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Swiss Covid-19 exit strategy

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https://www.worldometers.info/coronavirus/
Mortality Rate is 5% of Swiss citizens tested positive.

Compared with Mortality Rate of 13.5% of UK citizens that have tested positive
https://coronavstats.co.uk/

That's one in twenty Swiss die, one in 7.5 UK die, when tested positive. Skullie


Quote …….
"Health Minister Alain Berset will outline a three-stage plan to start a gradual opening of businesses and schools which have been shuttered for a month.
Under Berset’s plan, companies which provide personal services like hairdressers and physiotherapists will be allowed to return to work from April 27, Tages-Anzeiger and Neue Zuercher Zeitung reported.
The number of customers will be allowed on their premises will be restricted, the papers said.

Following a gap of two or three weeks for monitoring, schools could reopen on May 11. Bars and restaurant would remain closed until at least June 8, before reopening in the third phase.
No plans have so far been drawn up for when mass events like concerts or soccer matches can restart. Switzerland has banned gatherings of more than 5 people under its emergency measures.
The plans are not yet settled, the Tages-Anzeiger said citing sources, with the government seeking to prevent the country’s regional authorities acting alone.
Switzerland’s business community, facing huge losses from the shutdown, has been lobbying for lifting the restrictions as a soon as possible."

Source ….. https://uk.reuters.com/article/uk-health-coronavirus-swiss/switzerland-to-announce-three-phase-exit-from-coronavirus-restrictions-idUKKCN21Y0FT
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skimastaaah wrote:
https://www.worldometers.info/coronavirus/
Mortality Rate is 5% of Swiss citizens tested positive.

Compared with Mortality Rate of 13.5% of UK citizens that have tested positive
https://coronavstats.co.uk/

That's one in twenty Swiss die, one in 7.5 UK die, when tested positive. Skullie


I wouldn't read a lot into that type of statisitic at the moment as so much will depend on a countries rate of testing.
I strongly suspect that differences in European countries mortality at the end will depend on age and underlying health structure of the population and how many people get it
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skimastaaah wrote:
https://www.worldometers.info/coronavirus/
Mortality Rate is 5% of Swiss citizens tested positive.

Compared with Mortality Rate of 13.5% of UK citizens that have tested positive
https://coronavstats.co.uk/

That's one in twenty Swiss die, one in 7.5 UK die, when tested positive. Skullie



Not sure where Worldometers get their info from but it’s not in line with the official figures:
https://covid-19-schweiz.bagapps.ch/de-1.html
That gives 1133 deaths and 27,573 confirmed positive cases, or 4.1% fatalities as a percentage of confirmed cases.

Comparisons of infection rates and deaths/confirmed cases between countries aren’t particularly helpful when the testing rates vary so much at the moment.
From NZZ (grafik a good way down)
https://www.nzz.ch/panorama/die-wichtigsten-grafiken-zum-coronavirus-ld.1542774
Switzerland: 22,614 tests per million inhabitants (as of 12.04)
UK: 4,214 test per million inhabitants (as of 12.04).
Switzerland are doing more than 5 times as many tests as the UK, so they pick up more of the mild/moderate cases.

Having said that, (next grafik down at the same link) the UK is doing worse at deaths per 100,000 population (23.31 and not over the peak in the UK vs. 16.06 in Switzerland and clearly flattening). As T-bar suggests I strongly suspect the population here has a different health profile as compared to the UK which will make a significant difference to the mortality rates however good the standard of care is.
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@Gämsbock, Swiss deaths per million population = 158

UK deaths per million population = 228

(figures correct as of 13.30 Hrs 19/04/2020 taken from https://www.worldometers.info/coronavirus/ website.)
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T Bar wrote:

I wouldn't read a lot into that type of statisitic at the moment as so much will depend on a countries rate of testing.
I strongly suspect that differences in European countries mortality at the end will depend on age and underlying health structure of the population and how many people get it


The stats are truly "skew-wiff" due to inconsistencies in national testing programmes.

But it is interesting to note that the UK death figures are following France/Italy/Spain day on day. AND currently only 25% of tested positives in the UK have recovered. Couple that with the 13.5% mortality rate the conclusion is that over 60% of tested positive cases still remain un-recovered. Considering that the UK is in day 34 with 15,464 deaths and approaching 2000 cases in critical the "green shoots" and "flattening curve" do not look that close! Extrapolating the current trend suggest the mortality figures at the end of the month will be in the region of 27,500.
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skimastaaah wrote:
... the conclusion is that over 60% of tested positive cases still remain un-recovered.
What's the definition of 'recovered'?
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skimastaaah wrote:


The stats are truly "skew-wiff" due to inconsistencies in national testing programmes.

