I suspect that flights might be even more needed and necessary in the post-epidemic world. Because, I think, that term is only going to apply to developed countries.

Places with poor sanitation and bad healthcare are probably going to be fighting waves of this virus for a long time.

I propose that we need a whole new paradigm on flights. We should see them as a finite resource and we should be very careful about their use. 

But we do need to consider sanitation to be as important as medicine (both long term and emergency) and if we would be prepared to fly in skills and equipment to address medical inequalities, we should do the same for sanitation.

Thank your for your posts in this thread. I am learning a lot and an finding it useful to be able to discuss various fears, assumptions, open questions with my peers here (even if it deviates from our normal sanitation focus).

It seems that there is something about the "exponential nature" of new infections that is different from other diseases. It means that if left unchecked, the number of people in intensive care in hospitals and the number of deaths sky rocket.

On the other hand, if tough lock-down measures are put into place early on then the number of deaths can be limited to a very small number. In that case the discussion starts "was it worth wrecking our economy for this?". Examples for this are Australia and New Zealand. My country of residence, Australia, currently has only 61 deaths, 6300 confirmed cases, and the number of new infections per day has thankfully reduced to about 50 currently (down from 400 per day about 3 weeks ago). Australia has several aspects going for it, like being an island, lots of space in its largely "suburban living", an excellent healthcare system, a competent, reliable and transparent government, a population that is willing to comply and is quite disciplined. Nevertheless, Australia's economy will suffer a lot, e.g. massive loss of tourism, a big jump in unemployment and so forth. Luckily, the government probably has enough "reserves" (and future higher taxes) so that unemployment benefits can be paid out, nobody has to starve or become homeless etc.

But how will it pan out in countries where a large part of the population live a more precarious life? Will the lock-downs in those countries result in the end in more deaths due to poverty and malnutrition than Covid would have? 

One thing that I hope for in a post-Covid world is that unnecessary travelling will remain to be curbed to reduce CO2 emissions. We have talked a lot about reducing air travel in this thread: forum.susana.org/39-miscellaneous-any-ot...-worth-in-some-cases
Few people have been willing to cut down on their air travel in a work context based on climate change considerations alone. To reduce the spread of Covid we have now agreed to (or been forced to) cut down on air travel quite drastically which is good from a climate protection perspective. I guess it's an example of the fact that short-term consequences are always more likely to lead to action than longer-term consequences 

Regards,
Elisabeth

In my role as moderator, I have changed the thread title to this: "Discussions around assessing risks related to COVID-19 and its impact in different countries". FYI, I generally change thread titles from time to time when I feel that the original thread title no longer adequately reflects the actual content of the thread. The aim is to make it easier for readers to know what the thread is about. 
If this thread title is still no good, or needs to be adjusted a few days from now, please don't hesitate to suggest that.

Another thing to bear in mind is that the declared statistics are wrong. 

For example in the UK we have daily announcements of the death statistics, but it turns out that these are *not* the real number of deaths that happened the previous day (as previously strongly implied) but the number which were *declared* that day. In fact the patients actually died days or even weeks ago.

We have efficient hospitals and record keeping - and we still have a delay of nearly 7 days to get accurate data.

In the days between 31 March and 6 April around 2,500 deaths were registered in the UK. If the death rates are growing at the rate they were previously - where the cumulative total doubled every 2-3 days - the real rate once they have been collated could be something around 10,000. We have other statistics and numbers but they are also delayed. Anacdotally the medics say they are completely swamped.

Which suggests, to me at least, that there may be other countries where the problem of collating and publishing coronavirus statistics is even worse.

Indeed to return to original question about underestimating the risks assessed to COVID-19, which may governments did (myself included), it is very informative to read the special report in  Nature on " The simulations driving the world’s response to COVID-19 ", which explains the science that finally woke those governments up. 

Arno, I completely agree with Joe, just want to say something about the biological aspects, because it seems to me that you are pursuing the dubious advice: “if you can't convince you have to confuse.”
 
First you did the comparison with the flu (also virus), but now with a bacterium (Streptococcus pneumoniae), which is completely different in infection route and medical treatment options.
 
Than you say that 50% of the world's population is vaccinated against Streptococcus pneumoniae, what this is really great, but it has nothing to do with the COVID 19 transmission rate and hospital occupancy due to COVID 19.
 
Last you doubt the WHO statement "no evidence about the survival of the COVID-19 virus in drinking-water or sewage" because in the Netherlands has been found genetic material (RNA fragments) of COVID 19 in wastewater and in China “viable SARS-CoV-2” in stool samples. I don't know the background of the Chinese study (how and where was the virus eliminated) but if there are really infectious virus in wastewater, the correct conclusion would be that the risk of COVID is actually "underestimated", isn't it?
 
