Deterioration in R number

[HSTEd]

You have a source for this claim?

Amongst other things, Newsnight a few days ago.

Again - you have a source? You can say how many critical to supporting life?

Well given the death toll amongst NHS workers, it is extraordinarily unlikely that they all had it.
We would have many many times more dead healthcare workers.


And if 40% of the NHS have had it.
That means 40% of the NHS are immune.
So we can't go below 40% strength for the rest of this crisis due to coronavirus casualties.

Can't have it both ways.

Or suspected stroke, heart attack and cancer patients presenting?

Cancer diagnoses are down by something like 2700 per week

By discharging them, do you mean sending them home to die when they could have had a chance of treatment?

That is what triage means.

The people with the most chance of survival get treatment, those with the least go to the back of the queue.

It is unlikely they would be sent home, they would likely end up in a "Nightingale" facility and would be treated with whatever personnel and material were available.

The UK has ~300,000 CPAP machines, most in private hands.
Even in the Ferguson "mitigation" model with a quarter of a milion dead, total hospitalisation numbers are ~120,000 at peak.

We do choose. We lockdown, minimise contact, contain the virus. Fewer people catch it, fewer people die.

And the secondary impacts and economic collapse kill huge numbers and will continue to kill huge numbers for years.

Unemployed people have much much higher mortality rates.
By collapsing the economy you destroy QALY on an unimaginable scale.

Do it fast, well and early and there's a good outcome. I'm looking at New Zealand here.

New Zealand is an isolated agrarian state on the end of the world.
In order to achieve a New Zealand like result we would have to lock down probably before Wuhan did.

This is the downside of being an international trade and travel hub.

Dither, come out of lockdown too soon and we're left with a killer virus circulating in the country. Either we lockdown properly to halt the spread or we accept that people will die, including those that are treating them and we would rely normally for other care.

People will die.
That is just the reality of the situation.

You just don't want to accept this, but this is the truth of it.
Whether they die of coronavirus, of loneliness, of cancer, of dementia or drinking themselves to death because they have no job or life prospects - they are still just as dead.

There are ~200 dead below 40 so far.
Noone below 40 is at any significant risk at all.

The vast vast majority of the dead are pensioners who are economically inactive and have relatively few QALY left to them.
That is the simple reality.

 

[Silverlinky]

There would appear to be evidence from other countries that have been affected that the virus is burning itself out, the number of cases will remain high but the number of people needing hospital treatment and ultimately dying is falling.
Even our own figures seem to reflect that. Don't forget that we are seeing 1500-2000 new cases a day still, but thats from 100-150000 tests.

Looking back over the figures on the same days of the week for the past few weeks, today they have announced 1557 new cases, last Saturday 1604, the week before 2959, and the week before that 3450.
Similarly deaths are showing 204 today, 226 last week, 282 the week before and 468 the week before that.

Don't lose sight of the fact that recorded cases and deaths are falling, on every level, day after day and week after week.

The R number is also misleading. Lets say that earlier in the epidemic 25000 people had the disease, and if R was 1 they would infect 25000 more. Compare that to where we are now, we have 6000 (?) currently infected, and R being 1 infects 6000 more. Same R figure, many fewer cases.

When people say about a "second wave" they assume we'd be in the same position as we were a few months ago..... I can't see that happening as R would have to massively increase in a short space of time.

 

[adc82140]

We cannot stay in lockdown forever. The death rate is falling. Infection rates are falling. The R value is very complex and the concept should never have been introduced to the general public or media. I will happily go into lockdown to prevent the NHS being overwhelmed, but with only 9% of ITU beds occupied by Covid-19 patients we are far from that. The UK doesn't have a different strain of the virus to everywhere else. The R is fluctuating madly in Germany, and I don't see everyone flying in to a blind panic there.

I work in the frontline NHS. I have seen first hand the terrible consequences of people not seeking help for other things because they are afraid to leave the house.

Edit - Silverlinky has nailed it there whe I've been typing.

 

[xc170]

If we are facing a second wave, we have a choice:

1) Lockdown, save lives.
2) Continue as is, more people die.

