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Coronavirus.

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Bantamzen

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Indeed, but the estimate of the proportion of cases that require hospitalisation is based on data from China, S Korea and the other countries that have carried out mass testing. And even in the unlikely event it is out by an order of magnitude, that would still mean that no more than 3% of the UK popoulation can have contracted COVID-19 to date. So at least 20 times more people would need to be infected to reach the 60% where herd immunity might be expected to slow the transmission rate, meaning 20 times more hospital admissions for the NHS to cope with.

Prof Neil Ferguson was on the R4 Today programme this morning and indicated that the government's exit strategy from lockdown is now mass testing combined with contact tracing and quarantine measures, as has successfully slowed the outbreaks in China, S Korea, Japan, Hong Kong, Taiwan and Singapore. This completes the slow motion policy U-turn from the herd immunity strategy that Prof Ferguson and the government's SAGE committee were advocating only a few weeks ago.

Prof Ferguson said his modelling now indicated that the full lockdown will have to remain in place until at least the end of May before some gradual easing might be considered. It seems to me that this is consistent with the timescale for manufacture and commissioning of additional ventilators, and training of new staff, to enable the new field hospitals to handle an increased flow of critically ill patients.

There is at least one fatal flaw in Prof Ferguson's modelling, and that is that our economy cannot withstand a lengthy lock-down. It might be the ideal situation in laboratory conditions, or in a data model, but the reality is that our economy is largely service sector based, and that locking it down for as long as that will have additional consequences. In a few short weeks, millions of people might be running out of money, with no clear indication as to when they might get paid again.
 
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Mogster

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The only practical way forward I can see is to increase NHS capacity and gradually ease the lockdown.

If the virus subsides in summer it could return in winter, it will probably be something we’ll have to learn to live with (like the other many virus’s that cause influenza like symptoms) even if that means accepting a bit higher death rate than we are used to.

A large scale antibody screening study would help us understand what we are facing.
 

Bantamzen

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This is probably the only realistic option for the UK. The British public, as @Bantamzen points out, simply are not disciplined enough to deal with Chinese style lockdown (i.e. no going out even if you're hungry and destitute). You could put the Army on the streets, but if you did the social consequences would be being felt for many, many years, which is why the Government are shying away from this. A liberal democracy using its army "against" the populace would cause a massive, massive crisis, far greater than the disease itself.

Indeed, rightly or wrongly we are not equipped either socially or economically for anything like what has been seen in China. Sticking the army on the streets won't help, for a start we have nothing like the military resources that China have, and frankly the public would not have the stomach for any kind public vs army clash. Ultimately testing for the virus & antibodies has to be the way forward so that we can get to the people that need the most protection, whilst allowing society to move back towards a semblance of normality. If we persist with a lock-down for too long, we risk damaging the services that we need to get through this.

The only practical way forward I can see is to increase NHS capacity and gradually ease the lockdown.

If the virus subsides in summer it could return in winter, it will probably be something we’ll have to learn to live with (like the other many virus’s that cause influenza like symptoms) even if that means accepting a bit higher death rate than we are used to.

I'm afraid this is our reality, the virus is with us now and is not going away.
 

Meerkat

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So at least 20 times more people would need to be infected to reach the 60% where herd immunity might be expected to slow the transmission rate
Surely every immune person slows the rate - the same breaking the chain that isolation is supposed to create.
The government has ‘ordered’ 17m antibody tests (but they are waiting for someone to make one that works before they physically buy them). They are clearly going for population wide testing plus quarantine and isolation. Block travel, test an area, isolate/quarantine the positives for a couple of weeks and then that area can move to contact tracing of imported cases and those that leaked through the first time. Obviously it’s a a massive operation......
 

Peter Sarf

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There are too many unknowns.

I cling to the hope that a good proportion of the population are getting COVID-19 but do not suffer much at all and are therefore part of the herd immunity.
BUT we do not know if that is the case yet or ever.
Home testing antibody kits might be pointless IF we can learn from other countries' experience/results instead.
The UK has the luxury of not being the first to experience this - lets hope we learn from other countries.

