Covid-19 Discussion

[SW18]

But in April the Peak was nowhere near what was expected was it?. The Nightingales hospitals never got used did they?
Is 50% of what it was in April an unusual figure for hospital admissions? Then for this time of year a rise is to be expected?

These are questions, not accusations or anything else.

All good questions. My thinking is that given COVID hospital admission rates are on the increase, the admissions curve won’t just flatten out; the numbers are still rising fast. And hospital admissions lag cases, so the numbers in hospital today reflect the case count 1-2 weeks ago. Cases today are substantially higher than 2 weeks ago, so we can expect hospital admissions to rise further. So it’s reasonable to expect a continued increase until a peak is eventually reached. This will then be followed by a rising death count - deaths are now in the hundreds daily, so are already heading the same way as they did in the Spring. Let’s hope treatment has improved and it keeps the death count down to the levels of normal seasonal respiratory illnesses.

Nightingale hospitals were always a last resort and I wouldn’t want to be admitted to one: how will they work, who will staff them, will they be effective? Even though we had them in the Spring, the death rate in April was exceptionally large. What’s to say we won’t reach that point again?

 

[Deleted member 150136]

But The figures are normal figures for this time of year for the UK? nothing extraordinary?

The CFR(which i have learnt on here) is decreasing, so the more admissions to hospital don't necessarily mean more deaths(than say this time last year)

Quoting figures without context is misleading.

 

[st13phil]

Today, The Spectator has published SAGE's "Reasonable worst-case planning scenario" for Covid-19, from 30th July 2020. Separately, they have explained why they have published it:

In the UK’s pandemic response system, an independent committee of scientists – SAGE –draws up a ‘Reasonable Worst-Case’ planning scenario. This isn’t a prediction, but what it thinks could reasonably happen. Importantly, government then plans along these lines. But it has no obligation to tell the Cabinet, let alone the rest of the country, what is going on. As a result, government policy can be decided along lines that mystify senior government members, let alone those affected. Secrecy helps keep SAGE advice candid and allows for quick decision-making. But now that we’re settling down for what this week’s Spectator calls ‘the long winter’ it’s harder to justify the secrecy. So we’re publishing the document which points to 85,000 deaths until the end of March, with restrictions lasting until then.

If government plans are being made along these assumptions, there’s a public interest case in publishing. Lack of transparency means lack of scrutiny: there’s a chance that big errors can creep in. This secrecy also undermines trust in government. In another era, there’s an argument that publishing the RWC document would be alarmist – that case was certainly made during Swine Flu. But now, the stronger argument is that the government should level with the public.

The also make the following comment regarding the lack of information transparency:

We’re in an absurd situation now where the people of Manchester and Liverpool are told that their hospitals are at breaking point. Such stories, if untrue, risk lives: people who need care may not seek it, leading to the pile-up of at-home deaths we’re seeing now. But when the Manchester Evening News contacted local hospitals to ask for the figures – which are compiled on a daily basis and available on an internal NHS Covid dashboard – they were sent away and told to submit a Freedom of Information request that gets a response in 28 days. SAGE will publish selected documents – the minutes of its meetings for example – but not the all-important RWC scenario. It’s hard to see why not.

Just read that point about the MEN's request for hospitalisation information again, and think about what the consequences of the response are.

I realise that John Ioannidis' research on the Covid-19 Infection Fatality Rate wasn't published until after the SAGE RWPC so it would be reasonable to assume that SAGE have updated their scenario(s), but we are still hearing today reports of "85,000+" Covid fatalities by the end of March in the media (as per the RWPC of 31/07) because SAGE had used an overall IFR of 0.7% to create it (see Table 1 in the linked article, below), even though that is at least 3.5 times the real-world overall IFR found by Ioannidis.