But it is interesting to note that the UK death figures are following France/Italy/Spain day on day. AND currently only 25% of tested positives in the UK have recovered. Couple that with the 13.5% mortality rate the conclusion is that over 60% of tested positive cases still remain un-recovered. Considering that the UK is in day 34 with 15,464 deaths and approaching 2000 cases in critical the "green shoots" and "flattening curve" do not look that close! Extrapolating the current trend suggest the mortality figures at the end of the month will be in the region of 27,500.

I think there is pretty good evidence that the curve is flattening but not that it is going down much.
I don't think the UK statistics look good and we were too late with good social distancing measures. In this phase we will get more deaths than most , but I suspect that the mortality form actual covid cases will not be a lot different, just that we will have had allot more of them but identified fewer of the ones not requiring hospital care due to our testing regime.
We may also get a lot more in care homes because of our testing regime and the higher incidence of covid generally.
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Here’s the official Swiss stats


https://covid-19-schweiz.bagapps.ch/fr-1.html
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Another 600 Covid-19 deaths in the UK in the past 24 hours takes the cumulative in-hospital mortality rate over 16,000. The highest mortality rate of the day with the given stats at 15.00 hrs of 596.

The Swiss figures are encouraging.

The Belgium stats are something of an anomaly currently.

Sweden's chickens are coming home to roost with a higher mortality rate than the Swiss, with half the number of total positive cases.
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@skimastaaah, "mortality rate" is probably not a useful measure since it depends on the testing regime. But the Swiss are seeing a lower rate of infections (only meaningful if their criteria for testing has stayed constant) and a probable reduction in daily deaths.

UK the best you can say currently is that both have stabilised. But given test numbers are now (finally!) increasing you can at least speculate that new infections might be decreasing.

Interestingly Sweden seems to be holding at pretty constant numbers (thought the fact that they are relatively low produces a lot of day to day volatility). What they are doing might be just enough to maintain the rate of onward infection R at 1, but not to bring it down. The key thing is that they put measures in place when numbers were pretty low, unlike the UK.

When did Switzerland apply restrictions?
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I think that by the time the next 12 months are up the death rate per million citizens will be fairly similar across most countries (barring miracles). The earlier and harder a country locked down, the longer it will have taken to kill its quota of citizens.

There will be some anomalies; countries where there is no healthcare will suffer much higher death rates; Italy, where they filled their hospitals with people with mild symptoms at the start and overran their health service.

The citizens of Sweden and the UK and Italy will be free of this long before the citizens of Switzerland. And places like Taiwan that have managed to keep it away almost completely. In the UK I think we should be looking now to find the steady state, i.e. be at a position where R0 = 1; at the moment it is well below which is just saving up trouble for later.

If not, then there will be no international travel to or from these countries for years.
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@j b, started shutting things down on 13/03 , full shut down on 17th March.
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Thanks @Nadenoodlee. The UK's first day of full restrictions was 24 March when deaths were 422. If they had responded at the same time as Switzerland on 17 March it was 71, so if the subsequent slowdown followed the same course the current toll would be one sixth what it actually is. People would be looking at it very differently.

It was obvious at that stage governments needed to address the crisis. I think from memory France locked down on 15th or 16th (we had to cancel a skiing holiday, as did many others) while Italy and Spain were around a week before. Denmark responded appropriately and the UK could. Up to that point you could possibly defend the UK approach.
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James the Last wrote:
I think that by the time the next 12 months are up the death rate per million citizens will be fairly similar across most countries (baring miracles). The earlier and harder a country locked down, the longer it will have taken to kill its quota of citizens.

“Miracle” would be a drug that improves survival rate by say 50%

Countries that pushed the “death quota” beyond that miracle drug’s introduction will have lower death rate overall. Their “infection quota” is the same, but the “death quota” will be lower.

Also, most “expert” expect outbreaks will continue for 2-3 years. So it’s possible we’ll have a vaccine sometime in the middle of that time span. If so, the “death quota” will drop for countries that has lower death initially.
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James the Last wrote:
abc wrote:


Patients become infectious 2-3 days BEFORE they show symptoms!!!

