Deterioration in R number

[philosopher]

Agreed. So If there is no vaccine what will this lot do then? Hide in their homes until the breakdown of society and the looters arrive? We have to live with this. Relax the lockdown - gradually.

I think a lot of people who hold this view seem to neglect the fact that you need a functioning economy to fund public services including the NHS. There is no such thing as a magic money tree. Therefore you are going to have to reopen at some point if you want a functioning economy and society, even if that involves a risk that R value goes above 1 and the virus starts spreading more widely again.

Italy, Spain and France have all largely reopened and have not seen a second wave. I know some will say that those countries had fewer cases and deaths when they started easing their lockdowns and reopening. However the flip side of this is that the easing of the lockdown here as so far has been far less than those three countries.

 

[underbank]

Italy, Spain and France have all largely reopened and have not seen a second wave. I know some will say that those countries had fewer cases and deaths when they started easing their lockdowns and reopening. However the flip side of this is that the easing of the lockdown here as so far has been far less than those three countries.

But they're nowhere near back to how they were prior to covid. People ARE still aware of social distancing, mask wearing, etc., plenty of places are still closed, and crowds in usually busy places like central Rome just aren't there. Not to mention, the vulnerable will still be very cautious about what they do and where they go. The "second wave" won't be 2-3 weeks after lockdown is released, because you're starting with a very low base of infection. It will start to grow gradually and then accelerate - that's what exponential growth is all about. The second wave is more likely to be 2-3 months after lockdown ends, or even longer if people respect personal space, wash their hands, wear masks, etc.

 

[43066]

I think a lot of people who hold this view seem to neglect the fact that you need a functioning economy to fund public services including the NHS. There is no such thing as a magic money tree. Therefore you are going to have to reopen at some point if you want a functioning economy and society, even if that involves a risk that R value goes above 1 and the virus starts spreading more widely again.

This is a very good point which, as you say, is largely ignored by the “lock down until we have a vaccine”, “lives before economic growth” brigade.

Fixating on reducing deaths from COVID 19 is irrational if, as a result of the measures imposed, we end up with more overall deaths from other causes.

 

[Huntergreed]

This is a very good point which, as you say, is largely ignored by the “lock down until we have a vaccine”, “lives before economic growth” brigade.

Fixating on reducing deaths from COVID 19 is irrational if, as a result of the measures imposed, we end up with more overall deaths from other causes.

Indeed, we need to reopen the ecpnomy and widen our perspective, however it seems many, even the government, are almost solely focused on COVID and that they’re not considering anything else, which is starting to get worrying.

 

[adc82140]

This article has been hidden away on the Sky News website, and implies that Covid-19 is getting less potent, ie anyone infected is becoming less ill than in April

Coronavirus 'no longer clinically exists in Italy', top doctor says

A study conducted at a hospital in Milan found that the number of viruses present in people who tested positive has decreased.

news.sky.com

The fact that the infection rates are falling a lot more slowly than the hospital admission, ITU occupation and death rates would support this.

 

[Bletchleyite]

This often naturally happens with viruses, both because of developing immunity and because they evolve to become less likely to kill their host, because of natural selection - a virus that doesn't kill or incapacitate the host spreads more effectively. It's very positive news if it's happening with this one.

 

[Sherlock49]

This article has been hidden away on the Sky News website, and implies that Covid-19 is getting less potent, ie anyone infected is becoming less ill than in April

Coronavirus 'no longer clinically exists in Italy', top doctor says

A study conducted at a hospital in Milan found that the number of viruses present in people who tested positive has decreased.

news.sky.com

The fact that the infection rates are falling a lot more slowly than the hospital admission, ITU occupation and death rates would support this.

This might be the case, but it's disputed and doesn't have much science behind it (see some opposing viewpoints here) - one other cause could be that now cases have dropped significantly, those who have mild symptoms are much more visible. There's lots of research still ongoing though so hopefully it will turn out to be losing potency.

