H5N1

Japan: COVID-19 spike suggests Tokyo teeming with infected people

Via The Asahi Shimbun: COVID-19 spike suggests Tokyo teeming with infected people.

Health experts warned that Tokyo is teeming with people who are unknowingly infected with the new coronavirus as the capital on April 5 reported a new daily high of 143 infections, the second straight day of cases topping the 100 mark. 

Overall, Tokyo now has 1,033 confirmed cases of infection, more than any other prefecture in Japan. 

The metropolitan government also reported seven deaths from the coronavirus the same day, bringing the nation’s death toll to more than 100.

Tokyo Governor Yuriko Koike stepped up her call for residents to stay at home, particularly at night, to slow the spread of the virus. 

“New cases (on April 5) went far beyond the number of the previous day,” she said, referring to 117 infections confirmed on April 4. “And the number of people who cannot be tracked down where they became infected with the virus is rising. I strongly urge you to refrain from going out, particularly at night, unless it is essential.”  

Koike made the remarks in a video streamed on the evening of April 5. She warned on March 23 that the next three weeks will be critical in deciding whether to put Tokyo in a "lockdown."  

Although the metropolitan government initially reported there were 118 new cases on April 4, it later revised the figure to 117. 

Tokyo officials said of the 143 cases, the route of transmission was not clear in 92 of them, or more than 60 percent of the daily total. 

Such cases represented nearly 70 percent of the overall number on April 4. 

Officials said an increase in the number of new cases whose infection route cannot be ascertained is contributing to the spread of the outbreak in Tokyo.  

“The surge may reflect the number of people who became infected with the coronavirus after they let their guard down two weeks ago,” said Atsuro Hamada, a professor of travel medicine with Tokyo Medical University.  

“It is difficult to predict the extent of an increase in coming days and when Tokyo will hit the ceiling," Hamada added. "I am afraid that the infection is nearing a prevalent phase, given the rise in the number of cases whose path of infection is not identified.” 

The coronavirus infection is spreading throughout Japan, with no signs of slowing down. Experts warned that hospitals could be overwhelmed with new cases, placing the nation’s health care system at risk. Infections of medical personnel and patients have been reported at some hospitals.

COVID-19 in the DRC: Bulletin 12, Saturday April 4 2020

MRC has published Covid-19: Bulletin n° 12 Samedi, le 04 avril 2020. Excerpt from the Google translation:

COVID-19 EPIDEMIOLOGICAL SITUATION IN KINSHASA, IN ITURI NORTH AND SOUTH KIVU ON APRIL 04, 2020  

Saturday, April 04, 2020 

•  Since the start of the epidemic declared on March 10, 2020, the cumulative total is 154 confirmed cases. In total, there were 18 deaths; 

• 3 people healed; 

• 6 new cases confirmed in Kinshasa.  

NEWS  

RMC Covid-19 Technical Secretariat receives two mobile ambulances from the Denise Nyakeru Foundation 

 • The Technical Secretariat of the Covid-19 Multisectoral Response Committee, through its Incident Manager, Prof. Steve Ahuka Mundeke, received this Saturday April 04, 2020 from the First Lady of the DRC, Mrs. Denise Nyakeru, president of the Foundation which bears her name, two multifunctional mobile ambulances; 

• These two ambulances are support from the United Nations Population Fund (UNFPA) in partnership with Canada and Sweden on behalf of the Denise Nyakeru Foundation; 

• These mobile clinics will therefore be used to monitor contacts, evacuate bedridden patients, awareness campaigns and interhospital transport of Covid-19 treatment inputs; 

• For the first lady of the DRC, Mrs. Denise Nyakeru, who gave the keys to the Minister of Health who in turn gave it to the Incident manager of the Covid-19 response, this aid is only a beginning; 

• To this end, she took the opportunity to insist on the fact that the population must continue to practice barrier gestures and to respect the hygiene measures as recommended by the health authorities and health zones, especially washing their clothes regularly; 

