Coronavirus: How scared should we be?

[Journeyman]

The government doesn’t ban smoking because cigarettes are a healthy source of tax revenue!

After witnessing my mum's gruesome smoking related death, which I wouldn't wish on my worst enemy, I felt furious about smoking still being legal, but banning it completely would probably have very serious unintended consequences. Primarily it would put the supply of tobacco into the hands of criminals who wouldn't give a toss about the damage it would cause. At least at the moment it's fairly tightly controlled, and the government gets tax revenue out of it.

 

[43066]

After witnessing my mum's gruesome smoking related death, which I wouldn't wish on my worst enemy, I felt furious about smoking still being legal, but banning it completely would probably have very serious unintended consequences. Primarily it would put the supply of tobacco into the hands of criminals who wouldn't give a toss about the damage it would cause. At least at the moment it's fairly tightly controlled, and the government gets tax revenue out of it.

Sorry to hear that. It’s an awful, awful habit, which causes nothing but misery, and I say that as a former smoker! The psychological aspect of the addiction is far, far more powerful than the physical element.

 

[Journeyman]

Sorry to hear that. It’s an awful, awful habit, which causes nothing but misery, and I say that as a former smoker! The psychological aspect of the addiction is far, far more powerful than the physical element.

That's what did it for her, she was absolutely hopelessly addicted, and kept puffing away in complete denial of the damage it was doing as COPD slowly suffocated her over a 10-year period. Anyway, we digress...

 

[Peter Mugridge]

Don't know why the US got away with that particular one better than the UK. The UK estimate is 80,000 (equal to 100,000 today after population growth).

The USA population in 1968 was just short of 206 million. It's 331 million now, so the estimate of 100,000 Hong Kong Flu deaths in the USA in 1968 would be the equivalent of about 161,000 now if the percentages affected were the same.

 

[yorkie]

"When the second wave comes". This is a message you hear time and time again from Politicians, Healthcare Professionals and Armchair commentators.

Interestingly it tends to be used by people who suggest we should not be partaking in activities in the Summer, even though any such event would occur in the Winter.

 

[Bantamzen]

Yet, linking back to the title of this thread, I think it has had the opposite effect on many people who are now scared to use public transport as they see that you have to wear a mask which must surely mean it is a dangerous environment where you are very likely to catch the virus - masks have long been seen as 'protective gear' and they 'know' you only need to wear protective gear if what you are about to do or encounter is (potentially) dangerous.

The government have made a real hash of the messaging around public transport, and the cynic in me wonders if there might be method in their madness. After all, they are facing at least a 9 figure sum for all of this, and having taken ownership of some of the franchises & now paying for the day to day operation of the rest, I can't help but wonder if this wasn't a convenient way to supress long term demand and allow them to justify cutbacks.

In the latter case normally accompanied with “straight back to full lockdown”. I provoked a bit of a storm on my local Facebook page with the mere suggestion that a second lockdown is unviable.

Likewise when I took to pointing out that comparing the Spanish Flu pandemic to this one was highly flawed, yet this is where the concept of the worse second wave actually derives from as I understand it. What the people promoting the concept fail to reconcile is that the Spanish Flu pandemic came on the back of one of the worst wars the world had ever seen, health services were completely overwhelmed, and a good proportion of the younger generation were killed in conflict. Completely different parameters to today.

Of course none of this means there won't be spikes or more waves, but will they be the much touted Spanish Flu like ones? Given the advancements we have made in the treatment of illnesses in the last 100 years, very possibly not. We just need to make sure that we haven't tanked our economy & can't afford to step the NHS when needed.

 

[Bletchleyite]

"When the second wave comes". This is a message you hear time and time again from Politicians, Healthcare Professionals and Armchair commentators.

If you look at local stats, there have been second waves (well, second peaks) in a number of towns, in some cases larger than the original one.

 

[Bantamzen]

If you look at local stats, there have been second waves (well, second peaks) in a number of towns, in some cases larger than the original one.

