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A COVID-19 Interim Report (3): R0-differences per country

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When (in March – May) we were still panicking and the intelligent lock-down was announced, I started looking for certainty, for a better picture of the situation. In February and March 2020, COVID-19 gained a foothold in our world, literally everywhere.

I deduced from the media that the virus is highly contagious, that it travels with its carriers around the world and that it is characterized by local outbreaks of variable magnitude.

(In order to make progress I need aphorisms that can be tested. I understand aphorisms as concise, reasonable and with the aid of common sense understandable propositions, or, even more elegantly, as hypotheses or theorems.)

3. R0-differences per country

COVID-19 often leads to flu-like symptoms that regularly develop into serious and sometimes fatal forms of pneumonia. Starting from the first two preliminary conclusions, I argue that the effect of the virus on a population depends on how elements from the action repertoires of virions and humans interact.

That yielded my first COVID-19 aphorism:

Aphorism I – Until an effective policy is established in a jurisdiction, the first COVID-19 spread will be exponential, which will only change under the influence of such a policy.

Can I test that claim? Perhaps. I searched (with computer support) for the R0 values for 9 countries, such that they coincide with the start of the curve that records COVID-19 deaths. This allowed me to determine the week in which the curve with registered deaths will deviate from the hockey stick – the week in which the observations will deviate from the expected number (the exponential model). Only then can I see whether that moment closely follows the adoption of policy. If I can’t, aphorism I is false.

Fig. 1 provides an overview of such aphorism-I graphs for 9 countries.

Looking at Fig. 1 I think to have managed to find R0-model values for all nine countries, R0-values that meet the first requirement that is, of initially coinciding with the observed COVID death rates.

(The graphs start in the week in which the first COVID death was registered. This means that the start of the R0-model may be slightly earlier. Furthermore, it should be noted that the horizontal lines indicate the number of registered COVID deaths under the assumed policy. Those numbers are equal to 1/3 of the values indicated above left.)

In all graphs there is a week to which I can allocate the deviation expected. That week is indicated in each graph with a vertical line. It should be noted that R0-values vary by jurisdiction. About that later. First, I examine whether the weeks found can be related to the times when a local policy was first adopted. I deal with the jurisdictions in the order in which the first COVID-19 death was registered there and give the week in which the curve will deviate (and the duration in weeks between the two). As a source I use, as a simple citizen, the jurisdiction-related COVID-19 contributions of Wikipedia.

Fig, 1 Calibrated values for testing aphorism I in 9 countries

wk 4-6 (2): 11 February – China. In retrospect, China probably did not recognize the virus at the time of its appearance (likely in mid-December 2019). That couldn’t be very well otherwise: it was a new virus. At an early stage it was feared already that it was a SARS-like virus. The Wuhan health authority announced on December 31 that a cluster of cases of unknown pneumonia had occurred there. The first death was recorded in late January. A lock-down is announced on January 24. The New Year’s festivals were canceled as of January 25. That’s two-and-a-half weeks before the consequences become visible in the comparison of the recorded death curve with the hockey stick model and in accordance with my aphorism. As in many countries, there has been an inconsistent response to (the discovery of) the virus and how to handle it: Dr. Li Wenliang, was banned by the police from spreading false information and died of the virus himself on February 7, at the same day that another discoverer (and warning about it) of the virus, Ms. Dr. Zhang Jixian, was decorated for it by the Hubei administration.

wk 8-10 (2): 10 maart – South-Korea. South Korea is a different story. There have been hardly any government-enacted lock-downs, but there have been recommendations and a significant and widely shared concern for the spread of the pandemic among the population. The focus is mainly on supportive measures (testing, distancing, masks, temperature measurements, quarantine of who has symptoms, contact analyzes). In the three days following February 18, however, the numbers of registered infections rose exponentially in and around Daegu. The source was traced back to a religious gathering of the Shincheonji movement. The COVID-19 explosion involved made a big impression. But it appears that the adoption of the measures came from within the people themselves, not by any rule of law. As far as I can tell, the government is assisting with testing and contact tracking and with making quarantine hotels available. If the Daegu outbreak has been a tipping point, it is to be expected that the curve will rise exponentially with it and will deviate again a month later. No regulation in sight. So it is much more likely that that outbreak occurred in an environment that was already living under the acceptance of the measures based on what had become known during the Wuhan outbreak in China. So what happened in South Korea doesn’t match my aphorism I.

