Post Publication Independent Review of
"How will country-based mitigation measures influence the course of the COVID-19 epidemic?"
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Post Publication Independent Review of "How will country-based mitigation measures influence the course of the COVID-19 epidemic?"
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Post Publication Independent Review of
How will country-based mitigation measures influence the course of the COVID-19 epidemic?
Roy M Anderson, Hans Heesterbeek, Don Klinkenberg, T Déirdre Hollingsworth
Published: March 09, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)30567-5
1. The title gives an impression that this article might provide valuable insight regarding effectiveness or expected outcomes of country based mitigation measures with reference to COVID-19.
2. Quote "Governments will not be able to minimise both deaths from coronavirus disease 2019 (COVID-19) and the economic impact of viral spread" End of Quote. The first line of the manuscript states so. It gives rise to a doubt whether the manuscript is only one sentence long. In the title, the authors have asked a question. In the first line of the manuscript they have answered in the negative. Does it mean that the manuscript is only one sentence long?
2a. What was the need for the authors to make such an opening statement? Is it supported by any analysis? But no analysis is found, coz between the title and the first line, there is only some blank space. Blank space cannot be accepted as a defense/justification for making such a statement in a research article.
2b. Were the authors already Heads of many Governments that they are making such a statement from their experience as Heads of Government of various nations?
2c. Were the authors trying to heighten reader anxiety by exploiting the fact that fatality due to COVID-19 has been high?
2d. Authors need to realize that making such opening statements will not help provide any significant research outcome from their article, as this is a research manuscript and is not any brochure (to attempt to make an opening impression).
3. Quote "Keeping mortality as low as possible will be the highest priority for individuals" End of Quote. How can individuals try to keep mortality as low as possible with a high priority. Authors need to understand that as far as an individual is concerned, he is either going to be alive or dead. There are only two options, that is being either alive or dead and there is no possibility that the patient cannot be neither alive nor dead and also there is no possibility that the patient can be both alive and dead (applying Quantum Superposition). So, the only possibility is that the individual can be either alive or dead. When there are only two states, similar to on-off states, the above sentence "Keeping mortality as low as possible will be the highest priority for individuals" has no meaning.
4. Quote "Keeping mortality as low as possible will be the highest priority for individuals; hence governments must put in place measures to ameliorate the inevitable economic downturn" End of Quote. What is the relation between an individual trying to stay alive and govt. reaction to economic downturn? Maybe it can be explained with a simile. If it is said that the Devil and the Deep Sea are related to each other, atleast they have two alphabets similar "De". How are the authors trying to relate the action of an individual trying to stay alive and govt. reaction to encomic downturn? Especially with no defense or justification?
5. Quote "In our view, COVID-19 has developed into a pandemic, with small chains of transmission in many countries and large chains resulting in extensive spread in a few countries, such as Italy, Iran, South Korea, and Japan.1 " End of Quote.
This sentence cites the following article (listed as Reference 1)
Coronavirus disease 2019 (COVID-19) situation report—44.
Date: March 4, 2020
(accessed March 5, 2020).
Preliminary examination of the cited WHO article indicates that it is an official document of the WHO and authors list doesnt seem to be provided, which implies that the authors of this article may not have been authors of the WHO document. So, how can the authors state that "In our view" and cite a WHO article, when there doesnt seem any evidence that they have authored the WHO document?
Then, the WHO document is published on March 4, 2020; accessed by the authors on March 5, 2020 and this research article is published on March 09, 2020.
Even if the authors wrote this research article on the same day, that is March 5, 2020 and submitted on the same day, how was the article published on March 09, 2020 in a matter of just a few days? Was this article able to be processed, evaluated and processed in such a short time?
If the authors were not able to complete the article on the same day that is March 5, 2020, then they could have submitted it later, in which case, the processing time for the article becomes still more reduced. How were the authors able to get this research article, involving a very serious current health concern of the world, processed and published in a matter of just a few days or hours?
Further, why are the authors focussing attention on Italy, Iran, South Korea and Japan?
Examination of the WHO document
Table 2. Countries, territories or areas outside China with reported laboratory-confirmed COVID-19 cases and
deaths. Data as of 04 March 2020
classified as Western Pacific Region, European Region, South-East Asia Region, Eastern Mediterranean Region, Region of the Americas, African Region.
The countries mentioned by the authors, namely Italy, Iran, South Korea, and Japan appear as follows.
European Region S. No. 1. Italy 2502
Eastern Mediterranean Region S. No. 1. Iran (Islamic Republic of) 2336
Western Pacific Region S. No. 1. Republic of Korea 5328 S. No. 2. Japan 284
Either the authors should have chosen the first serial number in each classification and indicated, but they have not done so.
If they have chosen the first and second serial numbers in each classification, then choice of the first and second items in Western Pacific Region might stand justified, but again they have not done so.
What was the rationale in choosing a random set of 4 nations with specific concentration to the Western Pacific Region?
