On December 31, 2019, the World Health Organisation’s (WHO) China office heard the first reports of a previously unknown virus behind several pneumonia cases.  On 9TH of JANUARY, China CDC publicly shared the gene sequence of the coronavirus COVID- 19. That was at least two weeks before the first cases hit the West. The table below sums up the timeline. Although most media relate the start of the epidemic at after 100 reported cases, we think that in view of the Chinese data available the first alarm should have been raised around 10 cases in the large EU countries of 50-70 million population. We have taken Italy as the basis and adjusted equivalent figures of other countries (Greece 1/5, USA 6 times more). This makes all figures comparable as a function of the population in each area. The 100 cases used by the media as the start of the epidemic (which we call our 2nd alarm) is also adjusted for instance 696 cases in the US vs 32 for Greece at the extremes. The panic level is put at 10,000 cases at least one and a half months since the first warning Some countries like South Korea, Singapore, Hong Kong and yes even Greece reacted quickly setting up measures to dampen the epidemic and latten the curve. But others did nothing.

COUNTRYFrance Italy   Spain USAGreece
First cases3 cases 25-Jan 3 cases 25-Jan 1 case 01-Feb1 case 23-Jan1 case 27-Feb
days since China warning25 days25 days32 days23 days58 days
first Alarm9 cases 22-Feb12 cases 22-Feb12 cases 17 Feb62 cases 29 Feb3 cases 28 Feb
days since China warning53 days53 days48 days60 days59 days
2nd Alarm191 1st Mar124 cases 24 Feb114 1st Mar696 cases 11 Mar32 cases 6 Mar
days since 1st alarm8 days2 days13 days11 days7 days
1st Panic12475 cases 21 Mar10149 11 Mar9191 17 Mar63570 cases 26 Mar  NO PANIC
days since 1st case55 days45 days45 days62 days 

We reproduce below a graph produced by Johns Hopkins University which compares the cumulative identified cases of COVID-19 between some of the main countries affected. Note that day 1 in the curve regardless of the population size starts when infections have reached 100. Interestingly enough, whereas the point when China’s curve becomes horizontal is day 30, Korea manages the same feat after 20 days.

The cumulative curves for Singapore, Hong Kong or Greece because of the scale would be lost on the graph’s horizontal line.

We have heard of the flattening of the curve and the lowering of its apex. The rationale is that if the rate of infection can be lowered early enough by measures such as better hygiene, social distancing and lockdown, the apex occurs later in the epidemic, but it also is less intense. The curves below issued by the White House and photographed courtesy of CNN although only showing the evolution of the number of possible deaths in the US without any intervention and with restrictive policies fully implemented is very similar to the infection curve shapes talked about in the media. These mortality curves are a component of the infection curves with similar shapes. It is just that, unfortunately, part of the infected people die of as a result of complications related to underlying health conditions, a weaker heart, extreme style of life or some weakness in their immune system that we are yet to understand.

 The numbers may be exaggerated either for election political motives or hopefully to induce fear in people to apply strictly hygiene and social distancing but illustrate well the philosophy of flattening the curve.

 What seems to be clear is that the US one of the medically most advanced countries in the world has been caught flat footed.

 In a set of infection curves, exactly the same shapes occur except they are on a much larger scale something in the order to 20 -30 times the numbers shown on this curve.  The peak rate occurs when the rate of net daily infections (new infections minus people cured and new deaths on that day) stops increasing plateaus and then starts diminishing. The rationale behind this approach is as we said, to delay the timing and the extent of the infection peak. This enables the hospital infrastructure to cope with the complicated cases with sufficient medical personal, protective equipment and emergency apparatus such as ICU beds and ventilators. If there is insufficient means to cope with the complications, not only the patient death rate can more than double, but doctors and nurses also get contaminated and some even die further weakening the system.

It is easy to draw a theoretical curve before or plot one after the event. but we have to find a way to guess where we are on the curve as the crisis develops. Fortunately, data are available on various sites which enable the construction of curves as the problem intensifies in different regions or states. We have been using the WHO data which although they come available one day late are the most reliable.

Rather than using the cumulative infection curves as the ones shown on the John Hopkins University graph above, we have been examining the evolution of the daily infection rates. To be effectively comparable at a region state or national level the rates of infections must be compared on a population number basis. In other words, to compare the number of infections between countries one must take one country as a basis and introduce a compensating factor for the other countries. We chose Italy as it was a large EU country and had the largest cumulative number of infections and high daily infection rate. Whereas for Greece one must multiply the infections by a factor of slightly over five, for the US one must divide the infections by a factor of almost 6. We examined the daily infection rates for Greece, Italy (the reference), Spain, France and the USA.  When trying to illustrate them on a graphic manner it was found that because the daily rate can vary substantially from one day to the other the curve of daily infections was slightly disorderly resembling a stock market trading curve. We therefore opted to smooth the curves by using the moving average technique. By averaging over three days the daily infection rates, the curves are fairly smoothed. And are represented below.

Number of days after start of epidemic                                    

As described at the beginning of the article the start day of the epidemic day one for the graph is 10 or the nearest number at the time for large EU Countries (Italy, France and Spain that have populations of similar magnitude. For Greece the day 1 number should be theoretically 2 cases and the US, 60 cases. We used the closest actual numbers respectively 3 and 64.

The results are interesting as the curves have different slopes. This may reflect how quickly distance standing measures were implemented. Surprisingly Spain that was initially less reported in the media has a steeper line of infection than Italy. Although it is too early to cry victory it seems that both Spain and Italy may have reached the peak. France may not be far behind. As for the US, the eventual steepness of the curve will depend on whether the Republicans governors of States situated on the middle of the US will finally implement distance standing or lockdown throughout their states. The longer they delay their decision, the later the inflection point will occur. They will pay even more than the rest of the country for their unpreparedness. All we can see is the intensity of infections the stress levels at the hospital level and the high number of deaths in New York which are hopefully near their peak and that Governor Cuomo is managing the crisis effectively with near limit means. 

And how about little Greece that very few people in the international press or the media look at except for Christiana Amanpour that interviewed our Prime Minister who was able to rebut calmly her most provocative suggestions. Well it seems we pushed the peak so far that if our general confinement is maintained and respected by our citizen even during Easter, we shall survive this odyssey with remarkably little human damage. However, the economic toll will soon become evident and Koumoundouros has full confidence that the Government is already planning the progressive reactivation of economic life. What is hopeful is that as a nation we are now unified again.

By Digenis 4th April 2020


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