus: UK gives £200m in aid to developing nations

• 12 April 2020

The UK will send £200m in aid to help developing nations battle coronavirus.

The money will mean more help for refugee camps - including new hand-washing stations.

International Development Secretary Anne-Marie Trevelyan said boosting fragile health systems overseas would help prevent a "second wave" of infections hitting the UK.

The latest donation brings Britain's total contribution to the global effort to halt the pandemic to £774m.

It makes the UK one of the biggest donors to the worldwide fight against the virus, according to the Department for International Development (Dfid).

Britain's funding will help install new hand-washing stations and isolation and treatment centres in refugee camps, and increase access to clean water for those living in areas of armed conflict, Dfid confirmed.

Duh? Maybe its anti-malaria drug use? Never heard of Chloroquine?

Why are there so few coronavirus cases in Russia and Africa ...

cosmosmagazine.com › biology › why-are-there-so-few-coronavirus-...
23 Mar 2020 - 2019 Sources: UN, World Bank, Statista, WTO and Worldometers.info. Jeremy Rossman. While this is a vastly simplified analysis of population ...

Russia Malaria Risk | Travel Vaccinations - Travelpharm

www.travelpharm.com › russia-former-soviet-union-i236
Malaria advice & vaccination information for travelling to Russia. Buy your anti malaria tablets & travel accessories from Travelpharm.

None available due to UK embargo.

No malaria in Russia?

Russia has been exposed to large-scale importation of vivax malaria since the dissolution of the USSR in 1991. The greatest challenge was importation from Tajikistan, the country that faced a malaria epidemic in the post-Soviet era. The peak of malaria cases in Tajikistan was officially registered as nearly 30,000 in 1997 [14], although the true number of cases, according to expert estimates, could have exceeded 100,000 per year [15].

Has the malaria epidemic protected the Tajikis?

Tajikistan's nonchalance on coronavirus shows cracks

Critics are exasperated by the government’s passivity, warning that the reforms needed for Tajikistan to weather this moment should have been adopted “the day before yesterday.”

Apr 6, 2020

President Emomali Rahmon and his son meeting constituents in Dushanbe on April 6. (Presidential press service)

While serious cracks begin to appear in Tajikistan’s blanket denials that coronavirus has arrived in the country, the struggling business community is already counting the losses the global pandemic has caused.

Critics of the government have grown increasingly exasperated by the passivity, and even indifference, evinced by President Emomali Rahmon’s regime, warning that the reforms needed for Tajikistan to weather this moment should have been adopted “the day before yesterday.”

Although as of April 6, the authorities continued to insist that it had registered no cases of coronavirus, much anxiety has been sown by developments at a hospital in the Jabbor Rasulov District, in the northern Sughd province. Over the weekend, officials placed the hospital under quarantine after the death of a 60-year-old man who was being treated for pneumonia.

RFE/RL’s Tajik service, Radio Ozodi, reported that the man had recently returned from a wedding in Kyrgyzstan, where the epidemic has reached new levels of intensity with 69 new cases being detected in a 48-hour period. The U.S.-funded broadcaster, which is one of only a couple or so locally based outlets to have questioned the government’s preparations for coronavirus, said 11 health workers at the same hospital have developed fevers and been taken for treatment at an infectious diseases hospital in the nearby city of Khujand.

The Tajik government’s case for business-as-usual was given support from an unexpected quarter last week, when the country representative for the World Health Organization, Galina Perfilyeva, gave Tajikistan the all-clear.

"According to official statistics, which we can confirm, as we work closely with the laboratory that does [polymerase chain reaction] testing, there is not a single positive registered case of COVID-19 in Tajikistan," she said in an interview on April 1.

Perfilyeva said suspected COVID-19 carriers in February underwent tests that were then sent for verification to Russia and that these returned negative results. More test kits have been supplied by Russia, China and Germany, she said.

While injecting that note of reassurance, Perfilyeva did advise, in line with WHO guidance, that the public be more rigorous in adopting preventative measures, such as careful handwashing and maintain social distance.

Officials will point to some drastic measures in helping keep the virus at bay. All commercial flights were suspended on March 20. The border with China has been closed since January 24. Entry from Iran was halted on February 23. Traffic to and from Kyrgyzstan was suspended only later, however, on March 24.

Authorities appear to have concluded that was enough to preclude the need for a total shutdown. Schools are still open and people are going to work as normal.

This is an article I wish I'd never read. My sense of what is likely tells me that it is very plausible. The article is a bit impenetrable, and seems to be saying that a linear high case per day phase to the epidemic could last until the whole population has immunity. That is not true. All spreading is governed by exponentials, but the problem is we can have a longer than expected time constant exponential in some cases.