On top of it, the authors never provided a defense or justification regarding how they could use the phrase "In our view" when there is no mention of it became their view.
6. Quote "Most countries are likely to have spread of COVID-19, at least in the early stages, before any mitigation measures have an impact." End of Quote. This sentence can also be written more precisely as "During the infinitesimal small duration between initiation and impact of mitigation measures, there can be a minimal spread of COVID-19", because what the authors have written boils down only to this statement. However the manner that the authors have written is that most countries are going to get affected before mitigation effects have an impact, and used the beauty of the language to disguise it. Now, why should the authors try to heighten reader anxiety by scaring them? Or were the authors trying to scare governments of various nations by their seemingly innocent statement? Author bias suspected.
7. Quote "What has happened in China shows that quarantine, social distancing, and isolation of infected populations can contain the epidemic.1 " End of Quote.
7a. Citing a WHO document, authors are very magnanimous in their praise for China. Is this a research article or are the authors trying to gain any undue advantage from China by singing its praise?
7b. Reading together Comment 6 and 7, according to the authors, the mitigation model of China alone can contain the epidemic compared to most other Nations. This article has been published on March 09, 2020.
Attention is drawn to https://www.worldometers.info/coronavirus/country/china/
As on March 09, 2020, total number of cases is 80,754. Number of active cases is 17,721. Number of deaths is 3,136. Number of new recoveries is 1,297. Number of new cases 19.
As on March 25, 2020, total number of cases is 81,285. Number of active cases is 3,947. Number of deaths is 3,287. Number of new recoveries is 401. Number of new cases 67.
If according to the authors, if the epidemic has been contained (for instance, taking the publication date of this research article as a reference), the figures are promising and are showing a good trend, but the disturbing factor is that beyond March 09, 2020, the number of new recoveries (which should have been showing an upward trend) displays a downward trend. It is supplemented by the number of new cases (which should be showing a downward trend) displays an upward trend.
When the statistics is examined, neither on the publication date of this research article were the trends very good nor did the trend start improving (post publication of this article) even if an futuristic allowance is permitted.
8. Reading Comment 6 and 7 together, it can be seen that China had its difficulties in mitigation measures and other Nations too could have possibly had difficulties in mitigation measures. But it is a disturbing sign that the authors have chosen to ignore facts but have tried to lavish their praise on China but at the same time discounting most other nations. Suspected absence of ethics in authors research statements.
9. Attention is drawn to News Item https://www.dailymail.co.uk/news/article-8155405/Up-14-cent-recovered-coronavirus-patients-China-test-positive-doctors-reveal.html PUBLISHED: 13:08 GMT, 26 March 2020 | UPDATED: 15:32 GMT, 26 March 2020
Highlights from news item:
Start of Highlights:
Three to 14 per cent of the patients tested positive after recovery, it is reported
Experts wondered if nucleic acid tests were reliable to detect traces of the virus
Medics said it was crucial to closely monitor those who were given the all-clear
China had discharged over 90 per cent of the infected as of Wednesday
Up to 14 per cent of the recovered coronavirus patients in China have tested positive again, medical experts have revealed.
Research showed about three to 14 per cent of the former patients were diagnosed with the virus once more after being given the all-clear.
The news came as experts feared that China is facing a second outbreak due to the increasing number of imported cases as well as the 'silent carriers' who show no symptoms.
End of Highlights:
Reading together with Comments 6, 7 & 8, a latest news item (while this Post Publication Review was being written),seems to indicate that China is facing difficulties even after clearing off people with complexities due to a second outbreak and silent carriers.
Reading together with Comments 5, 6, 7 & 8, what was the necessity for the authors to prepare submit a paper and get it published in a very short period of a few days or hours, singing praise of China and discounting other Nations, especially when other Nations had not felt the heat of COVID-19 outbreak (as on publication date of this paper)?
Manuscript seems to fail on ethics.
10. Quote "This impact of the COVID-19 response in China is encouraging for the many countries where COVID-19 is beginning to spread. However, it is unclear whether other countries can implement the stringent measures China eventually adopted" End of Quote. Authors sing more praise for China, perhaps never expected that reality might go against their research statements. Is this a research paper or have the authors tried to do a propaganda machine in support of China?
11. Quote "Singapore and Hong Kong, both of which had severe acute respiratory syndrome (SARS) epidemics in 2002–03, provide hope and many lessons to other countries. In both places, COVID-19 has been managed well to date, despite early cases, by early government action and through social distancing measures taken by individuals." Here the authors are singing praise of Singapore and Hong Kong. But above review comments do not permit attaching any scientific merit to these statements by the authors.
12. Quote "This is a very worst-case scenario for a number of reasons. We are uncertain about transmission in children, some communities are remote and unlikely to be exposed, voluntary social distancing by individuals and communities will have an impact, and mitigation efforts, such as the measures put in place in China, greatly reduce transmission." End of Quote. It is rather amusing to note that whatever the authors attempt to state, they eventually end up singing praise of China.
