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As the UK passes 20k COVID-19 positive deaths, why is the impact of the SARS-CoV-2 so different in Germany compared to the UK? The UK is a genuine centre of excellence for infectious diseases and had made relatively good preparations for such an event. So, where might it have gone so wrong? Real-world decision-making. The UK has not adapted effectively when (most) things have not gone to plan (e.g. assumptions about the incubation period). Lost February. The UK government “spun their wheels” in February whilst Germany got ready. Measure what you care about. Germany invested in testing and contact tracing. The UK, even now, is disorganised. Stepping up. UK politicians, civil servants, hospital administrators and academic advisers have not had the right skillsets for this crisis (as Tony Blair has recently pointed out) and they have lacked the wisdom and humility to bring in the right resource. So, what about France/Italy (very similar story to UK) and Spain (worst of big 5)? Are South Europeans too sociable? Intuitively, the reasons for a difference don’t seem to add up to the size of the difference. What else might be at play? Any money on a genetic/epidemiological explanation too?

What’s going on in South East Asia? Absolutely without a doubt, there are issues with stated numbers in most countries. At the same time, we are not hearing about large scale unreported infections and deaths in a region that is both densely populated region and with many countries having fairly basic healthcare systems. And this is from a region adjacent to China. China: Population: 1,435m, reported cases: 83,885, deaths 4,636 Original epicentre 2.2 x larger than South East Asia There have been quite a few theories put forward, including some interesting research linking by the New York Institute of Technology (NYIT): "We found that countries without universal policies of BCG vaccination, such as Italy, the Netherlands, and the United States, have been more severely affected compared to countries with universal and long-standing BCG policies” as typically enforced in Asia. We are also seeing quite similar scenarios in highly developed North Asia and Japan: South Korea: Population: 52m, reported cases: 10,708 deaths 240 Japan: Population: 127m, reported cases: 12,368 deaths 328 No answers! Let’s hope this is being properly investigated; with international co-operation somewhat patchy, just not sure who is doing it...

Background: Remdesivir was developed as a (“failed”) treatment for Ebola Granted “compassionate use” status in the US for treatment of severe COVID-19 Gilead forced to withdraw FDA “orphan drug” status as a treatment for COVID-19 Chinese clinical trial the first to report Chinese clinical trial: n= 237 patients: 158 administered the drug to 158; 79 received a placebo Case for Prosecution: After a month, 13.9% of the patients taking the drug had died compared to 12.8% of those receiving the placebo. The trial was stopped early because of side-effects. Draft report states "Remdesivir was not associated with clinical or virological benefits” Case for Defence: Patients allowed to start up to 12 days after symptoms 1st appeared. Some evidence to suggest better outcomes if treatment started earlier The trial was terminated early due to low enrollment The report was draft and has since been withdrawn by WHO Verdict: We will know more soon. 2 phase 3 studies in progress NIAID is running a study Study on 2 regimens for moderate COVID-19 >1,700 people on a compassionate use Drug available to studies run by other sponsors.

Herd immunity is an epidemiological concept that describes the state where enough people are sufficiently immune to a disease that the infection will not spread within that group (e.g. for the MMR vaccination, that means 92-95% of the population needs to be vaccinated). What if we don’t have a vaccine? A further theory has been raised that if enough people (60%+) get COVID-19, recover and develop immunity, then then we will achieve natural herd immunity. Sounds good, what’s the catch? - Time. Any strategy would need to be tightly controlled or else 1% would die, 10%+ would be hospitalised and our healthcare systems would fall apart. Prof Neil Ferguson from Imperial College London estimates it would take 2 years to reach a critical point of infection. Not good news if you are in a vulnerable group and need to self-isolate for two years! - Immunity. We aren’t sure yet if contracting COVID-19 make you immune. More worryingly, the virus might mutate or new viruses develop. - Long-Term Impact of COVID-19. We don’t know the long-term impact of contracting COVID-19. Perhaps nothing for many; but we know that COVID-19 goes beyond just infecting the lungs but can also impact other organs such as the kidney, liver and brain.

Another great visualisation from DanClark93 to share on how the price of oil futures has changed. But for the COVID-19 news, what’s happening to oil prices would be headlines for days/weeks. Ironically, COVID-19 has made what started as an oil price war into something even worse. The price of a barrel of West Texas Intermediate (WTI), the benchmark for US oil, has fallen as low as minus $37.63 a barrel. Basically, there is so much supply and such a reduced level of demand that there is nowhere to store oil. So oil firms have resorted to renting tankers to store the surplus supply and the cost of doing that has forced the price of US oil into negative territory. The markets are also signalling that the Opec+ output reduction deal will not be enough to balance supply with current demand. Don’t we want to use less oil? Pollution and global warming has abated as road transportation (50% of global consumption) and aviation industry (8%) have slumped. Good for the environment but it is also another negative impact to the world’s economy (and financial system). Distribution of oil demand in the OECD in 2017 by sector

The Washington Post produced a great infographic which deserves to be shared. A picture is worth 10,000 words: One of the things this visualisation does so well is to illustrate just how significant an impact that COVID-19 has had on the US healthcare system. Of course, we don’t know if all deaths of people testing positive for COVID-19 were caused by the virus, but, for all but a few, it would be fairly safe to assume that their deaths are likely to have been accelerated.