I'll summarise:

• If lock-in reduced R0 to < 1 we would get exponential increase followed by exponential decrease based on simple models
• What we see in Europe is exponential increase followed by a long linear tail
• This linear tail phase can be understood as the infection rate bound to happen from leakage of quarantine, e.g. asymptomatic cases that lead to more infections.

The idea is that due to past infections there will be a corresponding asymptomatic but infective pool, with leakage from these even under lock-down. For example, supermarket workers, doctors, etc. This can explain the linear phase seen in most countries. We do not see a decrease in infections until this asymptomatic pool is used up, but the time of that can be much longer than happens for symptomatic spreading, since those with symptoms are quarantined as soon as those occur. Symptomatic individuals will stop spreading when symptoms start, less than 7 days and typically 5 days. Asymptomatic individuals will stop spreading when the disease passes which we believe can take much longer (3 weeks, 4 weeks?). In any case the exponential decrease time, during lockdown, will be different from the exponential increase time, before lockdown, and can be longer depending on how much R0 is reduced.

https://www.medrxiv.org/conten….20055772v1.full.pdf+html

Thus the long high rates of infection under lockdown - seen in Europe and the US - come from the infected but asymptomatic people who in spite of lockdown have lots of contacts - maybe food workers. Until these reduce viral load we have ongoing infections.

We would therefore expect the epidemic exponential decay to be dominated by this asymptomatic pool, and have a much longer time constant than the exponential increase.

What would reduce this effect is much more testing of people without symptoms: not at the moment done in Europe or I think the US.

I had not considered the effect on epidemic curves of the pool of asymptomatic infective individuals: it seems likely from the fact that lockdown does not cause exponential decreases that they are significant.

The other reason for apparent linearity is that the time between infection and reporting (of anything) is stochastic, which has the effect of spreading out the peak. But that I think is not enough to account for what we see in Europe.

At what level of mortality from this disease do we give up our rights and stop our country from a bad flu?

20k deaths/1million infected

20k deaths/3million infected

20k deaths/5million infected

For me, 20k deaths/400k infected with at least 50% of those dying having no prexisting conditions or being immunocomprimised.

At what level of flu burden do we all need quantum dot tracking implant devices ID2020) and a mandatory vaccine?

For me, a very high bar is needed for this.

Very interested to hear others ideas.

BTW, this is mandatory watching.

Navid I agree somewhat. We need to pay attention to the implications beyond this and not allow governing panels to use this oppertunity as a fear accelerated increase of corperate and china-like control. I also think we should minimise paranoia and anxiety cause that influences economy, physical health, our ability to move forward technologically and productively. We need to calmly do what needs to be done at this time. It isn't as bad as social media and the news portray it, as sad as the knowledge of people dying is. Still social distance though.

There is a WHO recognised form of treatment which is more targeted than Mass Drug Administration (MDA). It is termed MASS FEVER TREATMENT (MFT) which would be more appropriate for COVID-19.

Mass fever treatment (MFT), like MDA, refers to the treatment of malaria with a curative dose of an antimalarial drug within a well-defined population without testing, but unlike MDA, only persons with a fever are treated. MFT is a rapid measure that can be considered as part of an outbreak response. The criteria for choosing an antimalarial drug for MFT are the same as for the national policy for treating uncomplicated malaria (most likely an artemisinin-based combination therapy [ACT]). WHO states that mass treatment of fever cases with an ACT is appropriate as a strategy to reduce mortality once malaria has been established as the cause of the epidemic. This strategy aims to get treatment to people with probable malaria cases as quickly as possible to cure illness, avert death, and help contain the epidemic. After the outbreak response is more fully implemented in the community, laboratory confirmation of malaria parasites will precede treatment.

Or in other words:

Mass fever treatment (MFT), like MDA, refers to the treatment of COVID-19 with a curative dose of an antiviral drug within a well-defined population without testing, but unlike MDA, only persons with a fever are treated. MFT is a rapid measure that can be considered as part of an outbreak response. The criteria for choosing an antiviral drug for MFT are the same as for the national policy for treating uncomplicated COVID-19 (most likely a Hydroxychloroquine --based combination therapy (HCT) [Z-pak Anti Bat]). WHO states that mass treatment of fever cases with a HCT is appropriate as a strategy to reduce mortality once SARS COV-2 has been established as the cause of the pandemic. This strategy aims to get treatment to people with probable coronavirus cases as quickly as possible to cure illness, avert death, and help contain the epidemic. After the outbreak response is more fully implemented in the community, laboratory confirmation of SARS Cov-2 will precede treatment.

Any sensible reason why we haven't been doing this for the last month?