But the linked article from the Netherlands is not about the infectious virus, is about the use of specific COVID 19 Virus RNA fragments in sewage systems as a possible future indicator to “virus circulation in the population before COVID-19 cases are reported through the health surveillance system”. A really interesting article and an important approach to control a second wave.
 
But none of these arguments or numbers serve as evidence that the risk of COVID-19 “may be exaggerated”.

I do agree with Skippi Jo, it is not only about the headline, it is also about “suggest or encourage people to think it's not serious”.  

In addition, it is critically that the headline appears in the context of “covid-19-corona-pandemic-in-relationship-to-wash” which could be interpreted that the meaning of handwashing to prevent Covid 19 also "may be exaggerated”. Not all people take the time to read long discussions. Even if they do, they won't get here one single SuSanA relevant question answered. 

One more thing: "Maybe it is fake, but I read in the Internet that..." is in Brazil exactly the introduction to a (easier to identify) fake news, aimed precisely at generating emotions and fears against what you consider to be the "mainstream". In reality, these are here the well-known tools of the "opposite mainstream" . Please, check before sharing! 

I don’t know what the correct title could be, for me the whole discussionis wrong, or in a wrong timing. We are actually in this difficult situation because the risks of a global virus outbreak were worldwide “grossly underestimated” or rather, irresponsibly ignored. There have been very specific models for years that have warned exactly about this. I will link, as one example, an interview with Bill Gates 

 

Of course we should learn the right lessons from this. But the acute solution is "physical distance" and “social solidarity”, what also happens in affected countries (and in my opinion describes the real challenge better than "social distance"), but “suggest to people to think it's not serious” is definitively not an option.

Ok, but we are not through this yet, Arno. It is entirely possible that millions will die from this infection.

It is rapidly spreading in places with good sanitation and high standards of medical care - at present it is not possible to know if it will have a limited effect, a delayed effect or no effect on other places.

Continuing with the line that the risk is being "exaggerated" when your thinking is informed by "exaggerated sources" is entirely unhelpful in my view.

Responding to the fact that those who already have weaker immune systems due to other infections are likely to be at increased risk of death from this infection seems entirely prudent.

Arguing that this is being exaggerated - and implying that we should really not worry too much about it - seems counter-productive.

Dear SkippiJo and others
Answering the question whether the risks surrounding COVID are exaggerated all depends on what COVID is being compared with.

Take Streptococcus pneumoniae for example, which causes pneumonia, bronchitis, meningitis, sinusitis, sepsis and a few other related diseases. This bacteria kills more than 1.6 million people in a normal year including from 0.7 to 1 million children under five.  Compare that with COVID-19 which has 76,201 fatalities to date www.worldometers.info/coronavirus/

Pneumococcal vaccine had been introduced in 145 countries by the end of 2018 and a global third dose coverage was estimated at 47%. www.who.int/news-room/fact-sheets/detail/immunization-coverage
www.gavi.org/sites/default/files/documen...isease-reportpdf.pdf

That this is a relatively new set of vaccines is reflected in that only 50% of the world is vaccinated. I asked a clinic in Stockholm whether the vaccine was being administrated to high risk groups in light of the COVID epidemic. The answer was yes and that supplies across the country had been exhausted. Waiting lists are being set up. 

Pneumonia caused by COVID-10 is becoming the major focus for advanced cases. www.theguardian.com/world/2020/apr/07/wh...coronavirus-covid-19
path.org/articles/lessons-covid-19-what-...ntion-and-treatment/

One might then question what is the role of other pathogens in COVID-related pneumonia? There is little evidence to be found yet but the writing is on the wall www.consumerreports.org/coronavirus/unde...avirus-complication/
www.fhi.no/globalassets/dokumenterfiler/...lderly-publisert.pdf

When it comes to the faecal-oral route of transmission, again we know little about this and WHO has written as late as March 19 - "Currently, there is no evidence about the survival of the COVID-19 virus in drinking-water or sewage" - www.who.int/publications-detail/water-sa...agement-for-covid-19

But a very recent pre-print from the Netherlands shows COVID-19 to be present in sewage samples - www.medrxiv.org/content/10.1101/2020.03.29.20045880v1.full.pdf
This paper also cites the several recent studies from China where the virus is found in stool samples and gastroeneterological symptoms are also described.
 
More on this as the data surfaces.

Regards

Hello Joe. Re: quantifying. I quantify covid risk as high. Not exaggerated.

Re: comparison between poor communities and rich about death toll and risk, I quantify poorest community as highest risk.

Re: semantics, I hope this clarifies my position.

I see the aouthor may not have intended to produce clickbaitish headline intentionally due to it being his second language.

It was a simple error but needs correcting because it implies the science is exaggerating the risks.

Of course poorer community is always struggling. I didn't mean to imply otherwise. I thought that was made clear when I said it's offensive to leave it unchallenged bearing in mind the continued avoidance of responsibility by Trump, Johnson and their followers.