In addition, given testing capacity has increased significantly and these include surveillance testing, you would expect positive tests to be at a higher level without necessarily seeing hospital admission rates at the same proportion as during the peak.

 

[edwin_m]

Agreed. So If there is no vaccine what will this lot do then? Hide in their homes until the breakdown of society and the looters arrive? We have to live with this. Relax the lockdown - gradually.

You don't keep lockdown until there is a vaccine. You keep lockdown until the rate of cases declines low enough that any new ones can be addressed by testing, track/trace and individual quarantine rather than putting general restrictions on everybody. Due mainly to errors by our government we have ten times as many cases as other countries that are relaxing lockdown, and most of them have a proper track and trace system which we certainly don't. And because our government has proven itself so incompetent, I find it hard to believe their current measures are well-advised especially when so many scientists are raising concerns. People who are arguing for relaxation of lockdown for economic reasons seem to ignore the fact that a second wave and resulting restoration of lockdown will be economically far worse.

because of natural selection - a virus that doesn't kill or incapacitate the host spreads more effectively. It's very positive news if it's happening with this one.

The mechanism of attenuation is that the virus becomes less lethal or has a longer period before symptoms appear, so those who are infected spend longer going around infecting other people. This virus already has a long incubation period before symptoms develop, it appears many can be infections and never show symptoms, and it is intrinsically highly infective. This means there is much less evolutionary pressure towards attenuation than with other viruses.

 

[yorkie]

If anyone has anything else to add about the subject of the thread, please do post it, but if we don't get back on topic soon, the thread will be locked.

You don't keep lockdown until there is a vaccine. You keep lockdown until the rate of cases declines low enough that any new ones can be addressed by testing, track/trace and individual quarantine rather than putting general restrictions on everybody. ....

I think this may be best in a separate thread, so if you want to make one, feel free, but you may need to address the issue of how you would track and trace everyone including people who have the virus asymptomatically; estimates of this number vary from anything between 5% and 80% so when you make your proposals you may wish to take this into account!

 

[philosopher]

Due mainly to errors by our government we have ten times as many cases as other countries that are relaxing lockdown, and most of them have a proper track and trace system which we certainly don't.

I agree testing and contact tracing are the best ways out of the lockdown. The UK has clearly improved a lot on testing however the contact tracing system at the moment is rather rudimentary and I suspect it is only stopping a low percentage of infections. It would be interesting to see what Italy, Spain and France are doing in terms of contact tracing and how effective it is in those countries. The only info I found on the internet is that France rolled out their contact tracing app last week.

People who are arguing for relaxation of lockdown for economic reasons seem to ignore the fact that a second wave and resulting restoration of lockdown will be economically far worse.

There is also the human behaviour aspect to consider. Humans are social animals. You can have a lockdown for 6 months, however compliance is going to get worse and worse over time as people will increasingly take the view that maintaining social relationships outweighs the risks of getting Covid-19.

 

[HSTEd]

It appears given what we know about R.... if we want to get out of lockdown it appears we have to accept an R above 1.
That is just the situation we are presented with.

 

[Huntergreed]

It appears given what we know about R.... if we want to get out of lockdown it appears we have to accept an R above 1.
That is just the situation we are presented with.

Unfortunately, the government are extremely focused on the “R” being below 1, and I imagine they’ll be very reluctant to reopen further if this happens, which in my opinion is inevitable. In Scotland anyway we are reminded by Sturgeon on a daily basis at the briefings that “The ‘R’ must not go above one, otherwise there will be a second peak that will overwhelm the NHS”. It’s one thing trying to convince a population that we need to live with this virus, but when those in government aren’t able to see it this way, it’s going to be difficult to open much more of the economy without either a vaccine or a large shift in focus from those on power, and whilst I hope it’ll be the latter, I’m not holding my breath. I fear we’re in for a very bleak 6-12 months indeed for the economy and mental wellbeing.