You can read the RWPC here:

Covid in winter 2020, a worst-case scenario

In pandemics, UK governments plan their response based on an unpublished ‘worst-case scenario’. Below, we are publishing Sage’s classified report for the winter of 2020. It’s intended not as a prediction, but an example of how bad things might get and what HM Government should prepare for. It...

www.spectator.co.uk

 

[Deleted member 65149]

But in April the Peak was nowhere near what was expected was it?. The Nightingales hospitals never got used did they?
Is 50% of what it was in April an unusual figure for hospital admissions? Then for this time of year a rise is to be expected?

These are questions, not accusations or anything else.

The only people who “expected” a certain April peak were the media and their public. Being an unknown, the government had to put in place measures to handle a “possible” peak, a peak that fortunately wasn’t reached because of other measures such as the lockdown that successfully kept the peak down. The belt and braces approach to protecting lives was a bit wobbly, but at least it was there.

Despite what’s been learnt over the last few months, this is still an unknown so renewing only part worn brake pads and tyres before they’re possibly needed doesn’t sound like a bad move to me.

 

[ChipChop]

As we are dealing with unknowns it is always unwise to make sweeping predictions such as we see every day on the news. Instead we should rely on evidence based medicine.

Here is an interesting article from CEBM looking at Pandemic theory versus Seasonal theory. If you look back to what happened in April we see a sharp unexpected rise in deaths. This was not only in the UK but also in Spain, Italy & Belgium. If we look at who was effected this will fit into either Pandemic theory or Seasonal Theory.

In an Pandemic you would expect to see the young disproportionately effected yet this was not the case. Instead 75% of all deaths were in people over 75 years old.

This fits into Seasonal theory not Pandemic theory.

Covid 19 - Epidemic ‘Waves’ - The Centre for Evidence-Based Medicine

Overview of the "epidemic waves" experienced in ten epidemics in history for which adequate documentation and data is available.

www.cebm.net

 

[C240Sport97]

I hope we don’t follow Germany and France into the insanity of another national lockdown

 

[markjay]

But in April the Peak was nowhere near what was expected was it?. The Nightingales hospitals never got used did they?
Is 50% of what it was in April an unusual figure for hospital admissions? Then for this time of year a rise is to be expected?

These are questions, not accusations or anything else.

The question that no one can answer is what would have happened if we didn't have the lockdown in March-April, and the restrictions that followed.

Some will say that the lockdown prevented very many deaths, other will say that the lockdown made no difference. But either way it will most likely remain debatable in perpetuity.

As for the Nightingales... given the frantic scenes than we saw in hospitals in Wuhan, Lombari, and New York, the Nightingales seemed like a reasonable precaution at the time.

As it transpired, some cities suffered far worse than others, and UK cities were among the luckier ones in that respect.

But I don't think we know yet for certain why some areas were far worse affected than others - probably a combination of factors such of age and density of the population etc.

 

[markjay]

I hope we don’t follow Germany and France into the insanity of another national lockdown

I agree, and I posted before that I think that at current the only 'justification' for a second national lockdown is the politics of the day, were local authorities resist being 'singled-out' for fear it might reflect badly on Council leaders. But the majority of the scientific community says that regional/local lockdowns is the way forward, not a national one.

 

[Dryce]

I agree, and I posted before that I think that at current the only 'justification' for a second national lockdown is the politics of the day, were local authorities resist being 'singled-out' for fear it might reflect badly on Council leaders. But the majority of the scientific community says that regional/local lockdowns is the way forward, not a national one.

Problem with regional lockdowns is that they may be meaningless.

The areas in which I live supposedly has a high rate - none of my peers and neighbours knows anybody who has caught it recently - so the implication is what is being measured is in other parts. The supposed lockdown doesn't seem to be having much effect on activity. And most people in work travel and commute to other areas.

So where are our local clusters ..... nobody is saying? It's difficult to react to risk when there is none visible in your vicinity and the authorities are being so coy about where they are detecting the infections.

Ms Sturgeon has put a 1800 curfew on restaurants and cafes and there is a ban on alcohol. They haven't explained the underlyng reason for the closures - only that they ythey didn't want to close cafes to people not in workplaces (eg. retired, 'working from home', furloughed, unemployed?) who might need to socialise. Hardly an explanation. And it raises questions about those in work basically aking the brunt of the 9 to 5 for the economy and then expected to have curtailed leisure while those who are not in work or furloughed or workng from home get a bit of space to play. Those troglodytes at the coal face of the economy expected to take on higher risks for less reward. Immoral IMO.