As for mental health. My partner has been getting quite stressed about her return to work. She had been on holiday for the last half of March to use up her leftover annual leave. She was due to go back on 1/4/20 but went sick. She was due to be on holiday again 6-21/4/20 to babysit the grand-daughter. That is in Cardiff (150+miles away) so no longer feasible and the parents are working from home anyway. The leave has been cancelled anyway because her employer has cancelled it. She is a cook in a private hospital and it seems to be busier than it ever was - I think they are taking on NHS work at capacity. She has diabetes and high blood pressure but not very serious levels of either. She has been having headaches (bordering on migraine) recently but a relaxant drug seems to have cut that down. My point is that she is suffering from NOT isolating !.

My own stress has been dealing with her and the knowledge that healthier people than her are dying. I do not tell her that I know that and she does not understand enough English to be burdened. She is from Laos so most people just view her as a tanned slit eyed Chinese person - result is that by February she was noticing people moving away from her on the bus. She has not been further than Paris for fifteen years so I pointed out to her that she is lucky as she won't be catching it from them !. She traveled to work by public transport so that was my greatest COVID-19 risk personally. Now that my factory has finally closed (only till 14/4/20) I am driving her to and from work. I have TOLD my boss that when we go back to work I will continue giving her lifts and also my closest colleague as that will be two risks out of the way.

As for suicide. That is a very real issue. Because it has always been swept under the carpet it is not appreciated how many suffer enough to believe MISTAKENLY that they are doing us a favour by taking their own life. I myself was confronted with (unsuccessfully) resuscitating a 24 year old male back in 2014. It still affects me but I do not suffer too much as I insist on boring people with it !. The thin end of the wedge is minor mental health issues that then get deeper over time. So self isolation does not help. The young man in question had already become quite isolated. I was working at breaking that down but, with hindsight, I was not successful/quick enough.

So don't underestimate mental illness but also don't underestimate the direct and indirect effects of COVID-19.

To get the balance right between spread and over-isolation is going to be difficult as we don't yet understand the spread.

What I actually believe (hope !) is that, as the rise in hospital admissions plateaus, then restrictions will be relaxed a little then progressively. I just hope the plateau does happen and is at a level low enough for the NHS to cope !. Then the number of admissions will be monitored. Note I am not talking about number of deaths - just how well the NHS is protected to keep it functioning.

The prime consideration is going to be civil unrest, as many have said. We all know what happened as a result of a single drug dealer, who was allegedly armed, getting shot dead by police in Tottenham. The scars of missing buildings still exist in Croydon - the other side of London. The kind of people who did that are far more likely to riot when their belly is empty rather than over some mistaken belief that allows them to loot shops for luxuries. I personally saw it as I ended up physically in the middle of it. A jewelers shop was attacked and I saw people leaving Icelend with bottles of spirits predominantly not food. I will be very disappointed if the authorities are caught napping this time.

Question - on furlough leave. How do I get it ?. We are now closed 4/4-13/4 inclusive - tat all. We have been told to use our annual leave. My belief is that losing 20% of my pay now is better than losing 100% later in the form of unpaid leave. I am sick of the place so happy to be at home rather than us cleaning door handles, switches, kitchens and toilets for 8 man(person) hours daily. I get to interact with as many people as possible on my site !.

I had quoted a load of posts but it is too complicated.

The following appeared while i wrote war and peace up thread !.

Indeed, but the estimate of the proportion of cases that require hospitalisation is based on data from China, S Korea and the other countries that have carried out mass testing. And even in the unlikely event it is out by an order of magnitude, that would still mean that no more than 3% of the UK popoulation can have contracted COVID-19 to date. So at least 20 times more people would need to be infected to reach the 60% where herd immunity might be expected to slow the transmission rate, meaning 20 times more hospital admissions for the NHS to cope with.

Prof Neil Ferguson was on the R4 Today programme this morning and indicated that the government's exit strategy from lockdown is now mass testing combined with contact tracing and quarantine measures, as has successfully slowed the outbreaks in China, S Korea, Japan, Hong Kong, Taiwan and Singapore. This completes the slow motion policy U-turn from the herd immunity strategy that Prof Ferguson and the government's SAGE committee were advocating only a few weeks ago.

Prof Ferguson said his modelling now indicated that the full lockdown will have to remain in place until at least the end of May before some gradual easing might be considered. It seems to me that this is consistent with the timescale for manufacture and commissioning of additional ventilators, and training of new staff, to enable the new field hospitals to handle an increased flow of critically ill patients.