They are at the heart of the causes of our struggling to deal with Covid. I totally agree with much if the content 9f the original post. perhaps I haven't made that clear.

It's just the headline that needs altering.

SkippiJo, first hello and welcome. 

Second, I understand and agree with much if what you say.

But third, I take issue with some of your phrasing. Because, as you say, we all need to use precise language.

SkippiJo wrote:
Risks surrounding covid are not being exaggerted because a risk is a risk. It's either a risk or not. If it's a risk it's not really possible to exaggerate, is it?

I am not sure what you are meaning here. 

We are used to weighing and quantifying risks when discussing aspects of sanitation. We are used to thinking of things as High Risk and Low Risk - or even DALYs and hearing about QMRA and so on.

So, no. A risk is not a risk.

Your title suggests you have some evidence that the virus is not as dangerous as health experts are claiming.

I think the provocative title was trying to have us think about something which is clearly a major public health incident and trying to put it into the context of the fight against faecal diseases and infections.

It seems fairly clear to me that something which is not a health concern where I live in Wales - cholera - is overall more of a global health issue than Covid 19. Handwashing to prevent the spread of faecal pathogens is still overall more important than handwashing because of this virus.

The measures taken to avoid covid risks may be being manipulated by abusive law enforcement.
That's more what you seem to be getting at is it?

The opposite is the case in the UK, where the risks are being wilfully ignored by vast numbers of people because the government is deliberately unwilling to intervene to protect the most vulnerable. We are left at the mercy of a broken health system that's starved of funding. Charity is incapable of stepping in where government has utterly failed.  Government there is failing in the most basic way to provide enough equipment and wages for care staff. People are dying right now, as I type, because UK government refuses to protect them adequately. that's not a situation that's possible to overestimate or exaggerate. It's a situation borne from massively misplaced reliance on individual freedom versus the need to prevent abuse.

That's a whole other discussion which cuts very little ice in places where there is zero healthcare, zero sanitation and poor quality water.

People are dying in my country and that's a tragedy. But, unfortunately, people are constantly dying of preventable disease due to poor sanitation and absent healthcare all the time.

Unfortunately however bad this thing is in North America, Europe, Japan, Korea etc, it is still only a taste of the life that a big percentage of the planet put up with.

This unfortunate mistaken headline disgusts me because of the people dying there.

Yes. I think we all can see you are upset. I think perhaps Arno might have been a bit less provocative. And appreciated the pain that people really are experiencing.

But that said, it isn't his first language and he was attempting to contextualise what is happening within our shared sanitation based community.

I don't think it was particularly wise or helpful, but I wouldn't go as far as you are.

It doesn't mean I represent the status quo or am so e sort of government lacky.

I don't think anyone was accusing you of being one. 

It's an error and not intended to offend of course, I see that, but please, I beg you to meet the issue head on and admit it's clickbaitish. It should not stand even with the change.

This, generally, I agree with.

People are having a stressful time. As I noted previously, this could have a serious impact on communities that lack sanitation.

Hello Elizabeth. Thanks I appreciate your noticing the problem that I have with the post's headline.
I don't think changing it to water it down slightly takes away from the main point I'm making which is that whilst we face a global pandemic we should not make generally sweeping standard statements like that and expect them to stand.

It's not ok to suggest or encourage people to think it's not serious. Even if you attract people back to the forum who are normally too busy.

The issues you raise above are separate to that suggested by the title.
Yes, Some individuals and some authorities, even some  regimes in some countries are using draconian, violent, or overly harsh penalties to enforce Covid measures. Yes. But that's not the same as suggesting scientists have exaggerated the facts.

I'm sorry but this post falls way below what I expect from a science based forum. Regardless of the poster's prior history. We are human. We all make mistakes.

Risks surrounding covid are not being exaggerted because a risk is a risk. It's either a risk or not. If it's a risk it's not really possible to exaggerate, is it? Your title suggests you have some evidence that the virus is not as dangerous as health experts are claiming.

The measures taken to avoid covid risks may be being manipulated by abusive law enforcement.
That's more what you seem to be getting at is it?

The opposite is the case in the UK, where the risks are being wilfully ignored by vast numbers of people because the government is deliberately unwilling to intervene to protect the most vulnerable. We are left at the mercy of a broken health system that's starved of funding. Charity is incapable of stepping in where government has utterly failed.  Government there is failing in the most basic way to provide enough equipment and wages for care staff. People are dying right now, as I type, because UK government refuses to protect them adequately. that's not a situation that's possible to overestimate or exaggerate. It's a situation borne from massively misplaced reliance on individual freedom versus the need to prevent abuse.

This unfortunate mistaken headline disgusts me because of the people dying there.

It doesn't mean I represent the status quo or am so e sort of government lacky.
It's an error and not intended to offend of course, I see that, but please, I beg you to meet the issue head on and admit it's clickbaitish. It should not stand even with the change.