there is an urgent need to act (11 concrete points) ... and then discuss

1. “Shanghai here”: there is an urgent
need to act (11 concrete points) ... and
then discuss
We have 10 Chinas in Europe, with a mortality ratio of 1 to 80!
Preamble
Our Covidminute.com team is made up of volunteers (except IT specialists!) and offers you:
1. A public health tool for decision makers
We bring in preview (at 7:30 am Paris time for breakfast), since January 28 (59th daily
analysis this day!):
● visual tools (key figures, minute table, mapping, ...) and analysis to enlighten public
and private officials and guide them in making good decisions, especially medical
ones.

2. ● a practical vision (China with variable geometry: Hubei / except Hubei, other
countries of East Asia, ...), and the historical vision (SARS, ...)
2. Useful and rational information for the general public
Our goal: to teach the general public to think like a “decision maker” and in a transparent
way, to understand the tendencies (the current) rather than the immediate aspect (the media
approach describes only the “scum”), in this over-information daily.
We have successfully completed our mission in China with 10 Social Media groups reached
in less than a month, and we are now offering it in France (& soon in Europe: English
version).
Dr Guillaume Zagury
Specialist in International Public Health.
20 years in China
Shanghai, 26th march 2020
A. France seen from China and Asia - From the
east will come the light: we have to learn from East
Asia
This section is produced with discussions with Dr Bachir Athmani in Paris and Mathieu
Bouquet in China.
“Put down the masks” and stop half-measures: we must adopt the recipes that work!
1. Three times in this moment of crisis
In chronological order :
● Health crisis: reaching the peak as quickly as possible, then on D-Day of the end of
the epidemic
● Restart and economic recovery time
● Remote analysis time: the best, and the least good to correct.

3. 2. Understand the issue and become aware of the proportions
(mortality from 1 to 80 with East Asia): "Stop tinkering!"
We are in the presence of 2 strategies (Asian and Western), and you must always have in
mind a key figure that I already offered you 4 days ago exclusively, namely the number of
contaminations and deaths reported in population :
● European style: half measure, lagging behind the wave!
○ Italy (60 million inhabitants): 1 month of health crisis for 7,300 deaths, and the
peak has not yet passed. The deaths already recorded are only the
culmination of cases occurring more than 3 weeks ago, or the contaminations
have been increasing until the last few days!
○ Most other European countries have so far followed similar, if not close,
trajectories.
● Asian (partly linked to the memory of the history of epidemics, especially SARS in
2003): we are not letting the wave happen.
○ China (1.4 billion inhabitants): in 2 months (55 days: Hubei freezing measures
taken on January 25, absence of new local cases on March 20), “only” 3,500
deaths, 90% concentrated in HUbei, the epicenter of the epidemic.
○ Most of the other Asian countries (Taiwan, South Korea, Vietnam, Japan,
etc.), each with different methods, have so far managed to contain the
epidemic, even though they have not had 2 months to prepare.
Between China and Italy, the ratio is from 1 to 80! All is said…
But behind this cold figure, there are thousands of lives to save!
In short :
● Let's be aware of the proportions: from 1 (China) to 80 (Italy… and soon Europe?).
● European experts were wrong in terms of strategy (and we can all be mistaken): they
did not understand the relevance of the Asian measures (and not only Chinese!). We
are facing a tsunami and not facing a “bad flu”!
● France is not yet "in the game" and time is not our friend. Our medical capabilities are
about to be overwhelmed. We must take the initiative and not be late for a battle.

4. 3. The “coro-action” table, updated regularly: to anticipate
rather than suffer!
● This unique and concrete table makes it possible to compare the measures taken by
the countries confronted with the epidemic, and which have shown their effectiveness
(Wuhan, Shanghai, South Korea, ...)
● If I were president, and if we want to “win the war”, it is possible!

5. 4. Expert committees are less necessary: ​​11 first measures to
be taken, taken from the “coro-action” table
4.1 Prevention
1. Masks
● For healthcare professionals: quality (FFP2) for the 2 million individuals in contact
(hospitals, nursing homes, etc.). Either a (strict) minimum mask per day and per
person during the epidemic time (probably 40 days, or 80 million units minimum).
● Masks like “surgical masks” for professionals in contact and extended to the general
population (if out and not taxed): gendarme, cashiers, ...
● While in China the mask was compulsory, in Korea or Vietnam, it is very often used
but not compulsory (except cluster).
● Vietnam is better equipped than France in professional protective gear: we have
seen videos with French general practitioners using trash bags to protect themselves.
In Vietnam, even second line personnel wear full protective suits.
● Note that China is becoming the “master of the world” by reorienting its increasingly
robotic textile industry in the “white gold” factory (surgical masks, medical protective
devices such as gowns and glasses, etc.). The capacity of an average factory is
around 1 million day masks. Dozens of textile factories have switched to mask
manufacturing in recent weeks.
2. Gels
Gel manufacturing, which must be offered at the entrances to collective points (or used at
home). This requires the participation of French industrialists.
We will offer a standard tomorrow (especially on the basis of what exists in China)