• " I think we will be able to get rid of the coronavirus, " said the president of the Foundation Denise Nyakeru, hoping that the Ministry of Health and the Technical Secretariat of CMR Covid-19 will wisely use this property received from UNFPA; 

• For the Minister of Health, Dr Eteni Longondo, these two ambulances arrived at the right time and will enormously help his institution and the Technical Secretariat in the mobility of sick people; 

• Dr. Eteni reminded that in the current context, the government alone will not be able to fight against this pathology. Thus, he appealed to anyone of good will to provide both material and financial support to save the lives of the Congolese; 

• These two ambulances are accompanied by several other kits, notably delivery, care and dignity kits; 

• In the past, the person responsible for the Incident had received equipment from the international NGOs ENABEL and PATH.

COVID-19: Lethality in Italy, between appearance and reality

Via Istituto per gli Studi di Politica Internazionale, the article by Matteo Villa mentioned in the preceding blog post. It first appeared on the ISPI website on March 27: Coronavirus: lethality in Italy, between appearance and reality. The Google translation of the conclusion:

First of all, the good news: in Italy there does not seem to be a much more lethal strain of coronavirus than in the rest of the world. The plausible lethality of the virus varies with the age structure and its spread in the population: with the same number of infected people, it is natural to expect a higher number of deaths in Italy than in China because the Italian population is clearly older than the Chinese one and the virus affects the most advanced age groups more severely. 

Only in the coming months and years will it be possible to investigate any variations between countries with respect to this central estimate: but it is difficult to expect very large effects compared to the average "strength" of the virus. In short, it will probably be difficult to demonstrate that in Italy more people die because the twenty-year-olds still live in the family and have more frequent contacts with their grandparents,  

A second good news is that by comparing apparent lethality with plausible lethality, it is possible to estimate the number of people infected and, at the same time, to observe the trend of the epidemic more correctly. Official cases do not in fact offer a good indication of what is really happening, while our estimate of plausible active cases allows us to do so (and to take into account the uncertainty around the central figure). 

But there is also bad news. The first, connected to the previous one, is that we have now lost contact with the spread of the virus in the general population. It is not uncommon for this to happen during the exponential phase of contagion, in which the available resources are mostly directed towards dealing with the health emergency here and now, rather than studying the distribution of the infected. In the meantime, lockdown measures are equally inevitable to prevent the many sick and unmonitored people from infecting a large number of healthy people. 

But to be able to imagine the post-emergency period, it will be necessary to adopt methods to track potentially contagious people, whether they have noticed it or not, and try to censor them to keep the epidemic under control. 

The second bad news is that if the virus is certainly less lethal than we could have imagined, its danger remains unchanged. On the one hand, lethality is lowered only because the plausible number of infected people increases, but unfortunately the trend of deaths remains the same. 

On the other hand, even imagining that the virus infected 1.2 million people, it would still be only 2% of the Italian population. We would therefore still be very far from spreading the virus in the general population large enough to approach the famous "herd immunity", obtaining the effect of slowing down new infections (this happens when there is a sufficient number of people around a contagious person healed and - partially or totally - immune, which act as a barrier). 

A final clarification, which applies to all countries, is that especially in regions where the health stress will be higher it is plausible to expect that a share of deaths will not be registered among coronavirus-positive people, because there will not be time and resources to do even a post-mortem swab. This does not invalidate our general reasoning, but will require revising upwards our estimate of plausible cases of contagion in the most affected areas.  

The fight against the virus will still be a long struggle. With this study we have tried to provide some more tools to deal with it.

What's the problem with Italy's official COVID-19 numbers?

Via TheLocal.it: What's the problem with Italy's official coronavirus numbers? Excerpt:

There is growing evidence that the death toll and infection rate figures being reported daily by Italian officials may be much lower than the reality.  

Since the coronavirus outbreak began in Italy in late February, the public has been relying on official government data for a picture of how many deaths, cases, and recoveries there have been in each part of the country, and how things are changing.  

Italy's Department for Civil Protection releases these statistics daily at around 6pm. The data is then pored over by experts worldwide, looking for evidence that Italy's quarantine measures are containing the spread as hoped – and that other countries can confidently follow its example.  