Which of your friends and relatives would you be happy to sacrifice for option 2?

No, we do what should have been done right from the start, don't impose a ridiculous lockdown, we instruct the elderly and vulnerable who are actually at high risk from this disease to isolate while the low risk population keep the economy going.

Or, we have a second lockdown, crash the economy and be left with no NHS at all, so I'll ask you the same question, which of your friends and relatives would you be happy to sacrifice to the many other non Covid related illnesses such as cancer, sepsis etc that the NHS won't be there to treat?

Think about it.

 

[adc82140]

Where's the like button? Cancer Research UK have predicted 75,000 extra cancer deaths in the next 24 months because of this.

 

[MikeWM]

As far as I'm concerned the only numbers that count are number of infections, number of hospital admissions, number of people in ITU beds and number of deaths (though the number of issues with the way deaths are recorded means that deaths is the least important of those, in my opinion).

They are all going down, consistently. They are also doing so in a very similar way in every country around the world that is at a similar stage of the outbreak (with the possible exception of Iran, and I've seen a few potential arguments for why that may be, none of which are alarming).

The R value is very complex and the concept should never have been introduced to the general public or media.

I completely agree, it isn't helping at all.

 

[Silverlinky]

As far as I'm concerned the only numbers that count are number of infections, number of hospital admissions, number of people in ITU beds and number of deaths (though the number of issues with the way deaths are recorded means that deaths is the least important of those, in my opinion).

They are all going down, consistently. They are also doing so in a very similar way in every country around the world that is at a similar stage of the outbreak (with the possible exception of Iran, and I've seen a few potential arguments for why that may be, none of which are alarming).



I completely agree, it isn't helping at all.

Spot on.......... R means very little!! Say we almost eradicated the virus....yet one person in the country was left with it, and they infected someone else...R would be 1! Thats how little the headline figure means.

As long as the other figures are coming down, and R does not shoot up to 3 or 4, then i'm not going to get too concerned by the doom and gloom media reporting an increase from 0.8 to 0.9!

 

[underbank]

No, we do what should have been done right from the start, don't impose a ridiculous lockdown, we instruct the elderly and vulnerable who are actually at high risk from this disease to isolate while the low risk population keep the economy going.

Or, we have a second lockdown, crash the economy and be left with no NHS at all, so I'll ask you the same question, which of your friends and relatives would you be happy to sacrifice to the many other non Covid related illnesses such as cancer, sepsis etc that the NHS won't be there to treat?

Think about it.

The NHS "closed down" before lockdown. It was collapsing the week before as new measures were being introduced almost daily as the crisis deepened. It wasn't the lockdown that closed it - it was being swamped with Covid patients, Covid rampaging through the wards infecting people who were admitted days/weeks earlier without it and staff going off sick or self isolating due to symptoms - some reported upto 40% of staff were off the week before lockdown! My OH's cancer treatment was stopped 4 days before lockdown as the oncology dept closed to all. Lockdown was caused by the NHS almost collapsing, not the other way around!

 

[xc170]

The NHS "closed down" before lockdown. It was collapsing the week before as new measures were being introduced almost daily as the crisis deepened. It wasn't the lockdown that closed it - it was being swamped with Covid patients, Covid rampaging through the wards infecting people who were admitted days/weeks earlier without it and staff going off sick or self isolating due to symptoms - some reported upto 40% of staff were off the week before lockdown! My OH's cancer treatment was stopped 4 days before lockdown as the oncology dept closed to all. Lockdown was caused by the NHS almost collapsing, not the other way around!

You've missed my point.

The point I'm trying to make is if the economy does crash, which with a second lockdown is almost a certainty, funding for things like the NHS and the benefit system will dry up meaning fewer routine operations, caner screenings and many, many deaths.

 

[edwin_m]

The problem is that "track and trace" is just an article of faith for people who believe in the lockdown.
They believe it will work, not because there is much evidence of this, but because they need it to work for their preferred strategy to make any sense at all.

A lot of studies dont share this optimism.

And isolating care homes is apparently killing substantial numbers of people anyway.

I doubt it will work when it has to deal with many thousands of cases per day, as is the current situation in the UK. It is part of a package of measures that appears to be containing things in countries where there are a few hundred cases per day.