Information from China might well be miss-information as they are less open. The proof is the media leads us to believe that local Chinese authorities were suppressing the facts at the beginning of the outbreak. We have to see what information comes from other countries - South Korea seems to have dealt with it well but its maybe too late for that now. The devil in me hopes that China has bigged this up to ensure the rest of the world suffers economically as much as they must have. So we might be less harshly hit than expected Just a rash few ideas there.

There is at least one fatal flaw in Prof Ferguson's modelling, and that is that our economy cannot withstand a lengthy lock-down. It might be the ideal situation in laboratory conditions, or in a data model, but the reality is that our economy is largely service sector based, and that locking it down for as long as that will have additional consequences. In a few short weeks, millions of people might be running out of money, with no clear indication as to when they might get paid again.

It does highlight how many of us work in non-essential roles. Most of our income comes from luxuries. My grandparents never ate out - "waste of money". I can recall a time when it was not normal to eat out takeaway or otherwise. Nowadays many people get meals delivered. This means they cannot cook - I know families where the cooker is unused - only a microwave needed for reheating.

A point out of the above is that cooked food deliveries must not stop !. it is possibly better isolation than visits to the food shops.
 
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Bletchleyite

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Surely every immune person slows the rate - the same breaking the chain that isolation is supposed to create.
The government has ‘ordered’ 17m antibody tests (but they are waiting for someone to make one that works before they physically buy them). They are clearly going for population wide testing plus quarantine and isolation. Block travel, test an area, isolate/quarantine the positives for a couple of weeks and then that area can move to contact tracing of imported cases and those that leaked through the first time. Obviously it’s a a massive operation......

Yes, the orders are options, i.e. the Government has guaranteed to be able to purchase from that company subject to them proving that it works, and the factory capacity etc is reserved. Not dissimilar to a TOC having an option for further new trains having already obtained some. I do note that quite a lot of people aren't quite getting that and it is perhaps not being made clear enough.

IgG/IgM tests aren't that complex a thing (for instance you can purchase a coeliac test that works that way for a tenner), but it does need to be got right.
 

Meerkat

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It does relax me a bit that the politicians seem willing to wait for a properly tested test rather than bow to public pressure and rush whatever they can get out.
 

Peter Sarf

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It does relax me a bit that the politicians seem willing to wait for a properly tested test rather than bow to public pressure and rush whatever they can get out.

That is right. And - I would rater take note of number of (reliable) tests achieved rather than promises from politicians. Fingers crossed that experience in other countries will show that a lot of immunity has quietly built up. Natures way of levelling the playing field rather than us waiting for vaccines etc. Mind you nature probably owes the human race very little !.
 

Mogster

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It does relax me a bit that the politicians seem willing to wait for a properly tested test rather than bow to public pressure and rush whatever they can get out.

Yes, particularly as under the recent FDA regulation changes the only criteria for implementing new molecular CoV2 tests is “a reasonable assumption they work”... This an incredible (bizarre?) turn round as previously getting anything approved by the FDA took years and was a significant achievement.

The USA is now the Wild West of CoV2 diagnostics it seems...

https://www.fiercebiotech.com/medte...ial-coronavirus-testing-without-agency-review

 

Greybeard33

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The internationally reported testing numbers are causing some puzzlement within the UK scientific community and with the international suppliers it seems. Germany are reporting 70,000 Covid tests per day for instance but what sort of tests and using which platforms. No one seems to know.
The media have reported that Germany uses Roche PCR machines, similar to those of PHE. But they have many more of them and got their order for consumables in early. Is this incorrect?
I don’t see how case tracking is feasible with the current number of infections. Its not my area but it seems like a mammoth task.
Yes, Prof Ferguson said it would be necessary to bring the infection rate down through the lockdown before case tracking became feasible - not just get to a plateau. And the less strictly people observe social distancing, the longer that will take.

Of course, infection rates vary considerably across the country, but it is not really practical to ease the lockdown more in some places than others, without introducing Chinese-style internal travel bans.
The government has ‘ordered’ 17m antibody tests (but they are waiting for someone to make one that works before they physically buy them). They are clearly going for population wide testing plus quarantine and isolation. Block travel, test an area, isolate/quarantine the positives for a couple of weeks and then that area can move to contact tracing of imported cases and those that leaked through the first time. Obviously it’s a a massive operation......
Reportedly antibody blood tests are no use for quarantine and contact tracing, because it takes a couple of weeks after recovery before they show a positive result. Antigen (PCR) swab tests are what is needed, to show who has the virus now.