 

[adc82140]

The R value is something that governments within the UK have latched on to, yet it's the figure most open to interpretation. Other European countries have been more straightforward, by picking a new daily infection rate figure and saying that lockdown will be eased when it falls below that number. Easy to understand, easy to act on.

 

[philosopher]

Unfortunately, the government are extremely focused on the “R” being below 1, and I imagine they’ll be very reluctant to reopen further if this happens, which in my opinion is inevitable. In Scotland anyway we are reminded by Sturgeon on a daily basis at the briefings that “The ‘R’ must not go above one, otherwise there will be a second peak that will overwhelm the NHS”. It’s one thing trying to convince a population that we need to live with this virus, but when those in government aren’t able to see it this way, it’s going to be difficult to open much more of the economy without either a vaccine or a large shift in focus from those on power, and whilst I hope it’ll be the latter, I’m not holding my breath. I fear we’re in for a very bleak 6-12 months indeed for the economy and mental wellbeing.

If the government sole aim is to Keep R below one, then how I see it is that there has to be some compensatory measures for reopening an aspect of the economy. Compensatory measure may be things better contact tracing or compulsory wearing masks in certain places. So reopening pubs may increase the R by 0.5, but this can be compensated by better contact tracing that reduces the R by 0.5. The problems with this approach is that compensatory measures may be hard to implement in practice and if the R is very close to 1, then there is very little room to manoeuvre.

 

[Scrotnig]

As a society, we agreed to the lockdown to prevent the NHS being overwhlemed - that was achieved
Then we were told it had to remain in place until the various figures came down substantially - that was achieved
Now it's the mostly fictional R-rate that needs to stay below 1.

The goalposts just keep getting moved and nobody ever says anything.

The R-rate is totally unquantifiable and is at best an estimate and at worst a guess.
Yet the government makes clear it proposes to further restrict our freedoms and civil liberties on the basis of this fictional figure.
All they need to do is tell us it's gone up - no evidence is needed.
And we all happily accept this, indeed welcome it.

Our society is now fully broken and entirely compliant and repressed, which I firmly believe is exactly what they are after.

 

[edwin_m]

The daily infection rate indicates the number of infections now, but R predicts where that will go in the future.

If the daily infection rate is low then short-term increases in R can be tolerated, and it becomes more variable anyway due to random variations. However increases in R above 1 for a significant period will need some countermeasure, whether it is better track and trace or some more general restrictions.

If the daily infection rate is already high then R becomes much more of a concern because an increase above 1 may push a manageable number of daily infections into something that's unmanageable. Compounded by the fact that R can't be determined with any accuracy, and the figures are based on emerging infection so they actually predict what R was a few days or even weeks ago. So if R goes well above 1 it may not be obvious for some time, by which time the daily infections could have shot up.

If this happens in Germany then the daily infections might increase from around 100 to around 200, so only 100 more to deal with. If this happens in the UK then an increase from maybe 10000 to maybe 20000 would be much harder to manage.

 

[yorkie]

... So if R goes well above 1 it may not be obvious for some time, by which time the daily infections could have shot up.

If this happens in Germany then the daily infections might increase from around 100 to around 200, so only 100 more to deal with....

So presumably they are banking on a vaccine being avalable as otherwise they would eventually reach much higher levels.

...The goalposts just keep getting moved and nobody ever says anything.

The R-rate is totally unquantifiable and is at best an estimate and at worst a guess...

True it is difficult to calculate the R value, and it is only one piece of the jigsaw, but I believe the reason the goalposts have moved is because of increasing confidence of a vaccine becoming available; WHO have said the virus isn't going to go away. So the aim is presumably to keep 'R' as low as possible and cases as low as possible until the vaccine is made widely available. It is a gamble though.

 

[yorksrob]

The daily infection rate indicates the number of infections now, but R predicts where that will go in the future.