By "isolating" I mean implementing proper precautions to prevent infection getting in and then spreading, not just closing the doors and forgetting about them.

Do you not accept that lockdown could have severe health implications in and of itself? We're about to enter a massive recession, which will be worse the longer lockdown continues - do you think the NHS will be able to survive that?

However if it is lifted too quickly the cases could rise and lockdown would have to come back, for a lot longer than if it was kept on for a few weeks to get the numbers down and could then be lifted with good confidence it would stay lifted. I can't help thinking the first course of action is more harmful economically.

New Zealand is an isolated agrarian state on the end of the world.
In order to achieve a New Zealand like result we would have to lock down probably before Wuhan did.

This is the downside of being an international trade and travel hub.

Germany is also an international hub, whose multiple land borders probably mean it has a lot more interaction with surrounding countries than we do. And yet it has managed by early lockdown, testing, track and trace and other measures, to keep its casualty numbers at a manageable level.

 

[northernchris]

Where's the like button? Cancer Research UK have predicted 75,000 extra cancer deaths in the next 24 months because of this.

If this is just the additional cancer deaths, add in the additional deaths from other illnesses which have either gone undetected or had treatment / operations paused and that's a significant excess death toll over the next couple of years

 

[adc82140]

If this is just the additional cancer deaths, add in the additional deaths from other illnesses which have either gone undetected or had treatment / operations paused and that's a significant excess death toll over the next couple of years

Yep. This is the medical equivalent of the elderly person in a Honda Jazz who keeps their eyes dead ahead, oblivious to the chaos in their wake.

 

[Yew]

As for ICU facilities, given that the survival rate for ICU is absolutely appalling, a complete collapse in COVID ICU care is not going to substantially increase the death rate.

Indeed and lots of people in the vulnerability profile of Covid-19 don't even make it into ICU, as it's unfortunately unlikely that they will survive invasive mechanical ventilation and sedation.

If we are facing a second wave, we have a choice:

1) Lockdown, save lives.
2) Continue as is, more people die.

Which of your friends and relatives would you be happy to sacrifice for option 2?

It's worth remembering that for people outside a very specific vulnerability profile, the risks are incredibly low. (ie: deaths in under 30's have actually decreased throughout this). The important thing isn't general circulation, it's transmission to the vulnerable population. Now that we have testing capacity, I'd like to think that we wouldn't see some of the mistakes of the first wave, late hospice lockdowns, and dismissing patients from hospital back to carehomes without a test.

 

[yorksrob]

I doubt it will work when it has to deal with many thousands of cases per day, as is the current situation in the UK. It is part of a package of measures that appears to be containing things in countries where there are a few hundred cases per day.

By "isolating" I mean implementing proper precautions to prevent infection getting in and then spreading, not just closing the doors and forgetting about them.

However if it is lifted too quickly the cases could rise and lockdown would have to come back, for a lot longer than if it was kept on for a few weeks to get the numbers down and could then be lifted with good confidence it would stay lifted. I can't help thinking the first course of action is more harmful economically.

Germany is also an international hub, whose multiple land borders probably mean it has a lot more interaction with surrounding countries than we do. And yet it has managed by early lockdown, testing, track and trace and other measures, to keep its casualty numbers at a manageable level.

Germany also collared a large proportion of the diagnostics industry and hadn't run down its manufacturing capabilities in terms of PPE.

There were some long term structural issues that put this country at a disadvantage ((as well as mistakes in acting late etc).

 

[Solent&Wessex]

The problem is that "track and trace" is just an article of faith for people who believe in the lockdown.
They believe it will work, not because there is much evidence of this, but because they need it to work for their preferred strategy to make any sense at all.

A lot of studies dont share this optimism.

I doubt it will work when it has to deal with many thousands of cases per day, as is the current situation in the UK. It is part of a package of measures that appears to be containing things in countries where there are a few hundred cases per day.

