Operation Warp Speed

The mission is for the United States to have the ability to inoculate 300m people by January 2021. In collaboration between Health and Human Services, the FDA and the Department of Defense, the DOD has a unique division known as The Research Regulatory Oversight Office (R2O2) which is the P&R component level oversight office for the authorities and responsibilities under Department of Defense (DoD) Instruction 3216.01, “Use of Animals in DoD Programs.” The R2O2 manages animal care and use review and oversight processes for research conducted and supported by the Uniformed Services University of the Health Sciences and the Armed Forces Radiobiology Research Institute, both of which are accredited by AAALAC as is required for all DoD institutions housing animals for Research, Development, Testing and Evaluation or training.

U.S. Department of Defense and FDA collaborate to help speed ... source

***

The Trump administration is organizing a Manhattan Project-style effort to drastically cut the time needed to develop a coronavirus vaccine, with a goal of making enough doses for most Americans by year’s end.

Called “Operation Warp Speed,” the program will pull together private pharmaceutical companies, government agencies and the military to try to cut the development time for a vaccine by as much as eight months, according to two people familiar with the matter.

As part of the arrangement, taxpayers will shoulder much of the financial risk that vaccine candidates may fail, instead of drug companies.

The project’s goal is to have 300 million doses of vaccine available by January, according to one administration official. There is no precedent for such rapid development of a vaccine.
Last month, Trump directed Health and Human Services Secretary Alex Azar to speed development of a vaccine, and administration officials have been meeting on the effort for three to four weeks, one of the people said. A meeting on the project was scheduled at the White House on Wednesday.

The people familiar with the project and the administration officials asked not to be identified because it hasn’t yet been publicly announced.

A spokesman for the Department of Health and Human Services, Michael Caputo, said the president refused to accept the timeline for standard vaccine development and encouraged a breakthrough process.
Speeding Up

Vaccine development is typically slow and high risk. The project’s goal is to cut out the slow part, the people said. Operation Warp Speed will use government resources to quickly test the world’s most promising experimental vaccines in animals, then launch coordinated human clinical trials to winnow down the candidates.
The group is discussing which Americans might be vaccinated first, as the medicines would likely roll off production lines in batches, one of the people said. The project would be funded from money already available to the government and won’t require new authority from Congress, one of the people said.

There are at least 70 different coronavirus vaccines in development by drugmakers and research groups, according to the World Health Organization. But drugmakers have not coordinated their efforts to the extent they could through the Warp Speed project, one of the people said.
Under the effort, the Defense Department would make its animal research resources available for pre-clinical work on vaccines.

The group is also discussing the use of what’s known as a master protocol to test the vaccines. Instead of multiple clinical trials run by each drugmaker, competing for patients and resources, the government would organize one large trial to test several vaccines at once and advance the most promising ones.
Oxford Vaccine

The Trump administration isn’t alone in trying to fast-track a vaccine. One of the world’s most promising vaccine candidates has been developed by a team at Oxford University in London. Last month, scientists at the U.S. National Institutes of Health innoculated six rhesus macaques with the Oxford vaccine and then exposed them to the coronavirus, the New York Times reported.

All six were healthy more than four weeks later, according to the Times. The researchers are currently testing their vaccine in 1,000 patients and plan to expand to stage two and three clinical trials next month involving about 5,000 more people.

The Oxford group told the Times they could have several million doses of their vaccine produced and approved by regulators as early as September.

In the U.S., the Bill & Melinda Gates Foundation has meanwhile shifted much of its research effort to the coronavirus virus.

One of the people familiar with Operation Warp Speed drew a distinction with the Oxford group, describing the U.S. effort as broader in scope. It’s unclear which vaccine candidates would be part of Operation Warp Speed, or whether it would include the Oxford vaccine.

More than 1 million cases of coronavirus have been confirmed in the U.S., and at least 58,000 people have died from the illness it causes in the last two months. Widespread social-distancing measures have helped slow the spread, but at the cost of millions of jobs and losses to the economy that experts fear will take years to recover.