But a growing number of Italian experts have now said these numbers may not be reliable.   

“For sure, the figures are wrong,” said Matteo Villa, a researcher at the Italian Institute for Political Studies and author of a new study (in Italian) titled ”Coronavirus: Lethality in Italy, between appearance and reality." 

He that the death toll may have been underestimated by up to 6,000, or a third of the official total. 

In total, Italian authorities have recorded 115,242 cases and 13,915 deaths as of Thursday, April 2nd. 

Authorities acknowledge that the data are incomplete, as the death toll doesn't include people who died at home, or in nursing homes, or those who were infected by the virus but not tested.   

"It is plausible that deaths are underestimated," Higher Health Institute president Silvio Brusaferro stated. "We report deaths that are signalled with a positive swab. Many other deaths are not tested with a swab."  

The possible scale of the disparity showed up this week when death records for the month of March from different years were compared. 

The data showed a very large difference between the number of Covid-19 deaths reported by authorities, and the total death toll in different Italian regions.  

Experts have said the only explanation is that coronavirus deaths have been under-reported.  

The deaths were “mostly attributable to the virus”, said Villa. 

“Some of the increase will be people who die of other illnesses, because they cannot find a hospital bed due to the crisis,” Villa explained, “but that will be partly offset by the decline in road fatalities due to Italy’s lockdown.”

"For every two sufferers in Italy there is another one you can’t see,” he added.

Branswell: Americans are underestimating duration of COVID-19 crisis, experts say

Via STAT, Helen Branswell writes: Americans are underestimating duration of coronavirus crisis, experts say. Excerpt:

Public health experts are increasingly worried that Americans are underestimating how long the coronavirus pandemic will disrupt everyday life in the country, warning that the Trump administration’s timelines are offering many a false sense of comfort.  

Coronavirus cases are expected to peak in mid-April in many parts of the country, but quickly reopening businesses or loosening shelter-in-place rules would inevitably lead to a new surge of infections, they said. 

Meanwhile, other parts of the country are only now implementing restrictions and others have not yet ordered the closure of non-essential businesses, creating a patchwork response that will slow progress toward the goal of driving down transmission of the SARS-CoV-2, the virus that causes Covid-19. 

“The administration has consistently shown a desire to underplay the severity of whatever is coming. And they’re constantly adjusting that — as it becomes harder to deny the reality will be worse than what they’ve conditioned people for,” said Jeremy Konyndyk, a senior policy fellow at the Center for Global Development. 

Konyndyk said he and other experts he’s discussed the matter with believe an “intensive period of social distancing and a national semi-voluntary lockdown” will last for months.   

President Trump, after signaling that he may try to restore some sense of normalcy in the country by Easter, has acknowledged that difficult times are ahead and that restrictions should remain in place until the end of April. 

But experts say that, even if some restrictions are relaxed, it’s unlikely life as normal will resume in early May.  

A former director of the Centers for Disease Control and Prevention, Thomas Frieden, said this week that it’s understandable that people want to know when businesses can reopen and some facets of life can resume. But he said the focus of public discourse now needs to be on the public health response, not the question of when restrictions can be lifted.  

“Decisions to reopen society should not be about a date, but about the data,” Frieden, now president and CEO of the global public health initiative Resolve to Save Lives, said during a briefing Wednesday for journalists. “How well and how quickly we do these things will determine how soon and how safely we can reopen.”  

He and others have outlined steps that should be taken before restrictions are lifted to ensure new cases do not continue to grow exponentially, collapsing health care systems under their weight. Frieden stressed the importance of expanded testing to know where the virus is transmitting as well as setting up public health infrastructures to trace the contacts of cases and monitor them in quarantine.  

“We need an army of contact tracers in every community in the U.S. to be ready to find every contact and warn them to care for themselves and stop spreading it to others,” he said.

Those resources do not current exist, said Konyndyk, who also noted that hospital capacity across the country needs to be expanded and protective equipment for health workers restocked. There are currently global shortages. 