The talk of Track and Trace not working reminds me of something I saw posted by Private Eye, from edition 1523:




For those unable to view the image, the text on the image attachment is as follows:

A contact tracer will text or email a person who has tested positive for coronavirus.
That person will assume it's some sort of scam and delete the message.
The contact tracer will then phone the person.
The person will block the caller, assuming the unknown number is one of those automated calls wanting to know if they've recently been in a car accident.
The contact tracer finally gets through 36 hours later to the person, who has meanwhile spread the virus widely, to ask who they have been in contact with, so those people can be made to self-isolate for 14 days.
The person with coronavirus includes a number of people they don't like in that list, forcing them to go into two-week quarantine.
And conveniently forgets to mention Karen from Marketing with whom they're having an affair.
Er...
That's it.

 

[43096]

It's worth checking that we're comparing like with like here. My understanding is that there is not only empirical data, but a various number of models. Given that the famous model from Professor Ferguson vastly overestimated the deaths that Sweeden would see with it's less invasive restrictions, and we continue to see a drop in infections and deaths. I'm going to take a large pinch of salt with this article.

Professor Ferguson is an utterly discredited individual; both personally (another do as I say, not do as I do type, along with Cummings) and professionally.

This is the man who has got it spectacularly wrong in the past: https://statmodeling.stat.columbia....al-is-why-did-anyone-ever-listen-to-this-guy/

[Imperial College epidemiologist Neil] Ferguson was behind the disputed research that sparked the mass culling of eleven million sheep and cattle during the 2001 outbreak of foot-and-mouth disease. He also predicted that up to 150,000 people could die. There were fewer than 200 deaths. . . .

In 2002, Ferguson predicted that up to 50,000 people would likely die from exposure to BSE (mad cow disease) in beef. In the U.K., there were only 177 deaths from BSE.

In 2005, Ferguson predicted that up to 150 million people could be killed from bird flu. In the end, only 282 people died worldwide from the disease between 2003 and 2009.

In 2009, a government estimate, based on Ferguson’s advice, said a “reasonable worst-case scenario” was that the swine flu would lead to 65,000 British deaths. In the end, swine flu killed 457 people in the U.K.

Last March, Ferguson admitted that his Imperial College model of the COVID-19 disease was based on undocumented, 13-year-old computer code that was intended to be used for a feared influenza pandemic, rather than a coronavirus. Ferguson declined to release his original code so other scientists could check his results. He only released a heavily revised set of code last week, after a six-week delay.

So the real scandal is: Why did anyone ever listen to this guy?

 

[43096]

We do have a choice. Lock down and protect, or stay out and spread. Without a vaccine and with a circulating virus your nearest and dearest remain at risk. It's that simple.

And massacre the global economy. With that you also kill people: poverty happens. Mental health deteriorates. That kills people.

The thing is, this virus has a wide spread of impacts. For some, it is fatal. For many more, it is less serious than a cold or flu. Keeping everyone under lock and key is a disproportionate response: to be blunt this is as much about a world wide panic as a virus.

 

[sheff1]

If we are facing a second wave, we have a choice:

1) Lockdown, save lives.
2) Continue as is, more people die.

Which of your friends and relatives would you be happy to sacrifice for option 2?

A classic false dichotomy.

 

[Yew]

Well given the death toll amongst NHS workers, it is extraordinarily unlikely that they all had it.
We would have many many times more dead healthcare workers.

Remember that a huge number of fatalities are in the over 75's, I'd imagine that the NHS doesn't have a great number of those in Covid wards.

 

[Puffing Devil]

A classic false dichotomy.

Your alternative?

 

[Puffing Devil]

And massacre the global economy. With that you also kill people: poverty happens. Mental health deteriorates. That kills people.

The thing is, this virus has a wide spread of impacts. For some, it is fatal. For many more, it is less serious than a cold or flu. Keeping everyone under lock and key is a disproportionate response: to be blunt this is as much about a world wide panic as a virus.

And your evidence for your hypothesis is?

 

[Puffing Devil]

Indeed and lots of people in the vulnerability profile of Covid-19 don't even make it into ICU, as it's unfortunately unlikely that they will survive invasive mechanical ventilation and sedation.