Cosmopolitan NY (a truly global city) has borne the brunt of the COVID-19 infections in the US. We just reviewed some of the latest data: Comorbidities. Almost in line with the Italian data, the existence of 1 or more comorbidity in COVID-19 deaths is around 98%. We now know that COVID-19 doesn’t just attack the lungs but also other organs like the kidney, brain and liver. Sex. Males are more at risk. Whether that is linked to comorbidity, lifestyle difference or there is a different link altogether (e.g. XX v XY chromosome), we still don’t know. Age. Thankfully, COVID-19 is sparing our children - why, we don’t know. Focus. COVID-19 has radically changed the focus on healthcare provision - those conditions have not stopped.

nuaxia, a technology and healthcare information company announces that it has appointed Scott Miller (former CEO at Vision Critical) to its Advisory Board. The remit of the Advisory Board is to support the development of the company’s elementary-ai brand and product suite. In his past CEO roles at Vision Critical, Synovate North America and Synovate Motoresearch, Scott has been a driving force behind innovation, commercialisation and business transformation. His experience in the technology and customer experience industries is directly relevant to elementary-AI’s strategic plans. Peter Chopra, CEO comments: “I am delighted to welcome Scott to the team; he joins us at the perfect time. We believe the elementary-AI technology has reached the forefront of interpreting visual and audio data. With our ability to interpret and visualise large volumes of audio and video data already ahead of the market, we now turn to augmenting clients’ existing systems and CX/PX measures. So not just unique but uniquely useful.” Scott Miller, comments: “I am delighted to be joining the nuaxia team. I have been following the development of the technology brand for some time and am inspired by how quickly it has evolved its market leading capabilities. It is pretty clear how the elementary-AI technology will improve patient and customer experiences in the near future. ”

Why have the world’s populations so easily submitted to lockdown/stay-at-home orders? COVID-19 is a new and unknown threat. We have been bombarded with images of danger which have been triggering our basic instinct for survival. Our decision making is 90% driven by instincts, emotions and associations rather than logic & rationality. Fear only enhances our use of mental shortcuts. Our assessment of risk is based on perception, not hard data. Governments have been using language to “nudge” those heuristics and trigger our social instincts. People’s instincts have helped governments so far, but there are “bear traps” ahead: Familiarity breeds contempt. People will stop supporting lockdown measures as the “fear” related heuristics wear off. The social instincts to fight the disease will evolve into the need to socialise and break social distancing rules. Self-survival. As the economic impacts kick in, more people will be driven by their own “selfish” need to provide and survive. Post-hard lockdown buy-in. Managing the pandemic with data-driven complex measures and trade-offs will be required. Changing the perceptions of risk that they have reinforced will be very difficult.

It would take a prodigious “hail mary” for there to be any vaccine solution in 2020. That means there is no “exit strategy” until we have a vaccine(s) and/or the SARS-CoV-2 virus mutates into something less harmful. There are very good reasons why the lockdowns will need to be relaxed as we enter the summer months: Financial cost Mental health issues Fading compliance (especially in the free world) China has relaxed its lockdown and wave 2 infections have already commenced. This is unavoidable and why some restrictions will remain. At a certain point, restrictions will need to be strengthened again until the curve of infections and deaths pass their peak. The good news is that we are now better able to control these waves: Containment. Germany and South Korea have shown how to flatten the infection and death curve with testing and contact tracing at scale (although both still needed a lockdown period during wave 1). Treatment capacity. Specifically hospital/ICU capacity Treatment improvements. Reducing deaths and the time in hospital.

With so much research going into COVID-19 and with some many drug candidates being suggested as solutions, it is easy to get confused with what each drug is doing and how it helps. Vaccines for COVID-19: Prevent people getting COVID-19 No existing Coronavirus treatment Research picking up from failed research on SARS & MERS Requires Clinical Trials process and production facilities Estimate: 18 months to develop 2021 solution Treatments for COVID-19: Help people with the more severe COVID-19 Typically existing drugs available used to treat other diseases Clinical Trials on potential candidates quicker Blunt the severity of COVID-19 2020 solution Both types of drugs are critical pillars in tackling COVID-19 (and future potential strains).

SARS-CoV-2 is the third type of Coronavirus to cause severe symptoms after SARS-CoV (2002-3) and MERS-CoV (2012). And now it seems that SARS-CoV-2 is working in threes itself. Researchers who mapped some of the original spread of coronavirus in humans have discovered there are THREE variants of the virus throughout the world. They reconstructed the early evolutionary paths of COVID-19 as the infection spread from Wuhan, China, out to Europe and North America. Dr Peter Forster, geneticist and lead author from the University of Cambridge, said: ’There are too many rapid mutations to neatly trace a COVID-19 family tree.’ 17-18 years after the Sars outbreak and 7-8 years after MERS-CoV, there is still no coronavirus vaccine. Of the 33 vaccine candidates for SARS-CoV, only two reached clinical trials on humans, the rest stopped at the preclinical stage. For MERS-CoV, just three of the 48 vaccine candidates went to clinical trials on humans while the others only made it to the preclinical stage. WHO director general Tedros Adhanom Ghebreyesus said a vaccine could be available in 18 months. SARS-CoV-2 is already proving an elusive adversary and is highly likely to mutate further which means one vaccine is unlikely to be enough. Furthermore, there is an additional risk of new types of coronaviruses developing which would point to the development of multiple vaccine candidates which would be deployed in the same way as the annual flu vaccine; rather like flu, the strategy would be about mitigation of hospitalisation and deaths. As governments ponder how to get the world back to normality, relying on a “magic pill vaccine” does not seem to be an option, at least for 2020.