“If we want to be able to — as I think we need to — turn our economy back on in a safe way, we need to be able to do that sort of thing at scale,” Konyndyk said. “And we do not have anywhere close to the public health infrastructure that’s needed to pull that off.”  

“That’s fundamental to getting us out of this lockdown phase. And the government’s not talking about it, much less acting on it,” he said.

India COVID-19 cases rise amid fears true figure much higher

Via The Guardian: India coronavirus cases rise amid fears true figure much higher. Excerpt:

Doubt has been cast over India’s claim that it has no community transmission of coronavirus after the country reported its biggest daily rise in number of cases so far, connected to a religious gathering held in Delhi two weeks ago. 

India reported a record increase of 386 cases in the past 24 hours, pushing the total number to 1,637, according to the country’s health ministry. The death toll is now 38.  

In another worrying development, the first coronavirus case was also confirmed in Mumbai’s Dharavi slum, which is India’s largest and is home to almost one million people living in close, unsanitary quarters. The 56-year-old man was taken to Sion hospital and eight of his family members placed into quarantine. 

Yet for a densely populated country of 1.3 billion people, the number of cases is still relatively low compared with Europe and the US, and believed to be linked to both low levels of testing and poor access to an already overstretched healthcare system with people not reporting their symptoms. 

India spends only about 1.3% of its GDP on public health, among the lowest in the world. Only 47,951 tests have been done so far and there are just 51 government-approved testing centres across the country.  

The jump in number of cases was linked to an annual two-day convention of the Muslim sect Tablighi Jamaat on 13 March, for which about 3,500 people gathered from all over the country and abroad in the south Delhi neighbourhood of Nizamuddin. Almost 2,000 stayed in the area for days afterwards, and the area has become the coronavirus hotspot of India.

The outbreak from the Nizamuddin mosque gathering also inflamed religious tensions in a city still reeling from communal riots last month that took 50 lives, with Hindu mobs rampaging through the streets attacking Muslims in their homes.  

Across Indian media and social networks, Muslims were blamed for spreading the virus while “Corona Jihad” began to trend on Twitter. 

The gathering also appeared to trigger a spread of the virus across numerous states from Kashmir to West Bengal by those who returned home afterwards. So far, 10 people who attended the event have died while 1,800 people have been sent to nine hospitals and quarantine centres across the country.  

However, despite the jump in number of cases this week, the Indian government insists there is still no community transmission and that cases have been either from those who travelled abroad or in localised incidents. Lav Agarwal, the joint secretary in the health ministry, told reporters: “Nowhere have we said that there is a community transmission. We are still in a local transmission in this country.”

COVID-19 in the DRC: 123 cases, 11 deaths

MCR has published Covid-19 : Bulletin n ° 9 Mercredi, le 01 Avril 2020. The Google translation and then a comment:

COVID-19 EPIDEMIOLOGICAL SITUATION IN KINSHASA, IN ITURI IN THE NORTH AND SOUTH KIVU ON APRIL 01, 2020 

Wednesday, April 01, 2020  

• Since the start of the epidemic declared on March 10, 2020, the cumulative total is 123 confirmed cases. In total, there were 11 deaths. 

• 14 new confirmed cases, including: 

o 10 in Kinshasa; 

o 4 imported, including 3 from Kinshasa and 1 from North Kivu to Goma; 

• Pending approval by the competent services, the number of people healed will be given in the next bulletins.

I don't like the high number of deaths in such a small number of cases. It would also be helpful to know where in North Kivu the original COVID-19 cases were detected. The DRC response had a hell of a time tracking Ebola cases when so many regions were under the control of Mai-Mai militias or armed groups like the ADF.

Why Canada needs urgent revisions to its COVID-19 response strategy

Via CMAJ Journal, a March 27 opinion piece: Why Canada needs urgent revisions to its COVID-19 response strategy.