6. 3. Social distancing
No meeting of more than 3 people (public places, work, ...) as in China and Germany.
4. Containment according to 2 possibilities (depending on the prevalence of cases
and the epidemiological dynamics, etc.)
● Hubei type: strict and has proven its effectiveness. The population must adhere,
which requires good communication.
● Type “outside Hubei”: slightly more flexible (schools, certain professions exclusively,
...)
We will offer a standard tomorrow (related to China).
5. Massive disinfection
“Robot sprayer” widely used in Wuhan and Korea, “manual” disinfection measures in effect
in China and other Asian countries.
We will offer a standard tomorrow (based on what is done in different Asian countries).
4.2 Detection: identification and management of contact cases
6. Temperature control
In key locations (infrared socket in the metro in Shanghai): to detect cases, even if we know
that the fever is not constant.
7. Equip yourself in tests ​(priority measure!)
Great lesson from Korea. The generalization of tests has also changed the game in China.
We will offer a standard tomorrow (based on what is done in different Asian countries).
8. Management of proven cases
Strict solitary confinement. It is essential, while in France 50% of cases are under
observation at home! It is heresy in my opinion, when you know the risk of family spread. In
Wuhan, entire families were contaminated and some decimated, and authorities took
draconian measures of isolation in February after becoming aware of the family
contamination.
We will offer a standard tomorrow (based on what is done in different Asian countries).
9. Contact cases
To be isolated more flexibly (in hotels, etc.) during the incubation period.
We will offer a standard tomorrow (based on what is done in different Asian countries).
4.3 Treatment
10. Individual

7. Treatment of mild symptoms initially to reduce the viral load: in the absence of a
contraindication (cardiac in particular), I think that treatment with chloroquine started early
would be a risk to take if the patient requests it (let's not forget that we have observed very
young cases in intensive care.
11. Using private clinics in the collective effort
They must put their human and material resources (many fans, ...) at the service of the
collective. The ARS must be more offensive (public and private: same combat and no
antagonism of another time in the current situation).
5. Technological innovations (geolocation, ...) and individual
freedoms: let's act first, then discuss
B. France - Living with D21, confinement D10
“It's no longer a bad flu”
Period of uncertainty after a week of confinement: if some "furry" have spent 4 years in the
trenches, we can try to spend 4 weeks (between 1 and 6 weeks) at home.
1. Incidence: +2,933 new confirmed cases (2,450 yesterday)
We remain in the epidemic growth phase, the number of new cases does not seem stable
over the last 4 days.
2. Prevalence: 20k in observation (17.9k yesterday)
● Note a Franco-European specificity: 50% of cases are under observation at home! It
is heresy in my opinion, when we know the risk of family spread, a phenomenon
widely observed in particular in Wuhan, and which led the Chinese authorities to take
drastic measures in February.
● The doubling time remains stable at 5 days.
3. Health system: + 10% of cases in intensive care (doubling
every 7 days!)
● Hospitalizations: ​11,539 cases
● Observations at home: ​as many cases as at the hospital (which seems to me a
strategic error, when we know the risk of family contamination!).
● Resuscitation: ​2,827 (2,500 yesterday), a third of which are under 60 years of age.

8. ○ Note that the 1,000 intensive care beds in Paris are almost all occupied
(according to statements by Martin Hirsch, director of the APHP).
○ About 30% of hospitalized patients and 15% of Covid patients detected.
● Death: 1,331 deaths (+ 231 yesterday)
○ 5 times more than a week ago, but this figure does not take into account
deaths in Ehpad possibly linked to the virus. In Ile de France, a specialist
estimates that around 130 establishments out of the 700 are affected. We
know that the Ehpad are potentially broths of culture, especially since those
accompanying do not always have the necessary protection tools.
○ 6% of lethality (order of magnitude to know for later comparison in time and
space, even if this indicator is questionable by purists!)
○ in France, 80% of deceased patients are said to be over 70 years of age.
● Daily : extreme psychological difficulty in supporting families who are separated from
their loved one and sometimes will not see them during their lifetime. These personal
situations are extremely painful to live for both the family and the hospital staff ... but
it is in the community's interest to maintain these measures.
4. Comparative dynamics (/ Italy): France seems to be
deviating slightly from Italian development in recent days
● The average trend for the last 3 days is to slow down compared to Italy a week ago
(see graph below).
● However, be careful with the data and compare what is comparable: the Italians now
have a more case-oriented strategy, whereas we are much less so. Thus, according
to some (but to be confirmed because the figures are not officially communicated)
France has tested approximately 2 times less people than Italy at the same stage of
the epidemic.