Antibody tests could be useful to track the progress of the epidemic, plus an individual shown to have immunity would not need to observe social distancing or self-isolation/quarantine measures.
 

Bletchleyite

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Antibody tests could be useful to track the progress of the epidemic, plus an individual shown to have immunity would not need to observe social distancing or self-isolation/quarantine measures.

Antibody tests are most useful for two purposes. One of them is understanding the extent of spread, i.e. how much of the population may already be immune, and thus how difficult is it likely to be to reach "herd immunity", though I expect it'll just prove the answer to that to be "much too difficult". The other is being able to understand which key workers (e.g. NHS) are at low risk so staff can be used appropriately.

Once that's been done, I see no reason why people should not purchase them at a commercial rate just to allay curiosity, possibly even stick twenty quid's tax on them as a fundraiser for the NHS or something. I would love to know if I've had it and will happily pay to find out, even though this will not affect how I act because my actions are more about protecting others than me.
 

Peter Sarf

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Antibody tests are most useful for two purposes. One of them is understanding the extent of spread, i.e. how much of the population may already be immune, and thus how difficult is it likely to be to reach "herd immunity", though I expect it'll just prove the answer to that to be "much too difficult". The other is being able to understand which key workers (e.g. NHS) are at low risk so staff can be used appropriately.

Once that's been done, I see no reason why people should not purchase them at a commercial rate just to allay curiosity, possibly even stick twenty quid's tax on them as a fundraiser for the NHS or something. I would love to know if I've had it and will happily pay to find out, even though this will not affect how I act because my actions are more about protecting others than me.

The one risk is people who then (safely) act with less isolation which will only add temptation to those who do not know if they are immune. There will be a lot of people who do not (or do not want to) understand the complexities we are talking about. I like the idea of a TAX. Another advantage of testing for antibodies would be to allow immune people to do voluntary tasks like supplying vulnerable people.
 

Bantamzen

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OK I'm done. Will someone please stop the planet because I want to get off...

https://www.bbc.co.uk/news/uk-england-52164358

Mobile phone masts have been torched and engineers abused over "baseless" theories linking coronavirus to 5G. UK mobile network providers have warned against the spread of the theories after videos showing masts on fire were posted on social media. Masts were set alight in Sparkhill, Birmingham, on Thursday and Melling, Merseyside, on Friday. Trade body Mobile UK, which represents network providers, said the false rumours and theories were "concerning". In a statement on Twitter, the Department for Digital, Culture, Media and Sport said it was "aware of inaccurate information being shared online about 5G". "There is absolutely no credible evidence of a link between 5G and coronavirus," it added.

In Melling, Merseyside Fire and Rescue Service said it extinguished a 5G mast tower fire near the M57 motorway late on Friday. There was damage to the mast and control panels, a spokesman said. West Midlands Fire Service said the fire in Birmingham on Thursday involved a 70ft tower on a telecommunications site. However, the service said the cause was yet to be identified and could not confirm the mast was 5G. A West Midlands Police spokesman said: "We're aware of a fire involving a phone mast, but are awaiting further details on its cause."

On Friday, Facebook removed a page which showed several videos claiming to show 5G towers on fire and encouraged others to do the same. In addition to warning on the theories about the safety of 5G technologies, Mobile UK added: "More worryingly some people are also abusing our key workers and making threats to damage infrastructure under the pretence of claims about 5G. "This is not acceptable and only impacts on our ability as an industry to maintain the resilience and operational capacity of the networks to support mass home working and critical connectivity to the emergency services, vulnerable consumers and hospitals."
 

Mogster

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The media have reported that Germany uses Roche PCR machines, similar to those of PHE. But they have many more of them and got their order for consumables in early. Is this incorrect.

Yes they do have Roche machines but as I understand it not that many and they aren’t being supplied with 70,000 tests every day... I can’t really say much more than that.

70,000 tests per day is a massive amount. Also it’s not just the testing it’s collecting the samples, managing the patient data and results.
 

Greybeard33

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Yes they do have Roche machines but as I understand it not that many and they aren’t being supplied with 70,000 tests every day... I can’t really say much more than that.