It's worth remembering that for people outside a very specific vulnerability profile, the risks are incredibly low. (ie: deaths in under 30's have actually decreased throughout this). The important thing isn't general circulation, it's transmission to the vulnerable population. Now that we have testing capacity, I'd like to think that we wouldn't see some of the mistakes of the first wave, late hospice lockdowns, and dismissing patients from hospital back to carehomes without a test.

"I would like to think"

Please bring some facts to the table.

 

[trebor79]

But the R number in isolation doesn't tell you much. If most of the transmission is in care homes and hospitals, rather than elsewhere then it's an easier but to crack to bring it back down.
R could be 3 but if the virus is only transmitting on certain settings then the general public are safe.

 

[Yew]

"I would like to think"

Please bring some facts to the table.

I'm speaking of events in the future, in absence of a TARDIS or Delorean, we cannot speak with any certainty about what will happen. The idea that sending people who may have covid to live (in a care home) with other vulnerable people is bad, seems so uncontroversial that I can't understand why you're trying to dispute it?

 

[43066]

We do have a choice. Lock down and protect, or stay out and spread. Without a vaccine and with a circulating virus your nearest and dearest remain at risk. It's that simple.

Are you saying you think lockdown should continue until we have a vaccine? That is utterly nonsensical.

And your evidence for your hypothesis is?

Are you disagreeing that deaths will be caused by the recession, missed cancer diagnoses etc? Many of these deaths will be amongst those who are far younger than the average COVID 19 victim, and with many more years of life ahead of them.

Why are you only concerned about reducing deaths from COVID 19?

 

[Scrotnig]

Are you saying you think lockdown should continue until we have a vaccine? That is utterly nonsensical.

Unfortunately there are huge numbers of people who think like this. It's frightening.

 

[Tezza1978]

Unfortunately there are huge numbers of people who think like this. It's frightening.

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.

 

[158756]

Amongst other things, Newsnight a few days ago.

There are 10,000 excess deaths with Dementia/Alzheimer's on the death certificate, true. However... these deaths mostly occurred in care homes, before testing for Covid-19 was widely available or the care home problem was properly appreciated (excess deaths not attributed to the virus have since disappeared). It seems unlikely that none of those deaths involved the virus.

 

[Bantamzen]

Where do you get your £100 billion a month from?

I value human life - what would you say a life is worth? When you start to talk about economics you need to remember the lives that will be lost without controlling the virus.

The estimated cost of the crisis from the end of March up until June when the furloughed scheme was planned for is in the region of £300-350 billion. I'm pretty certain you will have seen these figures before, both on here (because I have regularly cited them) and in the media. And another figure I have banded about quite a lot is £141 billion. This is the entire NHS budget for the financial year of 2019-2020.

So as you can see, the cost is already more than twice as much as the entire NHS budget, and is still growing. Plus the NHS doesn't just deal with covid sufferers, many people right now are going without treatment for all sorts of diseases and conditions. Goodness knows how many people will die because the NHS has been focused heavily on this one virus so that some people can feel a bit safer. Add all these elements together and you get a financial crisis, one which send shockwaves not only through the economy, but through our healthcare system. Because put simply, we have to pay for it, and we do so through the economy.

I value life too, but I also understand that our healthcare system isn't something you can just shake out of a magic money tree. It needs the economy to fund it, and if the economy collapses so does it. And if that happens many, many more people would suffer.

This thread may be of some interest to you:

Millions in UK miss cancer screenings, tests and treatments due to Covid-19

moderator note : posts #1-#2 originally in this thread: https://www.railforums.co.uk/threads/sleep-during-lockdown.203508/ If we don't start getting our lives back on track its not a second wave of covid we need to be worried about, but a tsunami of health problems right through society for...

www.railforums.co.uk

 

[brad465]

The apparent increase in infection rate will have a number of negatives, however one upside that comes to mind with new cases plateauing is those trialling the Oxford vaccine maybe able to get more reliable data, where I recall they expressed fears if lockdown was too good the virus wouldn't be prevalent enough in the wider population to draw reliable conclusions (they've even contemplated deliberately infecting low risk people for that reason). That doesn't mean it should be allowed to go out of control and of course there is no guarantee the vaccine will be effective.