They are spikes, not waves. And in many cases these spikes can be easily traced to source and handled. Completely unlike the Spanish flu second eave which was a global wave worst than the first one, and where I believe he phrase second wave refers to.

 

[adc82140]

Most of the countries reporting a "second wave" like Australia never had a first one, just a handful of cases. Therefore no immunity is present at all, so when restrictions were lifted it was bound to happen. All their lockdown was doing was delaying the inevitable.

 

[Howardh]

After the dempnstrations, celebrations (Liverpool) and the illegal raves - all outdoors - was there a spike in those areas?

 

[scotrail158713]

After the dempnstrations, celebrations (Liverpool) and the illegal raves - all outdoors - was there a spike in those areas?

I don’t think so - but that might have been because the media seem intent on a second lockdown and this would be pretty large evidence suggesting it’s unnecessary.

 

[AdamWW]

The government doesn’t ban smoking because cigarettes are a healthy source of tax revenue!

That's clearly a good reason.

On the other hand if that was the main motivation why are they so reluctant to bring in a sugar tax? Improves health and brings in tax money...

 

[yorksrob]

That's clearly a good reason.

On the other hand if that was the main motivation why are they so reluctant to bring in a sugar tax? Improves health and brings in tax money...

I suppose it's a case of "what's the point of making ordinary food with some sugar in it, taste like cardboard, if people will just end up buying more overtly sugary foods anyway"

Compare baked beans, which in the scheme of things, have always been a comparatively healthy part of the diet, with their low sugar equivalent and one can well see why people might end up reaching for a greasy takeaway instead of their low sugar beans on toast.

 

[MikeWM]

The USA population in 1968 was just short of 206 million. It's 331 million now, so the estimate of 100,000 Hong Kong Flu deaths in the USA in 1968 would be the equivalent of about 161,000 now if the percentages affected were the same.

Good point - I tend to forget how much the population of the USA has ballooned

 

[Bletchleyite]

On the other hand if that was the main motivation why are they so reluctant to bring in a sugar tax? Improves health and brings in tax money...

Er, they did, didn't they?

 

[MikeWM]

Anyway my conclusion is that it is the virus itself, and it has a very dangerous combination of a relatively high fatality rate and high ability for asymptomatic individuals to spread it. The evidence that it's just "a bad flu" generally seems to come from comparing fatality rates with lockdown for Covid-19 against those without lockdown for other viruses, i.e. a false comparison. I think there is something particularly unusual about it.

I'd agree that comparing raw death numbers isn't especially helpful for a number of reasons, and less helpful still until the thing is over. But the IFR *is* a good indicator, and the evidence is increasingly pointing towards that being less than 0.2% - which does put it in 'bad flu year' territory, as does the demographic breakdown of those who have died.

Yes you're quite right about Sweden. But it's not a direct comparison for many reasons. (They probably have better hospital provision for a start).

According to Wikipedia, they have less beds and less ICU beds per capita than the UK. The difference is small though. The health service may be better too.

(That's not in itself a knock on the NHS. The NHS saved my life once, and my sight on another occasion, and I'm only in my early 40s. It's a great thing. Doesn't mean there aren't some areas that could do with improvement though).

I'll do my broken record bit now. We now have a far less harsh set of restrictions than when the lockdown started, and we still seem to be just about keeping R at 1. That says to me that unless herd immunity is now playing a big role, if we'd started early enough, we could have done this all along. It doesn't mean though that if we hadn't taken much more drastic action to pull R right down when we did have a lockdown, we wouldn't have had a lot more deaths.

Interestingly I've seen graphs where people have tried to calculate R based on the available data, and found that R possibly fell below 1 a few days *before* the lockdown. For political reasons, we didn't give the milder pre-lockdown measures time to see if they worked.

But this is all with hindsight - you can only make decisions based on what you know.

A lockdown on the healthy is very much a nuclear option, given the damage to the economic and society as a whole. You should only do it if you are pretty darn certain it will work.