Along with wider diagnostic testing for the virus and an effective therapeutic drug, a vaccine is one of the key tools for reducing long-term risk from the virus. Testing can help contain an outbreak in its early stages, or after it’s been curbed enough to manage. A therapy can help those who get sick, reducing the risk of death and the burden on hospitals.

Gilead Sciences Inc. announced Wednesday that in a trial conducted by Fauci’s agency, the U.S. National Institute of Allergy and Infectious Diseases, its experimental coronavirus therapy remdesivir helped patients recover faster than under standard care. More here from Bloomberg

A Deeper Dive on the World Health Organization

Hold on…it is gonna be a rough ride….President Trump must not only investigate but for sure suspend funding….the reasons go way beyond the recent scandalous headlines.

Given the tight relationship between Dr. Tedros Adhanom, the Director and the Chinese Communist Party, it is a certainty that WHO is in possession of the report noted below:

Chinese researchers initially pointed to the possibility of a lab accident in a study published in February on ResearchGate. “The killer coronavirus probably originated from a laboratory in Wuhan,” wrote researchers — although they also raised the possibility of natural transmission. “Safety level may need to be reinforced in high risk biohazardous laboratories,” continued Botao Xiao and Lei Xiao of Guangxhou’s South China University of Technology.

and then there is this –> The possibility that the virus leaked during a lab accident “is being seriously considered” within the U.S. government, according to another recently retired senior national security official, who pointed to the State Department’s 2019 compliance report on arms control, nonproliferation and disarmament. The report notes that Chinese officials have failed to reassure inspectors they are obeying the Biological Weapons Convention, including by not providing information about research on “numerous toxins with potential dual-use application.”  More here.

From my friend Adam Andrzejewski with his Forbes piece on funding the WHO…the money that flowed in recent years to WHO is remarkable.

With his recent vow to halt and reassess all aid to the World Health Organization (WHO), President Trump legitimized critics who allege that the agency shielded information from the world about the lethality of the coronavirus and its ability to spread by human-to-human contact.

The WHO delegation highly appreciated the actions China has implemented in response to the outbreak, its speed in identifying the virus and openness to sharing information with WHO and other countries.

World Health Organization | January 28, 2020 | Beijing

The most likely presidential policy response will be to re-purpose all or most federal money from the WHO. If done in this manner, the president must notify Congress, but has the executive power to reallocate the monies to other organizations. Therefore, legitimate programs will continue to help humanity.

Responding to our request for comment, the White House, Office of Management and Budget provided a fact sheet detailing the WHO’s “corruption and abuse.”

The W.H.O. really blew it. We will be giving that a good look.

President Donald J. Trump
Our auditors at OpenTheBooks.com reviewed all disclosed grants by federal agencies to the WHO since 2010 and found that $3.5 billion in taxpayer money funded the WHO during this period.

What’s more, only $611.1 million of that funding came from “assessed dues” required by participating countries. The U.S. government voluntarily sent the WHO roughly $2.9 billion more than their required contribution. It’s no surprise that, annually, the United States is the largest funder of the WHO.

We also found that federal funding of the WHO remained strong during the Trump era. We compared the first three years of the Trump administration (FY2017-FY2019) to the first three years during the second term of President Barack Obama’s administration (FY2013-FY2015).

The WHO received more money under Trump than Obama (inflation adjusted): $1.4 billion versus $1.1 billion.

Since 2010, the Agency for International Development (USAID) has led all federal agencies with $1.5 billion in grants to the WHO. Roughly half the USAID grant money funded three programs: humanitarian programs ($345.7 million); polio eradication efforts ($307.8 million); and efforts to eliminate tuberculosis ($116.6 million).

Other programs include efforts in Iraq, Afghanistan, Yemen, Libya, Sri Lanka, Sudan, and Pakistan and included gender-based anti-violence initiatives; life-saving healthcare services to vulnerable populations; and assistance in floods, emergencies, and to war-torn communities.

USAID efforts through the WHO and other international humanitarian aid agencies were singled out in a blistering USAID Inspector General report in 2018, Insufficient Oversight of Public International Organizations Puts U.S. Foreign Assistance Programs at Risk.

