Last Chance

[veronik-a]

Underwhelmed by your demanding, undemocratic, disparaging way of working. When someone can't see your point you prefer to call them stupid, rather than realise that you have not provided actual evidence just a a vague point or two. I too have been researching for a couple of months now COVID 19. I don't brag about it because I realise anyone can read widely but unless they synthesise points in a coherent way they haven't absorbed much at all.

Just so you know who you are dealing with. My journalist skill is in seeing and reporting on the things that fall through the cracks and are missed by most. I've received a stack of awards over the years. Explaining complicated things simply is what I do when I work in a collaborative environment. This year alone I've been invited to join four projects.  

I was selected to represent Australian media in the late 1980's at WHO Conference on AIDS in Japan. The Federal Health Department were extremely grateful for my report on cultural reactions to the Grim Reaper ads I was producing for Australia in over 60 languages at the SBS. I opened their eyes, they wanted me to tell the world. Darce refused to let me go to the conference, just like he refused to attend my graduation in Strategic Studies from Deakin University in 1994. I've grown up since then and no longer tolerate such behaviour from anyone.

I will give you one last change. Please write four dot points about the demonstrated benefits to be gained by widening the accommodation criteria. I think the authorities know full well what they are dealing with. They are now providing accommodation for health care workers, and now for families falling apart under the stress of being cooped up together. Multigenerational household will be on their radar but the question is the cost, the benefit compared to other expenditures.

[dentarthur]

I will try to write 4 dot points tonite.

Meanwhile:

1. The accommodation criteria were spelled out on Tuesday by APHCC in link provided in README here.

2. They drew pointed attention to legal obligations of States and Territories to provide that accomodation. Footnote refs:

PUBLIC HEALTH AND WELLBEING ACT 2008 - SECT 111 Principles     The following principles apply to the management and control of infectious diseases— ...

(d) a person who is at risk of contracting, has or suspects he or she may have, an infectious disease is entitled—               (i)     to receive information about the infectious disease and any appropriate available treatment;               (ii)     to have access to any appropriate available treatment.

3. The information required by (i) has been widely disseminated. Avoiding contact requires not being in same household. The only appropriate available treament is access to alternative accommodation for any infected person who wants it and/or others in same household.

4. Preliminary rough back of envelope plausible worst case needs offers capability 360,000 places.

5. That is achievable but requires plans and announcement.

[dentarthur]

Costs and Benefits:

1. Benefits are relatively small compared to the higher priority measures to reduce transmission and death rates already being implemented.

2. Costs are negligible compared with benefits. Empty holiday and student beds with current zero rental value and staff support from people unemployed or in pretend employment in businesses shut down for at least the duration.

3. There NEVER WAS any issue of "demonstrated benefits to be gained by widening the accommodation criteria." The criteria stated by APHCC are wide enough to include any infected person that does not want to infect their household (and vice versa) as required by law and obviously necessary to further reduce transmission.

4. The issue is actually organizing the accommodation and transport.

[dentarthur]

Initial back of envelope "plausible worst case" peak numbers infected cases needing isolation

"plausible worst case" is "flattened curve" horizontal plateau at max hospital capacity not overwhelmed till vaccine 12-18 months.

cf "suppression" with restrictions partially relaxed after driving to low level of outbreaks contained by tracking and contact isolation as at start.

cf sharper "elimination" (NZ policy, perhaps TAS and WA etc) lower level and more restrictions raised with tight border.

needs correction for stocks and flows, not just refinement:

2020-04-10

c = 6203 cases. stock d = 53 deaths r= 3141 recovered i = 74 ICU h = 236 hospitalized stock hi = h/i = 236/74 ~ 3:1 ch = c/h = 6203/236 ~

2020-03-31

vp = 2200 ventilated beds prior vs = 4400 ventilators surge with repurposed anaesthetic etc over past 6 weeks vt = 7500 ventilator target

Assumption: target includes inferior repurposed etc and reflects constraint on ramp capacity to meet reasonable worst case scenario

So at peak v = 7500 ventilated beds in ICU is a conservative reasonable worst case estimate including some avoidable deaths from inadequate repurposed ventilation. But not a merely "possible" worst case of catstrophic overwhelm as in USA, Spain, Italy and likely most of developing world.