wk 9-14 (5): 7 april – the USA. The US outbreak was declared a public health risk on Januari 31. Restrictions were placed on flights arriving from China. At the same time, however, President Donald Trump downplayed the threat of the virus and claimed the outbreak to be under control. Yet on March 13, he declared it to be a federal emergency. On April 17, the federal government approved the declaration of a state of emergency for all states and territories. I consider the US government responses to be rather incoherent. But if there is a first regulation moment that applies to the federation, it will be on March 13. That’s more than three weeks before April 7, which doesn’t conflict with my aphorism.

wk 10-16 (6): 21 april – Brazil. The pandemic has sparked a variety of responses from federal, state and local governments, impacting politics, education, the environment and the economy. On March 27, Brazil announced a temporary ban on foreign air travelers, and most of the state’s governors have instituted quarantines to prevent the spread of the virus. On March 18, Rio de Janeiro and five other municipalities – São Gonçalo, Guapimirim, Niterói, Nova Iguaçu and Mesquita – had declared a state of emergency in Rio de Janeiro state to help contain the coronavirus. The measures taken included the prohibition of interstate travel and restriction on items purchased in the markets. On March 21, the number of cases in São Paulo increased by almost 40% in two hours. The death rate also increased over the period. The state issued a lock-down for non-essential businesses, which ran from March 24th to April 7th. April 21 (the aphorism moment) is almost four weeks after the first effective regulation in Brazil. Not an anomaly. Despite the global impact of COVID-19 and repeated warnings from health experts and organizations, President Bolsonaro has routinely downplayed its seriousness. He has described the threat of COVID-19 as exaggerated and as a “fantasy” created by the media.

wk 10-14 (4): 7 april – the United Kingdom. The government ordered people to stay at home on March 23 with the exception of essential purchases, essential business trips (when remote work was not possible). Many other non-essential activities, including all public gatherings and social events except funerals, were banned, and many types of shops had to be closed. (The Health Protection Regulations 2020 went into effect three days later, on March 26.) April 7 (the aphorism moment) is two weeks after the first effective regulation in the UK. Not an anomaly.

wk 10-14 (4): 7 april – Germany. As of March 13, the pandemic has been assessed as in its conservation phase (according to a pre-established plan), with German states mandating closure of schools and kindergartens, postponing academic semesters and banning visits to nursing homes to protect the elderly. April 7 (the aphorism moment) is therefore more than three weeks after the first effective regulation in Germany. Not an anomaly.

wk 11-16 (5): 21 april – Ireland. On March 12, the government closed all schools, colleges, childcare facilities and cultural institutions and recommended that large gatherings be canceled. On March 24, nearly all businesses, facilities and amenities were closed. A maximum of four people were allowed per meeting. Three days later, on March 27, the government imposed a stay-at-home obligation prohibiting all non-essential travel and contact with people outside the home (including family and partners). April 21 (the aphorism moment) is six weeks after the first palpable, and four weeks after the first effective regulation in Ireland. Not an anomaly.

wk 11-14 (3): 7 april – the Netherlands. The government announced new measures on March 12 that will be in effect until the end of the month. All events (concerts, sports) and all gatherings with more than 100 people are now prohibited and the appropriate authority (RIVM) encourages people to work from home. The restriction also applies to museums. All Dutch universities will suspend physical education until April 1, but online education will continue. Schools remain open. April 7 (the aphorism moment) is more than three weeks after the first effective regulation in the Netherlands. Not an anomaly.

wk 13-16 (3): 21 april – Zuid-Afrika. On March 15, South Africa’s President Cyril Ramaphosa declared a state of emergency and announced measures such as immediate travel restrictions and the closure of schools from March 18. On March 17, the National Coronavirus Command Council was established to lead the country’s approach to contain the spread and negative impacts of the coronavirus. On March 23, a national lock-down was announced, effective March 27, 2020. April 21 (the aphorism moment) is more than three weeks after the first effective regulation in South Africa. Not an anomaly.

This overview calls for a closer look at aphorism I. I do that elsewhere.

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