And as for the Nightingales...maybe...the hospitals were (and are) there but it was never clear to me how they would get proper staffing for them. I hope we don't find out. It worked in China by pulling large numbers of staff from other parts of the country, so far as I know. So perhaps we could now fire up one Nightingale to deal with a local outbreak. But all of them at once?

We did step up a large number of retired NHS staff; I'm not sure any were actually used. But yes, I don't know if that would have been sufficient.

 

[AdamWW]

I'd agree that comparing raw death numbers isn't especially helpful for a number of reasons, and less helpful still until the thing is over. But the IFR *is* a good indicator, and the evidence is increasingly pointing towards that being less than 0.2% - which does put it in 'bad flu year' territory, as does the demographic breakdown of those who have died.

And once again we're in disagreement.

I'd say that IFR is only part of the story with the other part being how contagious it is.

I believe SARS had a pretty high fatality rate, but it didn't spread that easily.

Something with the same infection fatality rate as flu is a much bigger problem if it is spread much more easily - and that doesn't just refer to how contagious an infected individual is - it depends on how likely people are to be contagious but well enough to be out and about.

We will see in the end, once it's run its course one way or the other and we get to see to what extend excess deaths now are balanced by a reduction in the future as people didn't survive to be killed by the next bad flu season etc.

And indeed whether it's just impossible to put a lid on it and in the end everyone is going to have to take their chances.

Interestingly I've seen graphs where people have tried to calculate R based on the available data, and found that R possibly fell below 1 a few days *before* the lockdown. For political reasons, we didn't give the milder pre-lockdown measures time to see if they worked.

A lockdown on the healthy is very much a nuclear option, given the damage to the economic and society as a whole. You should only do it if you are pretty darn certain it will work.

I think this is a case of damned if you do, damned if you don't. Yes a lockdown is a huge measure and not to be undertaken lightly. But if it is needed, every day's delay costs lives and lengthens the time you will need it for. I think the flirtation with herd immunity has cost lives and (perhaps more importantly in the long term) significantly increased the time we needed it for.

I don't think the modelling that R was dropping before the full lockdown is very robust though I haven't looked at it in detail. But if we'd decided to stick to the milder restrictions and see what happened, there is a good chance that what happened would have been far more deaths than we have seen.

It also occurs to me that if it is true that the infection was seeded by a relatively large number of people coming in from Italy and other countries, any attempt to calculate R over that period will fail because it has to assume that each infection you see comes from transmission within the area you're calculating R for.

So we may have seen an artificially high value of R over the period before travel was restricted. (I don't think errors in R due to this will have had much impact on policy because I don't think the calculations supporting lockdown were taken primarily from UK data).

I think the one of the best things that the government could have done is to have declared essential travel only to countries where we knew Covid was taking a hold much earlier - and even offered to cover all losses from people without insurance that would cover it.

That takes some hindsight perhaps.

I imagine that next time round governments will be much quicker to take action, and it would be considered far more acceptable to do so.

 

[talldave]

If we had locked down earlier and there were less deaths (I'm sceptical on that..), we'd have still found something to criticise and make accusations about deaths that could have been prevented. And we wouldn't have had the results of a later lockdown to compare against.

So many people suddenly become experts with the aid of hindsight.

We are where we are, let's learn from what we now know about treating it and move on.

 

[Yew]

But if we'd decided to stick to the milder restrictions and see what happened, there is a good chance that what happened would have been far more deaths than we have seen.

Whilst by no means certain, I think we're seeing an increasing body of evidence suggesting that above a certain threshold, the impact of extra restrictions only has marginal benefit.

Though I do agree that bringing in milder things earlier would help, moving to home working earlier, and protections around care homes are examples of things that I feel would do a lot, without being overly invasive in case the potential future epidemic never kicks off over here.

 

[AdamWW]

If we had locked down earlier and there were less deaths (I'm sceptical on that..), we'd have still found something to criticise and make accusations about deaths that could have been prevented. And we wouldn't have had the results of a later lockdown to compare against.

Perhaps.

We might not be asking why the UK seems to be near the top of the table for deaths per capita, though.