When you ignore science, everything becomes a conspiracy. rolling eyes


I think if you have such an important point to make that you feel you have to shout it in red at the entire internet then it might be courteous to tell us where you got the information from.


Though I’m too lazy to go look for it again and again, such evidence fell into my lap:

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200402-sitrep-73-covid-19.pdf?sfvrsn=5ae25bc7_6

said Maria Van Kerkhove, technical lead for the WHO's Health Emergencies Programme, at an April 1 news conference. However, "we do have evidence, from testing and modeling studies, that suggest people who are presymptomatic can definitely transmit this virus," says Smith, the epidemiologist, most likely in the one to three days before they start showing symptoms


And a “super spreader” event by asymptomatic carrier: https://www.latimes.com/world-nation/story/2020-03-29/coronavirus-choir-outbreak

Feel free to “shout back” at me of opposing evidence. Toofy Grin
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As things stand my daughter will be back at school in Nyon on May 11th. Given that my canton, Vaud, has the highest number of infections I can't think how this is a good idea. Online schooling is working pretty well (I appreciate the school she is at may be the exception), and selfishly I admit I've been enjoying not having to commute to Lausanne or Vevey every day Very Happy

That said, I can't see how they can start reopening other businesses without childcare/schools being open
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@Whitters My understanding of the UK feedback so far is that infection rate among schoolchildren is relatively very low. And unlike the Spanish 'Flu, the mortality rate is also very low. So this makes the option of sending children back to school a 'low-risk/high-benefit' (children back in education + parents available to return to work) one. However, the concern among teachers is that they don't operate in a vacuum and will inevitably interact with other staff and their environment. So the infection risk for them is much higher and apart from the personal issues, if a lot of teachers are off sick as a result of a return, then all you're ending up with is a 'holding pen' for the pupils, and not a teaching environment. But if that allows their parents to resume work, then the Federal view may be that it's still a better option than the schools being closed.
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A three-phase exit strategy from Covid-19 lockdown
Like most countries in the world, Switzerland had implemented containment measures since the end of March to limit the spread of the coronavirus. The health situation is improving, and the Federal Council decided on 16 April to gradually ease measures against coronavirus with a three-step approach. Moving from one phase to the next depends on there being no significant increase in COVID-19 cases.
On 27 April, hospitals will be able to resume all medical procedures, including non-urgent procedures, and outpatient medical practices. Hairdressing salons, massage practices and cosmetic studios will be allowed to reopen. DIY stores, garden centres and florists will also be allowed to reopen. Restrictions on the range of products that can be sold at grocery stores will be lifted.
In phase two, which is set to commence on 11 May, it is planned that schools for children of compulsory-school age, shops and markets will reopen. The Federal Council will decide on whether to proceed with phase two on 29 April.
In phase three, set to commence on 8 June, upper secondary schools, vocational schools and higher education institutions will be allowed to resume face-to-face teaching. At the same time, entertainment and leisure establishments such as museums, libraries, botanical gardens and zoos may reopen, and restrictions on gatherings could be relaxed. The Federal Council will take a decision regarding the details of this phase on 27 May.

A severe recession and a slow recovery are to be expected

Swiss population is around 8.5 million
Currently 1500 deaths due to Corona Virus.
Equates to 175 deaths per million population.

Daily death rate continues to fall, on balance a phased return looks sensible.
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@LaForet, Schools is a really interesting one. There is a lot of evidence (even from the UK CMO) that asymptomatic carriers are responsible for a very small % of transmissions. Children are very rarely badly affected so they are almost all in this category. Ergo, schools are safe to open. And I say this as a teacher.
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We are all going to get it, they’re aiming for herd immunity, they just want to start off with more traceable professions and communities, and children seem to be the least affected age group. If the hospitals get swamped, then we go back to more restrictive measures is what I understood.

I have no qualms about sending my son back to crèche. Mainly because I’m not enjoying the 120chf a day pay out for two months, but I digress.... solidarity etc...
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Nadenoodlee wrote:

I have no qualms about sending my son back to crèche. Mainly because I’m not enjoying the 120chf a day pay out for two months, but I digress.... solidarity etc...


I feel your pain. Kids reaching school age is like winning the lottery in CH!
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@BobinCH, amen to that. We just deferred midget 1 kindergarten until 2021, might have been sensible given the circumstances but oh god I’ll be glad when that’s back in the bank
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philwig wrote:
I love the idea of smokers (highly at risk, after all...) using masks.