13. The authors are next discussing disease parameters. However, all those research discussions seem to lose their merit with relevance to News Item https://www.dailymail.co.uk/news/article-8155405/Up-14-cent-recovered-coronavirus-patients-China-test-positive-doctors-reveal.html PUBLISHED: 13:08 GMT, 26 March 2020 | UPDATED: 15:32 GMT, 26 March 2020. Hence discussions on disease parameters is unable to be accepted.
14. Quote "No vaccine or effective antiviral drug is likely to be available soon. Vaccine development is underway, but the key issues are not if a vaccine can be developed but where phase 3 trials will be done and who will manufacture vaccine at scale" End of Quote. Unwarranted statement by the authors. They cannot discount medical processes without any scientific reasoning and asking silly questions as "but the key issues are not if a vaccine can be developed but where phase 3 trials will be done and who will manufacture vaccine at scale". Authors scientific reasoning seems questionable and without merit.
15. Quote "The number of cases of COVID-19 are falling quickly in China,4 but a site for phase 3 vaccine trials needs to be in a location where there is ongoing transmission of the disease. Manufacturing at scale requires one or more of the big vaccine manufacturers to take up the challenge and work closely with the biotechnology companies who are developing vaccine candidates. This process will take time and we are probably a least 1 year to 18 months away from substantial vaccine production." The authors are discussing about vaccines, but again try to bring in a praise for China, without even realizing absurdity. What if the number of cases of COVID-19 are falling in China? Is there any rule that a site for phase 3 vaccine trials has to be setup/established only in China? Why cant a ite for phase 3 vaccine trials be set up in another Nation where there is ongoing transmission of disease at that time?
16. Quote "School closure, a major pillar of the response to pandemic influenza A,14 is unlikely to be effective given the apparent low rate of infection among children, although data are scarce." End of Quote. Authors shouldnt have made this statement when they already knew that data is scarce. Even if data is scarce, how can the authors state that school closure is unlikely to be effective? Dont the authors realize that when children go to school, so many processes and people and parents of children, teachers and others get involved so that the school processes are functional? Do the authors think that only children are involved in the school processes? Do the authors think that the children go to school, open the school, study, learn, teach, manage and also administer the school, and the processes, inclusive of financial processes? Children are only a part of the school processes as learners, and there are many others who are part of the school system. How can the authors make such irresponsible statements?
17. Quote "Avoiding large gatherings of people will reduce the number of super-spreading events; however, if prolonged contact is required for transmission, this measure might only reduce a small proportion of transmissions." End of Quote. If prolonged contact is required for transmission, what the authors state might be correct. But when the authors themselves are unable to state whether prolonged contact is required for transmission or only a infinitesimally small contact duration is sufficient for transmission, why should the authors discount the method of avoiding large gatherings of people?
18. Quote "Therefore, broader-scale social distancing is likely to be needed, as was put in place in China. This measure prevents transmission from symptomatic and non-symptomatic cases, hence flattening the epidemic and pushing the peak further into the future. " End of Quote. Again the authors have found an opportunity to sing praise of China. But at the same time, News Item https://www.dailymail.co.uk/news/article-8155405/Up-14-cent-recovered-coronavirus-patients-China-test-positive-doctors-reveal.html PUBLISHED: 13:08 GMT, 26 March 2020 | UPDATED: 15:32 GMT, 26 March 2020, seems to indicate otherwise. Authors should not have been in a hurry.
19. Figure with title "Illustrative simulations of a transmission model of COVID-19" seems to provide some infomation but is seen to carry a disclaimer that "Timing and width of peak uncertain due to Stochasticity in early dynamics, Heterogeneities in contact patterns, Spatial variation and Uncertainty in key epidemiological parameters". When such a disclaimer is provided for a transmission model of a disease, then the entire model cannot be relied upon.
20. Quote "Personal, rather than government action, in western democracies might be the most important issue. " End of Quote.
In the first line of this manuscript, authors state as below:
Quote "Governments will not be able to minimise both deaths from coronavirus disease 2019 (COVID-19) and the economic impact of viral spread" End of Quote.
Initially the authors discount the Governments of various nations. Then they shift the concerns to the individuals, clearing the Govt. off. Why are the authors incoherent?
21. Quote "There are difficult decisions ahead for governments. How individuals respond to advice on how best to prevent transmission will be as important as government actions, if not more important. Government communication strategies to keep the public informed of how best to avoid infection are vital, as is extra support to manage the economic downturn." End of Quote. This statement has just lost its significance with relevance to the National Lockdown enforced by India along with other support measures. This is the concluding statement of this manuscript and it has lost its significance too. Other insufficiencies observed have been discussed in Comments above.
22. Major observations about the manuscript is the seemingly harmless title, accompanied with discounting Governments of other Nations (right from the first line of the manuscript), while at the same time, praising China at every opportunity, with questionable insufficiencies related to author bias, ethics, and scientific merit.