As of January 2018, Office of Inspector General (OIG) investigations in the region have resulted in the suspension or debarment of several dozen individuals and organizations, 20 personnel actions, and the suspension of $239 million in program funds under investigation.

USAID Office of Inspector General

The U.S. Department of State gave $820 million to the WHO since 2010. The largest portion of the money consisted of “assessments” or dues to the organization which amounted to $611.1 million. In addition, the State Department funded programs for “general assistance” ($95 million); “refugee” health ($17.3 million); “peacekeeping” ($15.9 million); and emergency vaccines ($2 million).

Here’s an overview of programs funded by other U.S. federal agencies such as the Centers for Disease Control (CDC) ($1 billion), Food and Drug Administration (FDA) ($30 million), National Institutes of Health (NIH) ($13.5 million), Department of Defense ($10 million) and the Environmental Protection Agency ($3.2 million) at the WHO since 2010:

  • Immunizations, Research, Demonstration, and Public Education/Information: $524.1 million — Through the Department of Health and Human Services and Centers for Disease Control, this funding was spent on WHO programs for the eradication of polio around the world. These grants were centralized through WHO headquarters in Geneva, Switzerland.
  • Global AIDS: $134.8 million — The Department of Health and Human Services and the Centers for Disease control funded support services and the strengthening of public health guidelines around the world to mitigate global AIDS.
  • Ebola virus: $73.5 million — In July 2019 and January 2020, the Congo received $15 million in Ebola eradication grants from the Trump administration specifically earmarked for the provinces of North Kivu and Ituri. The rest of the funding flowed through WHO headquarters in Geneva, Switzerland, with the majority of the funding between the fiscal years 2015 and 2017.
  • Biomedical research: $37.9 million — The National Institutes for Health (NIH) collaborated with the WHO on biomedical research. These programs included research on allergies, infectious diseases, and immunology. The transactions show that most funding was for “accelerated public health and biomedical research in priority public health objectives.”

The coronavirus pandemic is testing the World Health Organization. Just like any other health care body, every aspect of their operation will receive scrutiny during these times of insecurity and crisis.

Our analysis of WHO funding by U.S. federal agencies shows that taxpayers have been generous and deserve to know how their money is being spent.

Until recently, American commitments remained strong.

Note: All federal government funded delineated in this piece was disclosed through the Federal Funding Accountability and Transparency Act of 2006, co-sponsors Sens. Tom Coburn (R-OK) and Barack Obama (D-IL). (Public Law 109-282, 109th Congress)

Then there is the matter of the CDC…we will cover that another time.

Make the Whole Nation an Opportunity Zone

Having just interviewed for a radio segment, Joel Griffith, an economic expert at the Heritage Foundation, I was motivated to draft this piece about how America re-opens and what will America look like in coming years.

Years ago, during the genesis of the dot com era, companies across the nation were launching incubation centers where innovation, creators and entrepreneurs were mobilized to advance business opportunity across all industries. Governments at all levels should get out of the way with stifling red tape, permits, fees, regulations, taxes and other bureaucratic measures to unleash business transformations.

So, Joel answered that the whole nation should be an opportunity zone where I used incubation centers….same thing.

Just about to collect some thoughts on this article, here comes an email from my favorite law firm, The Pacific Legal Foundation. The firm just published an economic recovery action plan. This plan is a framework that quite useful in supporting the notions of a nationwide economic zone policy or incubation centers.

The plan has 4 simple steps but each one is profound to the principles of economic restoration and practical.

  1. Liberate Healthcare
  2. Embrace Entrepreneurs
  3. Protect Property Rights
  4. Get Bureaucrats out of the Way

As the Trump Administration has gathered political and business professionals for the Economic Restoration Council that includes an estimated 100 business personnel from countless industries, new guidance will be shared with all 50 governors to use as a framework to reopen their respective states. This is a perfect moment in time to consider and deploy a revolution in ideas, resources and to eliminate vulnerabilities in the whole society such that lessons learned can be produce new skill sets and advanced solutions to encourage small business across sectors.