Canada’s response to the COVID-19 pandemic is not strong enough. Despite school closures, measures being taken at borders to minimize spread, and social distancing efforts, and despite the recent announcement of $82 billion to support the business community and the economy, more effort is urgently needed. New cases doubled over 4 days before reaching 1,426 on March 22nd, which was after a week of containment measures. Canada’s initial lack of a robust border policy or mandated supervised quarantine program for both incoming travellers and contacts of documented cases has impaired our ability to contain the epidemic here. 

If the main goal of our response is merely to try to flatten the epidemic curve in order to reduce the extent to which hospitals become overwhelmed, we will fail in Canada. Another very important goal must be to reduce the percentage of the population who will ultimately become infected, which has been estimated to between 10% and as high as 60% if there is inadequate containment, resulting in a massive death toll. Lessons from other countries and recent observations need to be urgently incorporated into our national strategy. 

Taiwan’s early and multifaceted response to COVID-19 successfully prevented uncontrolled spread in the community. It included a comprehensive border policy, mandated supervised quarantine utilizing a short text message service (“mHealth”), and rigorous case finding with contact tracing. Taiwan had previously been predicted to have the 2nd largest number of exported cases outside China, given its proximity and number of daily flights, yet only 252 cases have been reported in Taiwan to date (March 26th), putting it well down the league table of cases by country and illustrating the effectiveness of their public health policy. In contrast, Canada was predicted to have the 14th highest number of cases, but now we have 3,579 cases (March 26th) and are right where we were predicted to be. With a multipronged intervention like Taiwan’s it is difficult to determine which components were most important; however, their success so far challenges a popular view that early temporary travel restrictions (which included quarantine) have more negative consequences than benefits and should not be recommended. While Taiwan’s approach may be difficult to emulate in low resource settings, high resource countries like Canada should be able to follow their example. 

Two clear examples of successful responses to major COVID-19 outbreaks, so far, come from China and South Korea. China’s highly efficient response that included what might be considered “draconian measures” is unlikely to be replicated in Canada. However, democratic South Korea managed to largely control its epidemic with an aggressive approach, which has included extensive testing for case finding, extremely detailed contact tracing, plus mandatory supervised quarantine with fines for infractions of up to $2,500 USD. 

Convincing evidence is now emerging that cases may be contagious for days before they develop symptoms. Such evidence highlights a flaw in Canada’s previous program of allowing people returning from countries deemed to be ‘at risk’ (other than Hubei province and Iran) to self-monitor for symptoms, unsupervised and without self-isolation. That program was recently revised on March 12th to include instruction to returning travelers to self-isolate, but it remained neither mandatory nor supervised.  

Recently announced border control measures should help stem the flow of incoming infected travellers, but will do little to flatten the curve of our epidemic without the use of stronger mitigation strategies such as enforcement of social distancing measures, and supervised mandatory quarantine facilitated by the adoption of mobile phone short text message service. Quarantine has been shown to be more effective than self-monitoring for symptoms for infections where transmission can occur before patients become symptomatic. However, Canada’s Quarantine Service likely needs hundreds of additional staff across the country to accomplish this. 

Furthermore, we need to rapidly scale up diagnostic testing. This is already underway but obstacles include limited availability of testing kits from commercial suppliers, and also a shortage of swabs suitable for viral testing. Health messaging has been misleading regarding “who to test”. It should be clarified that although limited access to testing may make it impossible to test travellers with mild COVID-19 compatible symptoms right away, it is essential that such individuals be tested in the near future if we are to be successful in controlling further spread. Modification of the contact tracing protocol is needed to include testing of contacts of cases during the 2 days before the development of symptoms as recommended by the WHO. 

Canada also needs an increase in public health staffing to accommodate the burgeoning case load that greater requirements for testing will deliver. Increased funding targeted to public health and quarantine services will be needed if we are to follow South Korea’s response plan, over and above the $100M announced by the federal government last week, as well as creation of federally co-ordinated task forces and adequate funding (over and above the recently announced $500M) in order to lead efforts to secure adequate human resources, hospital and intensive care unit bed space, ventilators, personal protection equipment, swabs, facilities to house and support those who are infected but do not require hospitalization and whose housing is inadequate for home isolation.