70,000 tests per day is a massive amount. Also it’s not just the testing it’s collecting the samples, managing the patient data and results.
The following explanation of the German test capability is by Hannah Devlin, Guardian Science Correspondent. However, I am personally sceptical of the ability of reporters to get a full understanding of complex technical and logistic issues like this.
The UK’s health secretary said his German counterpart could call on 100 test labs and rely on the heavy presence of Roche, one of the world’s largest diagnostics companies, to achieve its current level of more than 50,000 tests a day. The UK had had to build from a lower base, he said.
As well as Roche, which has developed a single machine that can churn out 1,000 test results a day, Germany also has Qiagen, a major supplier of genetic testing kits, which are being used to diagnose Covid-19. Both companies also produce reagents and components used in kits put together by other manufacturers. The US has called on Abbott, Thermofisher, Quest Diagnostics and Hologic.

The more distributed hospital lab system in countries such as Germany and Italy has also served them well in being able to increase testing for Covid-19. The NHS has spent years centralising its testing labs, which under normal circumstances was both economical and clinically robust. It has allowed labs to be aligned to standard diagnostic criteria and to use the same test kits, reagents and equipment from the same suppliers, allowing bulk purchases from single suppliers at a competitive price.

During a pandemic, however, this dependency on a handful of non-domestic suppliers, such as Roche, for kits and reagents becomes a fundamental flaw.
https://www.theguardian.com/science...-lagged-behind-in-testing-for-the-coronavirus
 

Mogster

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If you can feed them the larger Roche machines can do 4000 tests in 24 hours. I’m not familiar with every small scale PCR machine but outside Roche and Grifols equipment you are left with 100 test per day bench top type things. Roche have cornered the market in high throughput.

I just can’t imagine smaller private laboratories using low throughput labour intensive machines being able to provide much additional capacity. At least in the UK typically they don’t have the staff and equipment to test much beyond a handful of samples per day. Then there are the problems of IT system integration if you want to do anything other than paper reporting of results. Accreditation and quality issues would concern the MHRA. I understand Germany with its semi private healthcare system uses private laboratories routinely unlike the NHS but this great level of surge capacity seems unlikely.

Apparently the USA has ordered 800 Abbott benchtop 100 test per day PCR systems but it makes you wonder who will install and support all this new equipment and train staff to use it. These aren’t toasters, you can’t just post them out to healthcare centres have the staff unbox them and be providing results an hour later...
 
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yorksrob

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Well, it looks like Germany's manufacturing capability has put it in a better position than us. Again.
 

Philip

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Why are people only focusing on testing and social distancing/lockdowns? The easiest solution to this seems to be the development of antiviral drugs to successfully treat or lessen the severity of the symptoms, available for all. And unlike an actual vaccine being developed, it is thought antivirals may be available for widespread use before the end of the year, rather than in a year or more. We know there are many drugs already in trial, with some producing very good results.

The biggest problem with this right now is that it is new and there are currently no treatments to either cure or lessen the symptoms, once this changes the picture changes hugely.
 

Bletchleyite

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Why are people only focusing on testing and social distancing/lockdowns? The easiest solution to this seems to be the development of antiviral drugs to successfully treat or lessen the severity of the symptoms, available for all. And unlike an actual vaccine being developed, it is thought antivirals may be available for widespread use before the end of the year, rather than in a year or
more.

Trials are currently underway.
 

Bletchleyite

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Exactly. Yes social distancing will be needed for more than just a few weeks and yes testing will help a lot. But the game-changer will surely be when the illness can be treated.

It will certainly make a difference, not only in reducing deaths but increasing the throughput of the NHS.
 

DarloRich

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Christ on a bike things must be bad. Michael Gove just thanks his friends in the trades union!

Things must be very bad indeed
 

Mogster

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Well, it looks like Germany's manufacturing capability has put it in a better position than us. Again.

Or as with their death statistics they are compiling the numbers differently to us. The numbers seem to have become a totem of national pride now, it’s hard to know what to believe.

The FT was quoting 500,000 tests per week for Germany a few days ago, which seems a crazy number. The USA are saying they’ve done 1.3M tests so far while only a week or so ago they’d hardly done any...
 

DarloRich

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Social distancing will only work until it becomes a problem. And it will soon.

Sigh. It will take as long as it takes and you and others need to grasp that and preapre for that. We have to do this or people will die who dont need to.

This weekend will be a test and may, if behaviour is not good, lead to more severe restrictions.

EDIT: Look at the numbers and the charts. They arent dropping yet. The rules will have to carry on until they do. They will drop if people stay at home.
 
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