 

[markjay]

Problem with regional lockdowns is that they may be meaningless.

The areas in which I live supposedly has a high rate - none of my peers and neighbours knows anybody who has caught it recently - so the implication is what is being measured is in other parts. The supposed lockdown doesn't seem to be having much effect on activity. And most people in work travel and commute to other areas.

So where are our local clusters ..... nobody is saying? It's difficult to react to risk when there is none visible in your vicinity and the authorities are being so coy about where they are detecting the infections.

When the overall/national R value is low, the idea behind local lockdowns as opposed to a national lockdown is that you only need to target those specific locations where the R value is high and the infections is spreading- because in other locations where the R value is low the infection is actually in decline anyway. And, the next 'wave' will start from somewhere - and it will be one of the high R areas.

That said, if you don't identify correctly the locations with the high R value, or if of the local population becomes indifferent over time and no longer complies with the lockdown, then obviously the local lockdowns will not have the effect that they were meant to have.

 

[Dryce]

When the overall/national R value is low, the idea behind local lockdowns as opposed to a national lockdown is that you only need to target those specific locations where the R value is high

Problem is the R number is a blunt single number that I think is of limited meaning.

Telling people in an area that the R number is 1.4 and they see no disease tells them nothing. The R number could be high but the numbers infected so low that it will take time for the infection level across the population to be sigificant. Or the R number could be low but a significant number of the population infected.

An infection rate expressed as a number of people in the population is probably more meaningful. Saying how many people are realistically estimated to be infected may also be useful.

Problem is that even these numbers are not useful if you have a population with different groups behaving differentlyor geographovally separate.

So if you live in a small village which is insular with a high rate of infection oit may have no bearing on your region's number if that is low. The risks to people in the next town may be low - your risk in your village high. Or you have an area with three big urban areas and a rural population. One of the urbam areas is perhaps bad - the whole region gets locked down.

My observation is that among my peer groups away from schools we haven't (yet) had visible Covid. And yet all round we supposedly have a high level. This leads me to believe that we have specific pockets - geographic or socially distinct. Or that the numbers are possibly being driven by clusters centred on schools.

But that information is not forthcoming - we have the R number and daily rates of infection - without context these are not meaningful.

 

[markjay]

Problem is the R number is a blunt single number that I think is of limited meaning.

Telling people in an area that the R number is 1.4 and they see no disease tells them nothing. The R number could be high but the numbers infected so low that it will take time for the infection level across the population to be sigificant. Or the R number could be low but a significant number of the population infected.

An infection rate expressed as a number of people in the population is probably more meaningful. Saying how many people are realistically estimated to be infected may also be useful.

Problem is that even these numbers are not useful if you have a population with different groups behaving differentlyor geographovally separate.

So if you live in a small village which is insular with a high rate of infection oit may have no bearing on your region's number if that is low. The risks to people in the next town may be low - your risk in your village high. Or you have an area with three big urban areas and a rural population. One of the urbam areas is perhaps bad - the whole region gets locked down.

My observation is that among my peer groups away from schools we haven't (yet) had visible Covid. And yet all round we supposedly have a high level. This leads me to believe that we have specific pockets - geographic or socially distinct. Or that the numbers are possibly being driven by clusters centred on schools.

But that information is not forthcoming - we have the R number and daily rates of infection - without context these are not meaningful.

As far as I understand, the issue isn't with the number of people infected at any given point of time in a given location, instead it is about the trend.

In theory, you could have an area where only (say) 1% of the population are currently infected, so you are unlikely to know very many people who are positive, but if the R value is high this means that left to its own devices the virus will very quickly spiral out of control.

On the other hand, again, in theory, an area might have a relatively high percent of the population infected (say 10%), so you'll probably know a few people who are ill, but if the R value is low this means that the infection is in decline and this area therefore does not need any special attention.