Whilst by no means certain, I think we're seeing an increasing body of evidence suggesting that above a certain threshold, the impact of extra restrictions only has marginal benefit.

I'd be interested to see any articles you can point to supporting that.

It certainly seems that at each stage of relaxation, infection rates don't seem to be going up significantly so far as we can tell.

 

[MikeWM]

And once again we're in disagreement.

I'd say that IFR is only part of the story with the other part being how contagious it is.

Yes, that also matters, but by the time we got to making key decisions we'd already decided most people would probably get it without any intervention (Ferguson said 80%). In retrospect, you have to wonder about that too (what % of the population gets seasonal flu every year, even taking into account that the flu vaccine protects about half)?

I think this is a case of damned if you do, damned if you don't. Yes a lockdown is a huge measure and not to be undertaken lightly. But if it is needed, every day's delay costs lives and lengthens the time you will need it for.

Depends on the definition of 'needed' I guess. I didn't think it ever could be justified for this particular disease, given what we already knew about it in March. As I've said elsewhere, for eg. airborne ebola, probably a good idea!

I think the one of the best things that the government could have done is to have declared essential travel only to countries where we knew Covid was taking a hold much earlier - and even offered to cover all losses from people without insurance that would cover it.

I would agree that this would seem to be a sensible move. Or quarantine people properly on return (as we were doing for a while in some cases - the people on the Wirral in February for example).

I imagine that next time round governments will be much quicker to take action, and it would be considered far more acceptable to do so.

Which is why those of us who don't believe a lockdown was correct need to keep arguing that, or we'll end up in the same situation multiple times in the coming years. Our society and our economy won't be able to bear that. Keep the nuclear weapon for a circumstance where things are so bad that there is literally nothing else left to try.

 

[AdamWW]

Yes, that also matters, but by the time we got to making key decisions we'd already decided most people would probably get it without any intervention (Ferguson said 80%). In retrospect, you have to wonder about that too (what % of the population gets seasonal flu every year, even taking into account that the flu vaccine protects about half)?

Well the logic for the 80% value is extremely simple.
You assume that infections grow until enough people have had it that on average one person infects less than one more.
"All" you have to know is how many people one person infects if nobody has immunity. It was based on the best estimate of that number at the time. (The (in)famous R number).

Of course there's plenty of assumptions - that once you have it immunity lasts long enough, that nobody has any pre-existing immunity....

Why don't we all get flu each winter? Good question. We vaccinate, people have more existing immunity? It tends to go away when the weather improves?

 

[MikeWM]

Well the logic for the 80% value is extremely simple.
You assume that infections grow until enough people have had it that on average one person infects less than one more.
"All" you have to know is how many people one person infects if nobody has immunity. It was based on the best estimate of that number at the time. (The (in)famous R number).

It is also based on having no innate immunity in the population. It seemed odd from the start to me that there was an assumption that people who had had other common-cold coronaviruses would have no immunity - but at the time that idea seemed to be easily dismissed, so I assumed the experts knew more than me and dropped the idea. Of course this idea eventually came back, and it looks like at least half of us actually do have some degree of immunity.

 

[AdamWW]

It is also based on having no innate immunity in the population. It seemed odd from the start to me that there was an assumption that people who had had other common-cold coronaviruses would have no immunity - but at the time that idea seemed to be easily dismissed, so I assumed the experts knew more than me and dropped the idea. Of course this idea eventually came back, and it looks like at least half of us actually do have some degree of immunity.

Absolutely - I did say that.

It seems plausible to me also that different countries might well have differing fractions of people with some immunity, which might be part of the reason that some countries have been hit harder than others.
The last time I looked though this didn't seem to be a generally accepted view.

And of course if experts thought it was unlikely that people had some immunity and now it seems they do, it doesn't necessarily mean they were wrong. It could be unlikely but nevertheless turned out to be true.

I have to think about this a bit more carefully but maybe it cancels out. You calculate the % who need to be infected to get herd immunity from the value of R, and that itself is a function of existing immunity levels.