Paul Kelly Friday 2020-04-10 https://www.abc.net.au/news/2020-04-10/deputy-chief-medical-officer-paul-kelly-covid-19-coronavirus/12141492 https://www.health.gov.au/news/deputy-chief-medical-officers-press-conference-about-covid-19-on-10-april-2020 6,152 diagnosed. 52 died 262 hospital this a.m. cf earlier in the week 400. ICU 79 of which 38 ventilators decreasing. 334000 tests so far. cf rest of world. Only a couple of thousand of 6000 cases are local transmission.

Assumption: iv = i/v currently = 79/38 ~ 2:1 (may vary)

So at reasonable worst case peak: ip = vtiv = 7500 79/38 ~ 15000 peak ICU hp = ip h/i ~ 15000 236/74 ~ 45000

2020 Volume 44 https://doi.org/10.33321/cdi.2020.44.30 COVID-19, Australia: Epidemiology Report 10: Reporting week ending 23:59 AEST 5 April 2020

a = hc = 628/5805 = 11% of cases admitted to hospital (will need adjustment - this mixes stocks and flows - admissions is a flow from new cases flow not from cases stock)

So ci = hp 89/11 ~ 45000 8 = 360000 places needed to isolate infected

Will need simple stock/flow spreadsheet with durations and flows.

2020-04-11 Confirmation ramp up is "large multi-agency operation".

https://www.abc.net.au/news/2020-04-11/nsw-travellers-in-coronavirus-quarantine-leave-hotels/12142158 "A mass operation is underway in Sydney as the first returned air travellers to go into mandatory coronavirus quarantine two weeks ago are released.

Key points:The first batch of guests under hotel quarantine were allowed to leave on SaturdayGuests were issued with official paperwork confirming completion of quarantineIt's understood interstate travellers are facing issues due to domestic flight cutbacks.

Roughly 1,300 passengers who arrived at Sydney International Airport on March 29 will today be allowed to leave the hotels they have been staying at after a 14-day quarantine period.

NSW Police said it was working with NSW Health, the Australian Defence Force, the Office of the Sheriff of NSW and hotel staff to organise the departures.

"A large-scale multi-agency operation is underway this morning as the repatriation of thousands of returned travellers in mandatory quarantine at hotels across Sydney begins," police said in a statement.

[dentarthur]

I have added an "Update 4" re current speculation about "flattened curve" at top of post here:

http://c21stleft.com/2020/03/31/covid-19-four-corners-looks-back-ignores-urgent-need-for-quarantine-accommodation/

My view is that people who insist they do understand the issues do not in fact understand this point.

The public health decision makers DO understand it.

But reaching them with a proposal will require getting a document passed on to them by somebody who currently believes there is no need for any such proposal either because not much further measures will be needed or because the plans are already in hand.

So additional material on both points needs to accompany the proposal.

Update 4 is a first draft on first obstacle. I don't have an understanding of how to draft anything to overcome second obstacle of a belief in unannounced plans.

[veronik-a]

I wrote the document below to you on 30th March. My position has not changed. Quarantine people with the virus is an important step in slowing the speed of the virus. As I said in the document : "This is course doesn't solve a lot because there are asymptomatic people with COVID-19 amongst us. It does buy us time and help flatten the curve. What's needed as well is random testing to glean an idea of how many asymptomatic people may be amongst us. Physical isolation possibly needs to be practiced until a vaccine is found. Do the people have recovered from COVID-19 have immunity? No-one is saying definitely yes yet."

In other words I do think that there will be future waves of the virus when community cases rise in Victoria. I have never doubted the Australian and other scientists opinion on that. As I said the tack of isolating multi generational households was not an emphasis I'm interested in pursuing. Fifteen percent of Victorians are aged over 65, most live alone, some live with a partner, some are in aged care homes or nursing homes and a very small percentage live in a multigenerational household. Jan

Jan Smith jansmith047@gmail.com Mon, 30 Mar, 15:19

Hi Arthur,

I hope you are well and are cleaning your CPAP machine everyday.

Kaye mentioned you would like feedback on your article on Covid-19.

Your article has no introduction, it has some commentary along the way but with no final directions or conclusions, it's a review of a research from a range of sources. While I agree the situation is dire, I think one answer is to quarantine all cases of COVID-19 when they are identified. .

QUARANTINE ALL KNOWN VICTORIAN CASES NOW Of the 821 known cases of COVID-19 in Victoria today, 193 have recovered, 4 have died and 33 are in hospital (including 4 only in ICU). That means there are 591 Victorians actively with the virus who are currently self-isolating WHAT MADNESS. They should be put in quarantine now. In Wuhan we saw on TV the city officials build a 4000 bed hospital in ten days. They told people they must go into quarantine, anyone not obeying this was forcibly removed and put in quarantine.