How to Be an Entrepreneur in Top 5 Easy Steps - Ejournalz

The marketplace is sure to change not only for America but across the globe as these discussions with unleashed imaginations are sure to alter everyday commerce, education, healthcare, national security, communications, hospitality, entertainment and perhaps even legislation.

A new discipline in our culture may just be creative new breakthroughs taken from lessons learned due to this pandemic and self-distancing. Where do ideas come from? They begin with discussions to questions we have all asked like: Why don’t we have…How come no one has invented….How did we get here….What do we do now….How do we make sure this does not happen again….

Our country is in distress so the bigger question that should be asked is how do we succeed as an individual, a family and as a business. Rewards are great when one has planned for risks and strategies during any type of crisis. Self management and that of all business is the purposeful task of a systematic strategy that fosters mood, creativity, production, perception and opportunities.

The ‘opportunity zones’ in place today in all 50 states is derived from the TCJA, The Tax Cuts and Jobs Act. Sounds great, however OZ’s leave behind or omits innovation across all regions. Investment capital generally is habitually applied to known and or proven commercial models, brushing aside ventures concepts that take risks unknown and unproven that with some development can be the next Fortune 500 success story.

Breaking Down the Benefits of Investing in the Opportunity ...

The Opportunity Zone concept must be considered in all framework guidance coming from the Federal government to the state and local governments to restart the nation, economic liberty, grow the GDP, improve the employment landscape and realize financial victory at all levels.

 

GWB was Obsessed with Pandemic Preparations in 2005

The efforts of the Bush administration was intense over the ensuing three years, including exercises where cabinet officials gamed out their responses, but it was not sustained. Large swaths of the ambitious plan were either not fully realized or entirely shelved as other priorities and crises took hold.

“There was a realization that it’s no longer fantastical to raise scenarios about planes falling from the sky, or anthrax arriving in the mail,” said Tom Bossert, who worked in the Bush White House and went on to serve as a homeland security adviser in the Trump administration. “It was not a novel. It was the world we were living.”

According to Bossert, who is now an ABC News contributor, Bush did not just insist on preparation for a pandemic. He was obsessed with it.

“He was completely taken by the reality that that was going to happen,” Bossert said. In a November 2005 speech at the National Institutes of Health, Bush laid out proposals in granular detail — describing with stunning prescience how a pandemic in the United States would unfold. Among those in the audience was Dr. Anthony Fauci, the leader of the current crisis response, who was then and still is now the director of the National Institute of Allergy and Infectious Diseases.

Bush told the gathered scientists that they would need to develop a vaccine in record time.

“If a pandemic strikes, our country must have a surge capacity in place that will allow us to bring a new vaccine on line quickly and manufacture enough to immunize every American against the pandemic strain,” he said.

Bush set out to spend $7 billion building out his plan. His cabinet secretaries urged their staffs to take preparations seriously. The government launched a website, www.pandemicflu.gov, that is still in use today. But as time passed, it became increasingly difficult to justify the continued funding, staffing and attention, Bossert said.

“You need to have annual budget commitment. You need to have institutions that can survive any one administration. And you need to have leadership experience,” Bossert said. “All three of those can be effected by our wonderful and unique form of government in which you transfer power every four years.”

***

Then in 2006, enter Senator Burr:

The Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI) is legislation introduced and passed by the U.S. Congress in 2019 that aims to improve the nation’s preparation and response to public health threats, including both natural threats and deliberate man-made threats.[1]

A previous bill (with a near-identical name), the Pandemic and All-Hazards Preparedness Act (PAHPA), was signed into law in 2006 and reauthorized in 2013 in order to create a system that prepares for, and responds to, public health threats that could turn into emergencies.

The 2019 bill (PAHPAI) was introduced by U.S. Senators Richard Burr (R-NC), Bob Casey (D-PA), Lamar Alexander (R-TN), and Patty Murray (D-WA).[1] Congress passed the bill and sent it to President Trump for his signature in June 2019. (The bill number is S. 1379).

