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.

Age, sex and the existence of comorbidities have all been documented as reasons why COVID-19 is mild or asymptotic is some and for others can cause hospitalisation and even death. There are exceptions of course but there are also very clear trends. As noted from our previous analysis of comorbidity data from Italy and China, hypertension is the most frequent comorbidity noted in COVID-19 positive deaths. US data on hypertension discloses a much higher age-adjusted incidence of hypertension in African Americans and Asians than in Whites. This is a good example of how ethnicity is a factor that can increase the risk of hospitalisation & death due to COVID-19. However, there are also other factors that increase the risk of exposure to the SARS-CoV-2 virus. In the UK doctors treating COVID-19 are much more likely to be from an ethnic group. In the USA, 17% of physicians are Asian but Asians represent less than 1% of the overall population. The trend for nursing is similar, especially with African-Americans nurses in the USA. Beyond front line medical staff, there are is also an ethnicity issue with those still working to support us, for example, delivery drivers, public transport workers and supermarket assistants. In the USA, Louisiana reports 70% of coronavirus deaths are black. In the UK, there are reports that ethnic minorities “are a third of (COVID-19) patients”. Age, sex and ethnicity factors are not going to make upcoming difficult decisions for governments any easier to make and to get our support behind.

Italian healthcare data released by the ISS on COVID-19 includes some quite extraordinary data on comorbidities in COVID-19 positive deceased patients in Italy up to 26 March 2020. 98% of COVID-19 positive deaths were recorded with at least 1 comorbidity. Over half had 3 or more comorbidities. Hypertension was recorded in 74% of cases. Diabetes, Ischemic heart disease, Atrial Fibrillation, Chronic Renal Failure and Active Cancer in the last 5 years were the next 5 largest comorbidities. This data supports that reported out of Wuhan which ranked Hypertension, Diabetes and Chronic heart disease as its top 3 comorbidities. The presence of a comorbidity does not mean the deceased was going to die at that point in time anyway. When all cause mortality data is released in Italy, we would expect there to be a statistically significant increase in death rates. As the prospects of an easy exit strategy from lockdown/stay-at-home fade ever further away and the economic and mental health damage spirals up, getting more data on this area is going to be essential.

Recently released US e-commerce data show how consumer behaviours are adapting to life under stay-at-home orders, home working and spending a lot more time with household cohabitees. Perhaps not too many surprises on what categories are winners and what are losers but the quantum of change and ranking still makes interesting reading. Its relevancy goes beyond the FMCG industry. It is also provides advanced warning to other sectors of what is coming next. As a recent Kantar report looking at recent Chinese retail data questions, are we facing “a new era, an acceleration of latent trends or just a short-lived blip?”

Recently released US e-commerce data show how consumer behaviours are adapting to life under stay-at-home orders, home working and spending a lot more time with household cohabitees. Perhaps not too many surprises on what categories are winners and what are losers but the quantum of change and ranking still makes interesting reading. Its relevancy goes beyond the FMCG industry. It is also provides advanced warning to other sectors of what is coming next. As a recent Kantar report looking at recent Chinese retail data questions, are we facing “a new era, an acceleration of latent trends or just a short-lived blip?”

At the time of writing, John Hopkins University has recorded 109,312 deaths with patients testing positive for the COVID-19 disease. There are, sadly, many more deaths that have not been reported to date (e.g. at home & care home deaths). Of the 1.8m confirmed cases, only 0.4m have been classified as totally recovered. Yesterday 0.1m new infections were reported – a trend yet to peak. Many more deaths are bound to follow. Even when this has abated, it is widely expected that official figures will be a significant underestimate. Death toll predictions range anywhere up to 2 million people. A horribly large number of people. How does COVID-19 rank as a global killer? Attached is the latest data I could find from the World Health Organisation ranking the top 10 causes of death across the world in 2016. At the moment, COVID-19 would not make the top 10 and it might not make the top 10 (based on more optimistic projections). Annual Flu WHO estimates that 290,000-650,000 respiratory deaths occur each year associated with seasonable flu. So why is the world in lockdown? COVID-19 is more likely to hospitalise and more likely to kill than seasonal flu. So, quite simply, the issue is about flow control. Every country’s health systems would break under the surge in demand but for the containment policies now in place.