Victoria is now putting all overseas arrivals in quarantine in luxury hotels under police guard. There are now thousands of people in quarantine, complaining like mad, just as well they are in quarantine. The 591 known Victorian cases of COVID-19 self isolating must also be quarantined. We know the overseas arrivals have been breaching the self isolation orders. I'm sure some of the self isolating diagnosed but mildly sick are popping out there amongst us.

This is course doesn't solve a lot because there are asymptomatic people with COVID-19 amongst us. It does buy us time and help flatten the curve. What's needed as well is random testing to glean an idea of how many asymptomatic people may be amongst us. Physical isolation possibly needs to be practiced until a vaccine is found. Do the people have recovered from COVID-19 have immunity? No-one is saying definitely yes yet.

On Sun, 12 Apr 2020 at 10:12 pm, Arthur notifications@github.com wrote:

I have added an "Update 4" re current speculation about "flattened curve" at top of post here:

http://c21stleft.com/2020/03/31/covid-19-four-corners-looks-back-ignores-urgent-need-for-quarantine-accommodation/

http://c21stleft.com/2020/03/31/covid-19-four-corners-looks-back-ignores-urgent-need-for-quarantine-accommodation/

My view is that people who insist they do understand the issues do not in fact understand this point.

The public health decision makers DO understand it.

But reaching them with a proposal will require getting a document passed on to them by somebody who currently believes there is no need for any such proposal either because not much further measures will be needed or because the plans are already in hand.

So additional material on both points needs to accompany the proposal.

Update 4 is a first draft on first obstacle. I don't have an understanding of how to draft anything to overcome second obstacle of a belief in unannounced plans.

— You are receiving this because you authored the thread. Reply to this email directly, view it on GitHub https://github.com/dentarthur/next-waves/issues/3#issuecomment-612605076, or unsubscribe https://github.com/notifications/unsubscribe-auth/APC4ZGQMVHQXEWFAH2PGPF3RMGV33ANCNFSM4MF3JEEQ .

[dentarthur]

Hi Jan,

Glad to see your email of 30 March.

I have not been on email since around 20 March as explained here:

http://c21stleft.com/2020/03/20/my-phone-has-gone-into-hiding/

and here:

https://c21stleft.com/2020/03/22/surveillance-society/

I thought I mentioned it when contacting you with my new phone number. Also when asking you to fork this repo.

We are in touch via github issues emailed to you by github, not by me.

Going for walk now and would welcome phone call.

[dentarthur]

All my comments in this issue and back of envelope calculations have been about quarantine accommodation for infected people to reduce transmission rate further.

I believe that should be the main focus.

However it also overlaps with several related issues concerning accommodation roll out.

1. As APHCC correctly identified, criteria excluding people from the option of home self isolation includes presence of vulnerable people as well as essential workers in same household. This naturally raises issue of isolating them from the household (as is already supposed to be done for health care essential workers). For vulnerable people that overlaps with much harder problem of 12-18 month or longer term isolation as opposed to 2-3 weeks for infected.

2. Quarantine accommodation for "contacts" required to self-isolate because they might be infected not because they are. These are currently much larger numbers and APHCC does not refer to them in its statement on clinical criteria. That should be the next consideration after dealing with the most urgent problem of accommodation for actual infected people (both not entering hospital and after recovering in hospital enough to be discharged but still infectious as in APHCC statement). Lower priority since not necessarily infected so less gain from reduced transmission to rest of househod.

3. Expansion of hospital beds for severe cases proportionate to expansion of ICU beds for critical cases. That is very much higher priority and could take some of the "low hanging fruit" of available accommodation like big city hotels as well convention center space for emergency field hospitals if necessary.

I will post notes in separate issues on both 1 and 2 including potential use of holiday homes for people vulnerable because of age rather than comorbidities. Some vulnerable may not need to be close to hospitals with ICUs for most of 18 months unlike people in second week of mild infection or recently disrcharged. But "contacts" in quarantine might also be feasible at more distant locations at least for first week of isolation since only minority of mild cases become severe.

My focus is on planning for the accommodation of actually known infectious starting with announcement seeking input and cooperation. APHCC statement makes that easier. Problem is how to get it to the desks of people currently preoccupied by many other matters despite inclination of intermediate links in 3 degrees of separation to not pass it on due to various misconceptions.