There is some evidence from multiple countries that smokers are protected from getting covid19 in significant numbers. . So perhaps not highly at risk.
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@ringingmaster, source?
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skimastaaah wrote:
https://www.worldometers.info/coronavirus/
Mortality Rate is 5% of Swiss citizens tested positive.

Compared with Mortality Rate of 13.5% of UK citizens that have tested positive
https://coronavstats.co.uk/

That's one in twenty Swiss die, one in 7.5 UK die, when tested positive. Skullie


Swiss have done 26,000 tests per 1m of population
UK have done 8,000 tests per 1m of population - if we had done 26,000 tests per 1m, then the deaths would still be the same number & would be looking at 1 death in every 23 Little Angel Blush
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@holidayloverxx, I heard about it from my wife who runs clinical trials (and is entirely refocussed on COVID at the moment). I believe there was an observation in several countries that the percentage of patients with COVID who were smokers was consistently smaller than the percentage of smokers in the general population. However those who did get it generally faired worse. Now this could be for any number of reasons, but it has enough data to start several trials, some observational, and some interventional.

https://www.qeios.com/read/article/574


There has also been some coverage in the more general press.

https://www.theguardian.com/world/2020/apr/22/french-study-suggests-smokers-at-lower-risk-of-getting-coronavirus
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Mr.Egg wrote:


Swiss have done 26,000 tests per 1m of population
UK have done 8,000 tests per 1m of population - if we had done 26,000 tests per 1m, then the deaths would still be the same number & would be looking at 1 death in every 23 Little Angel Blush


Agreed. However, with the current UK programme of testing for hospitalised/symptomatic cases the underlying math is blindingly obvious. If you test positive in the UK there is a 13.5% mortality rate. That is the stark reality of how the UK testing pans out. Sadly the UK testing programme has NOT done 25000 tests per million population, and that is shameful. Germany's testing is at 25000 per 1m, backed up by aggressive contact tracing, with deaths less than a third of the UK's. Currently Swiss have under 400 serious/critical cases, which shows a decline that ultimately should bring about less mortality rate, hence the optimistic easing of lockdown measures. Good for Switzerland.
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skimastaaah wrote:
If you test positive in the UK there is a 13.5% mortality rate.
Which is not a figure you can use to compare to other countries if they have a different testing regime. More generally deaths per population isn't a meaningful statistic either.
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@rob@rar, Not my figures, but taken from https://coronavstats.co.uk/ ….. "Fatality Rate - 13.56%"

This just underlines the absence of UK testing with the general population!
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skimastaaah wrote:
@rob@rar, Not my figures, but taken from https://coronavstats.co.uk/ ….. "Fatality Rate - 13.56%"

This just underlines the absence of UK testing with the general population!
Yes, I appreciate that, but Case Fatality Rates can only be compared country to country if each country has the same testing regime. Clearly they don't. To take an extreme example, if a country only tested patients who were ill enough to be admitted to intensive care they are going to have a very much higher CFR than a country which tested 50% of their population, regardless of symptoms. I think this is a good examination of Case Fatality Rates across different countries. It suggests that between countries, Case Fatality Rates vary significantly, and over time, which suggests considerable uncertainty over the exact case fatality rates for some of these reasons:

- The number of cases detected by testing will vary considerably by country;
- Selection bias can mean those with severe disease are preferentially tested;
- There may be delays between symptoms onset and deaths which can lead to underestimation of the CFR;
- There may be factors that account for increased death rates such as coinfection, more inadequate healthcare, patient demographics (i.e., older patients might be more prevalent in countries such as Italy);
- There may be increased rates of smoking or comorbidities amongst the fatalities.
- Differences in how deaths are attributed to Coronavirus: dying with the disease (association) is not the same as dying from the disease (causation).
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@rob@rar, Underlying health conditions are evidently "associated" with CFR. So is BAME, which is over-represented in CFR figures, especially in the US.