But as per my previous post, the logic behind local lockdown may be sound, but the measure will still fail in the local areas are not correctly identified or if the population isn't compliant.

 

[ChipChop]

Today CFR is 4.85%
Tuesday 27th Oct CFR was 4.94%
Sunday 25th Oct CFR was 5.24%
Tuesday 20th Oct CFR was 5.9%
Friday 16th Oct CFR was 6.3%.
Monday 12th Oct CFR was 6.78%.
Thursday 8th Oct CFR was 7.8%.
Monday 5th Oct CFR was 8.2%.

Regarding Germany & France and the justification for national lockdowns here are the current CFR %'s for these countries.

France CFR 2.9%
Germany CFR 2.15%

Global Covid-19 Case Fatality Rates - The Centre for Evidence-Based Medicine

The total number of cases and the total number of deaths from COVID-19 outbreak data was drawn down (scraped) from Worldometers.

www.cebm.net

 

[Dryce]

As far as I understand, the issue isn't with the number of people infected at any given point of time in a given location, instead it is about the trend.

People love summary graphs and tables.

But they don't tell you about the reality.

So the R number tells you something - but I would argue it is not meaningful when it comes to actual strategy.

Similary the rate - it gives you a glimpse of something.

The aim however is to *control that trnd* and the numbers and lack of explanation don't allow us to do that.

So as an example. If the estimate is that 10000 people in a city of 200000 are currently infected then I might figure as somebofdy living in that city my chances of encountering the disease are high. I can adapt. However if you tell me that 1 in 200 people are infected in a region of 1000000 then I might assume that only 1000 people living in my city are infected. Oh dear - I adapt wrongly.

The areas I live in and work in (this week) are high covid. But it's simply not apparent. That leads me to believe that the actual bits of the area I live and work in at the moment are low but that figure for the whole areas must mean other parts are high. So the risk varies (sigificantly?). No word from anybody as to whether it is some social or activity or geographic based differentiation.

So what is actually going on. The much used R number is just not meaningful. It is used to tell us things are bad or worse in a meaningless way. A number of infections per day is a bit more useful but still tells us very little. We have policy making without proper explanation.

My guess is that schools and some pubs are a problem. But there is an institutional reluctance to be open about schools and a reluctance to point the finger at the specific locales and communities. At the same time the elephant in the room is the age distribution of deaths. Nobody really wants to face the obvious regarding that either - though all the older 70+ people I know are effectively shielding even if they are not calling it that.

 

[st13phil]

At the same time the elephant in the room is the age distribution of deaths.

According to the latest information on the NHS Covid Death Statistics page, if you look at the COVID 19 total announced deaths 29 October 2020 – weekly file Excel workbook, the total number of Covid-related deaths in England involving individuals who were under 60 and without a pre-existing condition since the start of the pandemic is 315. In the last week ("Oh, woe! We're embarking on a disastrous, death-strewn second-wave!"), for the same group it was zero. Yet we continue to be encouraged to act as though the infection is equally lethal to the entire population.

 

[Swotty]

Yesterday Mrs Swotty went to the docs to report heart palpitations. Doc could not find anything untoward so took some blood and said she will call at the end of the afternoon if the results show up anything. We received the results at 4.30 p.m. and they seemed O.K. - no call from the doc, so next stage is for the missus to wear a heart monitor for 24 hours.

This morning we received another blood test result ..... saying the missus has tested negative for covid ..... we didn't know that was one of the tests.

Also, at the surgery yesterday we asked if medical services were operating as normal under the lockdown, which started this morning. Her reply surprised us both. She says the lockdown is an over-reaction and will achieve nothing if the children are still at school. She also said it was unnecessary for the green (low risk) regions such as ours to be completely locked down.

She explained ..... she had had a few (half dozen) patients who had tested positive and she has successfully treated them with medications in order to keep them out of hospital. She had 100% success.