In separate issue I will put notes on the 36 times harder problem of providing 18 months accommodation for vulnerable cf 2 weeks for infected and corresponding difficulty of keeping those in multigeneration households isolated for 18 months of waves between relaxed restrictions.

Will also link to issue on support workforce prep for regional aid eg Indonesia as in README file for this repo.

[dentarthur]

Re 30 March letter on compulsory quarantine.

My view is that aim should be to announce OFFERS of accommodation AHEAD of actual availability so that households and infected people CLAMOUR for places instead of resisting.

Initially surveillance via phone apps etc will adequately enforce for most households that CHOOSE self isolation. Better to do voluntary OFFER first then mandatory when needed.

APHCC criteria says non-compliant ineligible for self-isolation.

What is missing is the separate accommodation roll out. Isolation orders are already compulsory with heavy penalties and surveillance is being rolled out.

Focus on accommodation first. eg 1200 Tasmanian health workers just quarantined. Total 5000 with households. https://www.abc.net.au/news/2020-04-13/up-to-5000-tasmanians-in-isolation-over-north-west-coronavirus/12143936

[dentarthur]

This article is useful: https://www.abc.net.au/news/2020-03-14/coronavirus-started-in-china-but-it-may-show-how-to-end-it/12052686

"Already we have seen Italy, the United States and Australia step up measures this week. Other countries might look at what else they need to do soon.

"While it looks draconian, it's actually the best thing for the wider population to contain people in centres away from family," UNSW epidemiologist Mary-Louise McLaws said.

"We did learn in Australia, during the avian flu of 2015, people who were meant to be in isolation picked up children from school or went shopping.

"It's hard for individuals to have the greater good in their minds, so I completely understand why China chose that approach."

But Professor McLaws believes Australia's small population and sea borders provide an advantage other countries will likely be envious of.

"I'm an epidemiologist, so my response is an epidemiological one: go in early and go in hard," she said.

"And right now is the opportunity to ensure we close our borders. We need to do this until the northern hemisphere has a drop in numbers, and they call the pandemic off.

"If we don't do that, we could be like Italy."

[dentarthur]

All's well. Got call that this story is also in "The Age":

"Patients with COVID-19 could be quarantined in 'medi-hotels' instead of at home in a bid to prevent family members and housemates from being infected and ensuring compliance with isolation requirements.

Federal Health Minister Greg Hunt he was "very open" to the medi-hotel concept, which is being trialled in Tasmania at the behest of the state's peak medical body and is based on the Singapore government's approach.

...[more]...

https://www.brisbanetimes.com.au/politics/federal/medi-hotels-instead-of-home-isolation-for-mild-covid-19-patients-20200413-p54jfc.html?ref=rss&utm_medium=rss&utm_source=rss_feed

Will still work on some submissions about it but can relax now and setup laptop, clean cpap and (sigh) find spectacles which just went into hiding at same time.

[veronik-a]

Yes I saw that and am not at all surprised. I think authorities were timing this suggestion. The mess in Tasmania, the illegal party cluster of 49 cases and the Burnie hospitals disasters putting 5000 in quarantine has helped the government get braver in their decisions. The police this morning are worried public trust in them is eroding with their COVID-19 policing duties. So its definitely about bring the public along on this journey. Timing is everything.

I've got a lot of things on my plate I'm bowing out of this discussion and getting back to other things.

Jan

On Tue, 14 Apr 2020 at 10:47, Arthur notifications@github.com wrote:

All's well. Got call that this story is also in "The Age":

"Patients with COVID-19 could be quarantined in 'medi-hotels' instead of at home in a bid to prevent family members and housemates from being infected and ensuring compliance with isolation requirements.

Federal Health Minister Greg Hunt he was "very open" to the medi-hotel concept, which is being trialled in Tasmania at the behest of the state's peak medical body and is based on the Singapore government's approach.

...[more]...

https://www.brisbanetimes.com.au/politics/federal/medi-hotels-instead-of-home-isolation-for-mild-covid-19-patients-20200413-p54jfc.html?ref=rss&utm_medium=rss&utm_source=rss_feed

Will still work on some submissions about it but can relax now and setup laptop, clean cpap and (sigh) find spectacles which just went into hiding at same time.

— You are receiving this because you authored the thread. Reply to this email directly, view it on GitHub https://github.com/dentarthur/next-waves/issues/3#issuecomment-613166073, or unsubscribe https://github.com/notifications/unsubscribe-auth/APC4ZGV4IVYW5K47KUCVNXTRMOXDNANCNFSM4MF3JEEQ .