What went on at the State level during all this time? Well in recent years, there was an exercise called Crimson Contagion.

Crimson Contagion 2019 was/is a Functional Exercise, a national level exercise series conducted to detect gaps in mechanisms, capabilities, plans, policies, and procedures in the event of a pandemic influenza.  Current strategies include the Biological Incident Annex to the Response and Recovery Federal Interagency Operational Plans (2018), Pandemic Influenza Plan (2017 Update), Pandemic Crisis Action Plan Version 2.0, and CDC’s Pandemic Influenza Appendix to the Biological Incident Annex of the CDC All-Hazard Plan (December 2017). These plans, updated over the last few years, were tested by the functional exercise with emphasis on the examination of strategic priorities set by the NSC. Specifically, examined priorities include operational coordination and communications, stabilization and restoration of critical lifelines, national security emergencies, public health emergencies, and continuity. The Crimson Contagion 2019 Functional Exercise included participation of almost 300 entities – 19 federal departments and agencies, 12 states, 15 tribal nations and pueblos, 74 local health departments and coalition regions, 87 hospitals, 40 private sector organizations, and 35 active operations centers. The scenario was a large-scale outbreak of H7N9 avian influenza, originating in China but swiftly spreading to the contiguous US with the first case detected in Chicago, Illinois. Continuous human-to-human transmission of the H7N9 virus encourages its spread across the country and, unfortunately, the stockpiles of H7N9 vaccines are not a match for the outbreak’s strain; however, those vaccines are serviceable as a priming dose. Also, the strain of virus is susceptible to Relenza and Tamiflu antiviral medications. The exercise was intended to deal with a virus outbreak that starts overseas and migrates to the US with scant allocated resources for outbreak response and management, thereby forcing the Department of Health and Human Services (HHS) to include other agencies in the response. To do so, the exercise began 47 days after the identification of the first US case of H7N9 in Chicago, otherwise known as STARTEX conditions. Then, the HHS declared the outbreak as a Public Health Emergency (PHE), the World Health Organization (WHO) declared a pandemic, and the President of the United States declared a National Emergency under the National Emergencies Act. As was the case in the 1918 Great Influenza, transmissibility is high and cases are severe. At STARTEX, there are 2.1 million illnesses and 100 million forecasted illnesses as well as over half a million forecasted deaths. As the pandemic progresses along the epidemiological curve, the overarching foci of the federal-level response adjusts across four phases:

  1. Operational coordination with public messaging and risk communication
  2. Situational awareness, information sharing, and reporting
  3. Financing
  4. Continuity of operations

The outcome of the Crimson Contagion is that vaccine development is the silver bullet to such an outbreak, but there are complications beyond its formulation. Namely, the minimization of outbreak impact prior to vaccine development and dispersal, strategy for efficient dissemination of the vaccine across the country, allocation of personal protective equipment (PPE), and high expense of vaccine development and PPE acquisitions. The exercise concluded that HHS requires about $10 billion in additional funding immediately following the identification of a novel strain of pandemic influenza. The low inventory levels of PPE and other countermeasures are a result of insufficient domestic manufacturing in the US and a lack of raw materials maintained within US borders.  Additionally, the exercise revealed six key findings:

  1. Existing statutory authorities, policies, and funding of HHS are insufficient for a federal response to an influenza pandemic
  2. Current planning fails to outline the organizational structure of the federal government response when HHS is the designated lead agency; planning also varies across local, state, territorial, tribal, and federal entities
  3. There is a lack of clarity in operational coordination regarding the roles and responsibility of agencies as well as in the coordination of information, guidance, and actions of federal agencies, state agencies, and the health sector
  4. Situation assessment is inefficient and incomplete due to the lack of clear guidance on the information required and confusion in the distribution of recommended protocols and products
  5. The medical countermeasures supply chain and production capacity are currently insufficient to meet the needs of the country in the event of pandemic influenza
  6. There is clear dissemination of public health and responder information from the CDC, but confusion about school closures remains.