10. 5. Territorial distribution
5.1 Cartography
5.2 Regional analysis

11. 6. To note
● It is interesting to follow the case of Morocco, which made the decision to treat all
hospitalized cases with Plaquenil, for 4 days: equivalent to a large-scale clinical trial.
95% of French people approve confinement.
● The fight is both health and economic.
● In terms of triage in the hospital: "Any patient is suspicious and not only if they have a
fever, cough or AEG (deterioration of the general state).
● The French overseas departments and territories are also all affected: Tahiti,
Guadeloupe, Guyana, Noumea (where we see masks appear as in Asia!).
C. Incidence Monde: an exponential extension of
the pandemic
WHO Director-General Tedros Adhanom Ghebreyesus made the following observation
yesterday:
● 67 days to reach the first 100,000 prevalence cases;
● 11 days for the following 100,000 cases;
● 4 days the following 100,000 cases
Thanks to Stéphane, a companion from the start, for his participation.
1. Incidence : 46k new cases diagnosed (43.8k yesterday,
41.5k the day before)

12. These are very high levels, since in Wuhan, the number of new cases reported daily during
the peak of the epidemic was around 3,000 (although there was likely underreporting due to
the limited number tests available).
2. Global geographic vision
There are currently the equivalent of 15 Wuhan type homes around the world, including ten
exploded in Europe and which can be joined!

13. 3. Continent / country geographic analysis: arrival of the
tsunami on the west coast of the United States
● Vision by continent: the “next frontier” will be in the Americas
Country vision (top 7): the United States is now firmly established as the country with the
largest number of new cases daily.

14. ● United States: 13.3k new cases (11.1 yesterday), including a large part in New York
● Italy: 5.2k (5.2k yesterday)
● Spain: 7.5k (4.7k yesterday), 550 million masks ordered from China
● Germany: 4.3k (3.9k yesterday)
● France: 2.9k (2.4k yesterday)
● Iran: 2.2k (1.8k yesterday)
● United Kingdom: 1.4k (1.4k yesterday)
● The Italian case: slight improvement with a tendency to slowdown for 4 days on D16
of the confinement (03/10/2020).
● For a more detailed analysis, attached our daily dashboard

15. D. Prevalence worldwide: 332k active cases
declared (450k cumulative)
1. Time vision (chronological): a dynamic to consider

16. ● At the current rate, doubling of cases worldwide every 5 days (stable).
● Figures to be taken with caution given the disparity of testing strategies: the epidemic
can spread without it being reflected in the official figures, if the patients are not
subject to biological screening and a count official.
2. Spatial vision
Geographical location of countries with more than 10,000 active cases (top 7):
● USA 67k
● Italy 57k
● Spain 40k
● Germany 33k
● France 20k
● Iran 15k
● Switzerland 10k
● Chronological view by country

17. The epidemic is marking time in Italy. The increase in the number of cases of coronavirus
continued Wednesday to stagnate in the country, where the death toll still crossed the 7,500
mark, according to the official balance sheet. With 7,503 dead (+ 683 in 24 hours), the
peninsula remains the country most cruelly hit by the pandemic.
3. World space vision
● The map of the day shows us 5 outbreaks: Western Europe, the United States and
Central America, the Middle East and to a lesser extent (but to be considered with
caution because the means of detection are weaker ) West Africa.

18. ● At the continental level: a quarter of the current cases are in North America.
Coming tomorrow
● Probably a video: we have to change our strategy;
● The impact of new technologies;

19. ● A “stress test” on Russia;
● Follow-up: Morocco (use of chloroquine for all patients, even if slightly symptomatic),
India, Thailand.
Keep in mind the “3M reflex” (Hands-Masks-Meter) to protect
yourself… but above all to protect the most vulnerable.
Trust and solidarity for this collective fight
Dr Guillaume ZAGURY
Specialist in International Public Health
Consultant in “Health Innovations” ​
HEC
In China since 2000.
● “All success is collective”, thanks to:
○ the whole “Back Up” team (Mathieu Bousquet, Carole Gabay, Flavien, Marie, Laetitia,
Anne-Sophie, ...), without whom this project would not have been possible.
○ all the “Medical” team (Dr Bachir Athmani, Dr Ibrahim Souare ,, Dr Taieb, Dr Viateur
...) who allow this project to exist,
○ all historical financial sponsors (Jerome, Benjamin Denis & B Square, Benoit
Rossignol, Arnault Bricout) who work for “Citizen Actions”
● If you feel like a patron or of partners to finance IT development, don't hesitate to contact me
(guillaume@covidminute.com).
● Also, even if part of the team is based in Shanghai, do not hesitate to come and join us,
because there is no shortage of work :-)