However, she was not sure if all the positive tests were correct, as she said there are too many false positives, which makes the test uncertain. Her aim is to keep patients away from hospital because, in her opinion, once you go in you stand every chance of catching it and it becoming more serious.

She also said that the big French cities were being overwhelmed by GPs immediately sending too many patients testing positive to hospital without triaging at GP level and treating them there initially. She said that was the government instruction for the "red" areas. She said that covid had become more infectious but less aggressive and less dangerous. She actually said it needs to be treated annually like a new 'flu.

Interesting to get that frank view from a medical professional. The missus, having put up with me wittering on about a scamdemic, was absolutely amazed to hear from a respected and informed source how cases of positive covid tests can be better managed. In the car on the way back ... and since ... she cannot understand why more GPs are not treating patients before sending them to hospital. However, she puts it down to rank bad management, rather than the "C" word.

We are in quite a rural area, our nearest large cities, Bordeaux and Toulouse are each 2 hours by car. They, too, were not on the "red" list.

 

[markjay]

According to the latest information on the NHS Covid Death Statistics page, if you look at the COVID 19 total announced deaths 29 October 2020 – weekly file Excel workbook, the total number of Covid-related deaths in England involving individuals who were under 60 and without a pre-existing condition since the start of the pandemic is 315. In the last week ("Oh, woe! We're embarking on a disastrous, death-strewn second-wave!"), for the same group it was zero. Yet we continue to be encouraged to act as though the infection is equally lethal to the entire population.

I think that the issue is that you are looking at the absolute number rather than at the trend.

In terms of absolute numbers, 315 deaths for a population the size of the UK is indeed a very low figure (albeit each one a tragedy, obviously).

BUT - if you look at the trend, then a rise from zero to 315 deaths of the same cause within one month should get alarm bells ringing.

Definitely this would have been the case if the cause of death was (say) Meningits, or use of ecstasy pills, or electric scooter accidents, or anything else.

 

[st13phil]

I think that the issue is that you are looking at the absolute number rather than at the trend.

On that very subject, I've just spent a happy half-hour with Excel and the NHS Statistics COVID 19 total announced deaths 29 October 2020 file, creating some graphs to compare deaths in the initial phase of the pandemic with those that are occurring now, in (what we are told is) the "second wave". I also split the data down to deaths that occurred in those under 60 and those 60 / 60+.

For ease of comparison, I picked the first dates upon which the 7-day moving average of deaths (all ages) first exceeded 10/day (which turned out to be 12th March and 14th September) as the origin for both the initial and current "waves". I haven't split out deaths occurring for those with or without pre-existing conditions. The 7-day moving average is calculated as 4 days back, current, 2 days forward.

Here's the chart for all ages. Note the minor difference ( ) in the rate of acceleration in deaths between the two "waves":

Here's the chart for those 60 and over. Note that the y-axis scale is slightly smaller:

And finally, the chart for those under 60. Note that the y-axis scale is an order of magnitude smaller than that used on the chart for those over 60:

 

[Swotty]

On that very subject, I've just spent a happy half-hour with Excel and the NHS Statistics COVID 19 total announced deaths 29 October 2020 file, creating some graphs to compare deaths in the initial phase of the pandemic with those that are occurring now, in (what we are told is) the "second wave". I also split the data down to deaths that occurred in those under 60 and those 60 / 60+.

For ease of comparison, I picked the first dates upon which the 7-day moving average of deaths (all ages) first exceeded 10/day (which turned out to be 12th March and 14th September) as the origin for both the initial and current "waves". I haven't split out deaths occurring for those with or without pre-existing conditions. The 7-day moving average is calculated as 4 days back, current, 2 days forward.

Here's the chart for all ages. Note the minor difference ( ) in the rate of acceleration in deaths between the two "waves":

Here's the chart for those 60 and over. Note that the y-axis scale is slightly smaller:

And finally, the chart for those under 60. Note that the y-axis scale is an order of magnitude smaller than that used on the chart for those over 60:

That's brilliant - would like to use that, please?

 

[st13phil]

That's brilliant - would like to use that, please?

Of course, feel free