Rapid scanning of global data could ensure that experience from other countries informs and regularly updates the Canadian response plan. Given the accomplishment of South Korea, which, at least so far, has managed to restrict spread to 0.0002% of their population, and which should be considered the gold standard of public health care, we in Canada should aim for nothing less. Even if this goal is ultimately unsuccessful, it will at least buy precious time which may allow for drug or vaccine development, and improving access to critical supplies.

Those who have strong concerns regarding the negative consequences for human rights due to such disruptive mitigation and containment measures should look more closely at the current situation in Italy, which has seen more than 700 deaths today (26th March) and over 600 per day for the past week. Surely the rights of Canadians who are at greatest risk of becoming seriously ill or dying also need to be considered. Our current epidemic curve suggests that we could end up in a similar situation as Italy in the next few weeks, unless major steps are taken to change the course.

The federal government’s reluctance to adopt disruptive measures until very recently reflects a serious underestimation of the gravity of this pandemic. The upfront costs and disruption to both society and the economy associated with a comprehensive containment strategy are considerably less than that related to an uncontrolled outbreak requiring mass community quarantine. The benefits from the important vaccine and drug treatment development initiatives are likely many months to years away. Canada’s government needs to do more and to do it now.

Germany has relatively few deaths from COVID-19. Why?

An op-ed in The New York Times: Opinion | Germany Has Relatively Few Deaths From Coronavirus. Why?

BERLIN — Europe is in crisis. 

Countries across the Continent are in lockdown. Borders are closed off. Health care systems are dangerously overstretched. Economies are contracting. And people are dying, in terrifying numbers. 

Here is much the same. Though not in full lockdown, schools, shops, restaurants and theaters are closed; gatherings of more than two people are banned. The economy will shrink and jobs will be lost. Even Chancellor Angela Merkel self-quarantined after learning that her doctor was infected. (She tested negative.) Germany, it seems, is not immune to the ravages of the pandemic. 

Except in one way: Very few people seem to be dying. As of Saturday, of the 56,202 confirmed cases of the coronavirus, just 403 patients have died. That’s a fatality rate of 0.72 percent. By contrast, the current rate in Italy — where over 10,000 people have died — is 10.8 percent. In Spain, it’s 8 percent. Over twice as many people have died in Britain, where there are around three times fewer cases, than in Germany. 

The startling numbers are something of an enigma. Some have hailed the country for breaking the spell of catastrophe; others have been far more guarded. What is going on here? And what can we learn from it?  

First and foremost: Early and persistent testing helps. And so does tracking people. 

Take the country’s first recorded case. On Jan. 28, a man in Bavaria who works for a car parts company that has two plants in Wuhan, China, was confirmed to have the virus. Within two days, the authorities identified the person who had infected the patient, tracked his contacts and quarantined them. The company stopped travel to China and shut down its plant in Bavaria. The outbreak — several other employees tested positive — was effectively contained. Across the country, the pattern was repeated. Local health departments and federal authorities worked together to test, track and quarantine exposed citizens. 

Germany has also been better at protecting its older residents, who are at much greater risk. States banned visits to the elderly, and policymakers issued urgent warnings to limit contact with older people. Many seem to have quarantined themselves. The results are clear: Patients over the age of 80 make up around 3 percent of the infected, though they account for 7 percent of the population. The median age for those infected is estimated to be 46; in Italy, it’s 63. 

And many more young people in Germany have tested positive for the virus than in other countries. In part, that’s attributable to the country’s more extensive testing. But there’s also an element of chance and culture. Germany is a skiing nation — around 14.5 million Germans go skiing every year — and the Austrian and northern Italian Alps are popular locations. This year, after vacationers traveled to one of the centers of the European outbreak, Tyrol, they seemed to bring back the virus with them — and spread it. 

Closer to home, there’s carnival. One of the most substantial early outbreaks occurred at one of the centers of carnival, which involves parades and parties, popular with the young. Hundreds of cases seem to be traceable to a couple who took part in festivities in the town of Langbroich. “Both skiing and carnival may have affected the low average age of the first wave of confirmed cases,” said Karl Lauterbach, a physician and a member of the Bundestag.  