I can see the logic in Switzerland setting out an exit strategy, but I'm dumbfounded by the US's strategies and localised demonstrations. Just short of 50 000 deaths on Day 40, and climbing!
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skimastaaah wrote:
...but I'm dumbfounded by the US's strategies and localised demonstrations.
Indeed. The Guardian is reporting that Angela Merkel was expressing concern that the German states are unlocking too quickly, and there's chatter from Conservative backbenchers in the UK that steps towards lifting the lockdown need to be taken soon.
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rob@rar wrote:
skimastaaah wrote:
If you test positive in the UK there is a 13.5% mortality rate.
Which is not a figure you can use to compare to other countries if they have a different testing regime. More generally deaths per population isn't a meaningful statistic either.


And the disclaimer given in the link https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/ is "In the UK, only patients deemed ill enough to require at least one night in hospital met the criteria for a COVID-19 test.".

I suspect the death rate is MUCH HIGHER in patients who were admitted to ICU and EVEN MORE WORSE in patients requiring ventilation. Let's not put out stats which increase anxiety without giving all the facts.....
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Klamm Franzer wrote:
Let's not put out stats which increase anxiety without giving all the facts.....


Your link has dated data, especially regarding China stats. (Which are most likely "edited") and based on the WHO figures set out back in March. Later analysis of the US/NYC show increasing CFR in specific age groups that should be much more worrying to anyone over 50.

CFRs on mortality rate estimates can be misleading if the CFR is based on the number of deaths per number of confirmed cases at the same time. Using the denominator of the mortality rate as the total number of patients infected at the same time as those who died would lead to much higher CFRs. However, they report the full denominator remains unknown as asymptomatic with mild symptoms might not be tested and will not be identified, particularly in the early stages of an outbreak.
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Analysis from Thomas Pueyo on this (not sure if posted elsewhere on SH so apologies if its a duplicate) https://medium.com/@tomaspueyo/coronavirus-learning-how-to-dance-b8420170203e

As he observes, what you want to be seeing is a very low positive rate on tests, because its indicative of very widespread testing. Sadly, that's not the situation in the UK (nor, frankly, at c. 5%, does Switzerland look ready either)

Indeed, the crux of his article (and its followup in here) is that many countries will likely release lockdown too early, without sufficient testing/tracing infrastructure, and will see a bad second wave.
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Quote:
what you want to be seeing is a very low positive rate on tests, because its indicative of very widespread testing.

It’s so blindingly obvious.

I’m shocked nobody is paying much attention on the ratio of positive/all tests.

A high positive ratio is indicative of one of the two:

1) Not testing enough
2) High infection in the population.

Neither are good numbers.


Last edited by You'll need to Register first of course. on Thu 23-04-20 15:28; edited 1 time in total
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skimastaaah wrote:
Klamm Franzer wrote:
Let's not put out stats which increase anxiety without giving all the facts.....


Your link has dated data, especially regarding China stats.


Granted 24 hours is a long time in Pandemics, "*case fatality rate is the number of reported deaths per number of reported cases (Updated 22nd April)."

The table in the article backs up your CFR number (13.43% on 22/04/2020). That is not the issue. I would suggest that the measure is pretty worthless and comparisons between countries is even less useful as the testing regimes are different. Absolute numbers such as Death Rate per Head of Population would be better but it ignores demographics within countries, population densities and social norms.

There is so much data flying about at the moment, it is very easy to make it point any which way.
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Ultimately it's going to be a decision on balance. By planning an exit or delaying an exit really come down to a trade off between risking thousands of businesses to be lost, or thousands of lives to be lost.

I hope that in September there is no resurgence of Covid-19, and that the UK has not lost 75 000 to the virus by then just to save commercial concerns.
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Quote:

There is so much data flying about at the moment, it is very easy to make it point any which way.

As someone who had a degree in science, whenever I look at a table or a graph, the one thing that jump up on me is the missing of the error bar!

When I was in school, every piece of data, I mean EVERY, had to have a +/- associate with it. And every graph must have error bar on each graph point!

Granted, systemic errors are not as easy to get (estimate) as the statistical error. Still, the entire omission of error in any data table/graph just gives me all sort of misgiving.

Many of the "data" we're being shown, had there been error bar attached, it would have been gigantic. Yet, people are debating the minute differences between data points... rolling eyes
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https://www.worldometers.info/coronavirus/country/us/

shows NY deaths at 20 000 out of total US cases of 50 000

Sadly @abc, please tell Mr Trump that your degree in Science has currency to impact on his lack of vision …..

https://www.msn.com/en-gb/news/coronavirus/sadness-and-disbelief-from-a-world-missing-american-leadership/ar-BB135rGh?ocid=spartandhp
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