If the daily infection rate is low then short-term increases in R can be tolerated, and it becomes more variable anyway due to random variations. However increases in R above 1 for a significant period will need some countermeasure, whether it is better track and trace or some more general restrictions.

If the daily infection rate is already high then R becomes much more of a concern because an increase above 1 may push a manageable number of daily infections into something that's unmanageable. Compounded by the fact that R can't be determined with any accuracy, and the figures are based on emerging infection so they actually predict what R was a few days or even weeks ago. So if R goes well above 1 it may not be obvious for some time, by which time the daily infections could have shot up.

If this happens in Germany then the daily infections might increase from around 100 to around 200, so only 100 more to deal with. If this happens in the UK then an increase from maybe 10000 to maybe 20000 would be much harder to manage.

This is why the community testing that is taking place now is important - to give the wider picture of who is being infected and where.

 

[Bletchleyite]

True it is difficult to calculate the R value, and it is only one piece of the jigsaw, but I believe the reason the goalposts have moved is because of increasing confidence of a vaccine becoming available; WHO have said the virus isn't going to go away. So the aim is presumably to keep 'R' as low as possible and cases as low as possible until the vaccine is made widely available. It is a gamble though.

Yes, that's the "hammer and the dance" - a lockdown to get the caseload down to a level that is manageable by the health system for an indefinite period, then the "dance" of adding/removing measures to keep R as close to but below 1 as possible, so your caseload remains constant.

Coronavirus: The Hammer and the Dance

What the Next 18 Months Can Look Like, if Leaders Buy Us Time

medium.com

While the UK hasn't specifically said they're following it, it appears from the decisions being made that we basically are, pending a vaccine or effective treatment that would turn it into a mild inconvenience like a cold or flu is to most people.

There's a slight variant on that which is to fully release for short periods then lock down again, but that's more disruptive.

 

[edwin_m]

This is why the community testing that is taking place now is important - to give the wider picture of who is being infected and where.

Indeed, but it's a much bigger task at the UK's level of infection (probably around 10000 per day) than Germany's (a few hundred). And the Germans have it thoroughly organized whereas we … er … haven't. I know I keep on banging on about this but it is so intertwined with the R number that it would be inappropriate to split them into separate threads. The combination of our relatively high case levels and R going significantly above 1 could push us back to the sorts of figures we had in April.

 

[edwin_m]

So presumably they are banking on a vaccine being avalable as otherwise they would eventually reach much higher levels.

If R increases in Germany there may need to be extra restrictions, but because the total cases are low it's not so critical to put them in quickly. They can probably afford to spend a bit of time understanding what is happening and taking specific measures to target whatever the source seems to be. If R increases significantly in the UK then the infection numbers are increasing from a base ten times larger, so widespread and rapid measures will be needed to bring them back under control.

 

[yorksrob]

Indeed, but it's a much bigger task at the UK's level of infection (probably around 10000 per day) than Germany's (a few hundred). And the Germans have it thoroughly organized whereas we … er … haven't. I know I keep on banging on about this but it is so intertwined with the R number that it would be inappropriate to split them into separate threads. The combination of our relatively high case levels and R going significantly above 1 could push us back to the sorts of figures we had in April.

This is possibly true - although the hope is that what community testing is taking place, should act as the canary in the mine a lot earlier than the start of this year.

 

[Skimpot flyer]

Leaving aside the question of how reliable are the methods used to calculate it, what should the government’s objective be if R approaches or goes above 1 ?

The first duty of government is to protect it’s citizens. If the number of new infections starts to rise again, would it not be preferable for those infected to be only those in the groups least at risk? That way, the number of newly-infected that succumb to the disease is minimised. Shouldn’t policy be focussed solely reducing the death toll, not the R number?

If lockdown was eased for the groups that statistics show are least likely to die from Covid19 (those below age 65, without pre-existing medical conditions), this would help people of working age get back to some level of financial and mental health, restart the economy and not overwhelm the NHS (as those people are less likely to require hospital treatment for Covid19).