Both early testing and incubation of the virus among the young go part of the way in explaining why the country’s fatality rate is so comparatively low. “It’s how much and whom we test,” Martin Stürmer, a virologist who is the director of a lab that is running coronavirus testing in Frankfurt, told me. In general, countries that test less and reserve it for those already very ill, like Italy, have higher fatality rates. 

But we should be wary of reading too much into the statistics at all, particularly at this early stage. Though Germany’s health care system is overall in good shape — recently modernized, well staffed and funded, with the highest number of intensive-care beds per 100,000 patients in Europe — it hasn’t really been tested yet. Patients have only recently entered hospitals. On average, a severely ill Covid-19 patient dies 30 days after being infected. 

“We are only at the beginning of the epidemic,” Lothar Wieler, the president of the Robert Koch Institute, said on Wednesday. “How it is going to develop is an open question.”

It’s quite possible that Germany is just behind the curve. Opinions vary on how hard the strain on the system will be in the next weeks. “I think we are unlikely to experience a situation like in Italy,” Stefan Willich, the director of the Institute for Social Medicine, Epidemiology and Health Economics at Charité University Hospital in Berlin, said. Others are more pessimistic. Dr. Lauterbach, for example, warned that Germany’s fatality rate may yet rise. Indeed, in the past few days it has climbed from 0.48 percent to 0.72 percent.

And there have been signals that the health care system could soon be overwhelmed. More hospitals and doctors are reporting shortages of vital materials such as masks and other protective gear. A paper published by several medical associations on Wednesday predicted that it is likely that within “a short period of time, there won’t be sufficient intensive care resources in Germany to treat all patients, despite recent capacity-building.” The worst may be to come.

So there is perhaps one lesson we can draw from Germany’s experience. Don’t count your blessings — or your data — too soon.

COVID-19 live updates: US deaths double in two days, hitting 2,000

Via The Washington Post: Coronavirus live updates: U.S. deaths double in two days, hitting 2,000. The report and then a comment:

Breaking: Confirmed U.S. coronavirus-related deaths double in two days, hitting 2,000. It took about a month from the first confirmed death for the United States to record 1,000. That toll has risen rapidly as officials have been warning the worst is yet to come. 

President Trump said Saturday he may announce later in the day a federally mandated quarantine on the New York metro region, placing “enforceable” travel restrictions on people planning to leave the New York tri-state area because of the coronavirus outbreak.  

The news comes as the United States has become the epicenter of the pandemic, with more than 116,000 confirmed infections and 1,900 deaths. 

Here are some significant developments: 

• The outbreak in New York — the state hit hardest so far — will reach its apex in “14 to 21 days,” Gov. Andrew M. Cuomo (D) anticipated. The surgeon general warned that Detroit, New Orleans and Chicago are becoming “hotspots.” 

• Italy has now seen more than 10,000 coronavirus fatalities. More than 600,000 people have been infected worldwide with 30,000 total deaths, according to Johns Hopkins University. 

• South Korea marked a new milestone, as more coronavirus patients have been discharged than those undergoing treatment. 

• Following several days of back-and-forth criticism with Michigan Gov. Gretchen Whitmer (D), Trump granted her request for a disaster declaration, as well as one for Massachusetts.

To provide a little context, according to Worldometer, world cases doubled to 660,000 between March 24 (last Tuesday) and today. World deaths doubled to 30,000 between March 23 and today. To invoke a favourite premise of science fiction writers: If this goes on... Here's a very rough extrapolation, assuming 4-day doubling times for cases and 5-day doubling times for deaths:

April 1: 1,300,000 cases  April 2: 60,000 deaths

April 5: 2,640,000 cases  April 7: 120,000 deaths

April 9: 5,280,000 cases  April 12: 240,000 deaths

Somehow I don't think America's churches will be very crowded on Easter.

And with every doubling time, governments around the world will teeter; some will stay in power only because no one is ready to replace them.