A few years go, DHS published the National Response Framework Second Edition May 2013 and later,  FEMA published a 143 page report known as the Biological Incident Annex to the Response and Recovery Federal Interagency Operational Plans Final – January 2017

as a follow up to the work that began in 2008.

Many things certainly were going on that otherwise have not received media attention and the above is by no means a full accounting. The above is only referenced for perspective and context.

So while so many are working to find a single solution to Covid 19, there is not one cure but more in the realm of hundreds or perhaps thousands. Furthermore, while so many want to place blame, that too is misguided to point to U.S. politicians and medical experts. When it comes to Dr. Fauci or Bill Gates and his Event 201, understand that every medical counter-measure to pandemics call for growing viruses in laboratories and getting patents for the work each does including pharmaceutical companies and universities. We of course have the bureaucracy of clinical trials and they do take lots of time to launch and process.

Slow down readers, stop with the blame games, stop with finding fault, let’s deal with the here and now to get this behind us, never to repeat. If anything, blame the Communist Party of China, begin and end there and re-examine national policy with Beijing.

Vendors Return in Wuhan as China Prepares COVID-19 ... source

While Pelosi and Schiff have a new oversight commission led by Congressman Clyburn, which was in the $2T stimulus bill, so what? You say it is just another plot to go for another impeachment of President Trump? Nah…it is only the Democrats and media’s plot and wont happen. A full investigation of all things Covid 19 would hardly be completed by 2024.

Oh yeah, for those of you angry at Senator Burr for selling stock, we dont know how many in congress did sell stock. Remember, Senator Burr authored that pandemic bill in 2006….and it was signed into law.

Senators did receive a closed-door briefing on the virus on Jan. 24, which was public knowledge. A separate briefing was held Feb. 12 by the Senate Health, Education, Labor and Pensions Committee, which Burr is a member of. It’s unclear if he attended either session.

One must ask if the Senate Intelligence Committee received the briefing, who gave the briefing and did that same briefing happen in the House? That is always the policy. If so, how come the Chairman of the House Intelligence Committee, you know, Adam Schiff never said a thing about it. Inquiring minds want to know.

Meanwhile….

Just follow hygiene rules and let’s get America into full restoration mode…FAST.

 

 

 

The Reason for the WH and Dr. Birx Chilling New Probability Report

Primer: We all seem to guess this except for Jim Acosta/CNN and the others at MSNBC. Media continues to blame the Trump White House for the slow response to address COVID-19, while Dr. Birx and Dr. Fauci explained what they did not know very early on. Now we know.

Now some real questions and new policy towards China must be considered. We can start with the $1.8 T in U.S. debt that China holds. The next is challenging American telecommunications companies to squelch China’s advances of 5G. Then there is the next phase of the U.S. trade agreement with China. Add in the mission to stop China’s power agenda across the globe as it is clear, China is fine with killing people and economies across the world.

China has concealed the extent of the coronavirus outbreak in its country, under-reporting both total cases and deaths it’s suffered from the disease, the U.S. intelligence community concluded in a classified report to the White House, according to three U.S. officials.

The officials asked not to be identified because the report is secret and declined to detail its contents. But the thrust, they said, is that China’s public reporting on cases and deaths is intentionally incomplete. Two of the officials said the report concludes that China’s numbers are fake.

The report was received by the White House last week, one of the officials said. The outbreak began in China’s Hubei province in late 2019, but the country has publicly reported only about 82,000 cases and 3,300 deaths, according to data compiled by Johns Hopkins University. That compares to more than 189,000 cases and more than 4,000 deaths in the U.S., which has the largest publicly reported outbreak in the world.

Communications staff at the White House and Chinese embassy in Washington didn’t immediately respond to requests for comment.

While China eventually imposed a strict lockdown beyond those of less autocratic nations, there has been considerable skepticism of China’s reported numbers, both outside and within the country. The Chinese government has repeatedly revised its methodology for counting cases, for weeks excluding people without symptoms entirely, and only on Tuesday added more than 1,500 asymptomatic cases to its total.