If the article linked to above is correct, if it takes six months from the start of lockdown to bring back routine screenings for cancer, then a potential 70,200 people will die prematurely of cancers that are going undetected and untreated. This is a scandalous failing of the first duty of government.

https://www.bbc.co.uk/news/health-52382303

Delays in diagnosing and treating people with cancer could lead to more years of lost life than with Covid-19, according to a leading cancer expert.

A drop-off in screening and referrals means roughly 2,700 fewer people are being diagnosed every week, Cancer Research UK says.

 

[adc82140]

Focus has been lost recently. Originally it was to reduce the death rate and prevent the overwhelming of the health service. I agree with that. But now it seems to be eliminating the virus, which is unrealistic. I feel some mission creep is happening here.

 

[Huntergreed]

True it is difficult to calculate the R value, and it is only one piece of the jigsaw, but I believe the reason the goalposts have moved is because of increasing confidence of a vaccine becoming available; WHO have said the virus isn't going to go away. So the aim is presumably to keep 'R' as low as possible and cases as low as possible until the vaccine is made widely available. It is a gamble though.

Surely it's not enough to justify a restriction on civil liberties, especially as they are just now, that 'we might get a vaccine next year'. The initial purpose of the lockdown (preventing the NHS from being overwhelmed) was achieved, then following that the secondary purpose (getting cases and deaths down to a manageable level) has also been achieved, so surely justifying a lockdown on a 'maybe' is very weak. I appreciate that we can't go out and hug each other or that would result in a completely overwhelmed health service, but I do think the exceptionally cautious approach we're taking (In Scotland and Wales we're stuck within a 5 mile radius for months yet) being based on a 'maybe' is socially unacceptable at best and a downright denial of our civil liberties at worst.

I know friends in Europe who are enjoying open businesses, travelling abroad and visiting friends and family, eating out and going to tourist locations on days out. We were initially '2-3 weeks behind Europe' in the curve and yet it seems in 2/3 weeks we will have nowhere near as much freedom. It seems like either something has gone badly wrong or the government intend to restrict our freedom excessively for no justifiable reason, which is in a modern democracy incredibly unacceptable and must be stopped if that is the case.

 

[edwin_m]

Focus has been lost recently. Originally it was to reduce the death rate and prevent the overwhelming of the health service. I agree with that. But now it seems to be eliminating the virus, which is unrealistic. I feel some mission creep is happening here.

We have the choice of continuing with a fairly high level of casualties and a fairly severe level of restriction as we do now, or really cracking down in lockdown to drive the virus out, after which restrictions can be less severe with little chance of the virus reappearing at any significant level (as long as any resurgence is managed by track and trace). The third choice is to go back to overwhelming the NHS. Which of those is best for the economy and national wellbeing?

I know friends in Europe who are enjoying open businesses, travelling abroad and visiting friends and family, eating out and going to tourist locations on days out. We were initially '2-3 weeks behind Europe' in the curve and yet it seems in 2/3 weeks we will have nowhere near as much freedom. It seems like either something has gone badly wrong or the government intend to restrict our freedom excessively for no justifiable reason, which is in a modern democracy incredibly unacceptable and must be stopped if that is the case.

As I have posted five or six times on here: The UK has managed this far worse than many other European countries and our level of infection is about ten times that of Germany. So by relaxing lockdown the UK is at much greater risk of going back to the situation where the NHS is threatened, or measures have to be re-imposed. The UK and Germany are at opposite extremes in this, with other European countries somewhere in between.

 

[yorkie]

.... or really cracking down in lockdown to drive the virus out...

Feel free to create a new thread with your proposals if you want this; I'll argue with you in an appropriate thread if you really want to suggest it, but it aint happening.

 

[edwin_m]

Feel free to create a new thread with your proposals if you want this; I'll argue with you in an appropriate thread if you really want to suggest it, but it aint happening.

It's strongly related to the R number and in my view this discussion is already being spread across far too many threads.