Stacks of thousands of urns outside funeral homes in Hubei province have driven public doubt in Beijing’s reporting.

Deborah Birx, the State Department immunologist advising the White House on its response to the outbreak, said Tuesday that China’s public reporting influenced assumptions elsewhere in the world about the nature of the virus.

Coronavirus: Doctor at hospital in China's Hubei province ... source

“The medical community made — interpreted the Chinese data as: This was serious, but smaller than anyone expected,” she said at a news conference on Tuesday. “Because I think probably we were missing a significant amount of the data, now that what we see happened to Italy and see what happened to Spain.”

China is not the only country with suspect public reporting. Western officials have pointed to Iran, Russia, Indonesia and especially North Korea, which has not reported a single case of the disease, as probable under-counts. Others including Saudi Arabia and Egypt may also be playing down their numbers.

U.S. Secretary of State Michael Pompeo has publicly urged China and other nations to be transparent about their outbreaks. He has repeatedly accused China of covering up the extent of the problem and being slow to share information, especially in the weeks after the virus first emerged, and blocking offers of help from American experts.

“This data set matters,” he said at a news conference in Washington on Tuesday. The development of medical therapies and public-health measures to combat the virus “so that we can save lives depends on the ability to have confidence and information about what has actually transpired,” he said.

“I would urge every nation: Do your best to collect the data. Do your best to share that information,” he said. “We’re doing that.”

The outbreak began in China’s Hubei province in late 2019, but the country has publicly reported only about 82,000 cases and 3,300 deaths, according to data compiled by Johns Hopkins University. That compares to more than 189,000 cases and more than 4,000 deaths in the U.S., which has the largest publicly reported outbreak in the world.

Map of sampling sites in the Hubei Province of China. Red ... source

 

Abstract

Background: The COVID-19 outbreak containment strategies in China based on non-pharmaceutical interventions (NPIs) appear to be effective. Quantitative research is still needed however to assess the efficacy of different candidate NPIs and their timings to guide ongoing and future responses to epidemics of this emerging disease across the World. Methods: We built a travel network-based susceptible-exposed-infectious-removed (SEIR) model to simulate the outbreak across cities in mainland China. We used epidemiological parameters estimated for the early stage of outbreak in Wuhan to parameterise the transmission before NPIs were implemented. To quantify the relative effect of various NPIs, daily changes of delay from illness onset to the first reported case in each county were used as a proxy for the improvement of case identification and isolation across the outbreak. Historical and near-real time human movement data, obtained from Baidu location-based service, were used to derive the intensity of travel restrictions and contact reductions across China. The model and outputs were validated using daily reported case numbers, with a series of sensitivity analyses conducted. Results: We estimated that there were a total of 114,325 COVID-19 cases (interquartile range [IQR] 76,776 – 164,576) in mainland China as of February 29, 2020, and these were highly correlated (p<0.001, R2=0.86) with reported incidence. Without NPIs, the number of COVID-19 cases would likely have shown a 67-fold increase (IQR: 44 – 94), with the effectiveness of different interventions varying. The early detection and isolation of cases was estimated to prevent more infections than travel restrictions and contact reductions, but integrated NPIs would achieve the strongest and most rapid effect. If NPIs could have been conducted one week, two weeks, or three weeks earlier in China, cases could have been reduced by 66%, 86%, and 95%, respectively, together with significantly reducing the number of affected areas. However, if NPIs were conducted one week, two weeks, or three weeks later, the number of cases could have shown a 3-fold, 7-fold, and 18-fold increase across China, respectively. Results also suggest that the social distancing intervention should be continued for the next few months in China to prevent case numbers increasing again after travel restrictions were lifted on February 17, 2020. Conclusion: The NPIs deployed in China appear to be effectively containing the COVID-19 outbreak, but the efficacy of the different interventions varied, with the early case detection and contact reduction being the most effective. Moreover, deploying the NPIs early is also important to prevent further spread. Early and integrated NPI strategies should be prepared, adopted and adjusted to minimize health, social and economic impacts in affected regions around the World.