Do we trust the experts in regard to COVID-19?

[DB]

It is directly relevant. Chicken pox circulates widely and is transmitted throughout the UK population. Measles, thankfully, does not.

But again, so what? It's less than 1% of the population - that is herd immunity.

The Swedish experience should certainly be robustly examined by experts but it's far too early to draw conclusions and extrapolate across Europe.

We shall see over the next few months - if Sweden remains low while other countires don't then that's a pretty clear indication of which strategy is most effective!

 

[kristiang85]

I think there's quite a bit of conjecture about how this has happened. Certainly, there may be some takeaways in terms of how they have succeeded and failed but a holistic view on what happened there is probably what's needed.

However, Sweden hasn't achieved herd immunity or indeed anything near to it. Sweden's own Public Health Agency predicted that 40% of the Stockholm population would have the disease and acquire protective antibodies by May but even the best case in random testing for people with antibodies by June was 11.4% for Stockholm and 7.1% nationally.

In fact, here's a question.... has herd immunity to infectious disease ever been achieved without a vaccine?

There is evidence that only a low herd immunity is needed, due to the nature of previous CoV infections. This paper here from a couple of weeks ago estimates that the herd immunity threshold could be between 10-20% https://www.medrxiv.org/content/10.1101/2020.07.23.20160762v2

As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads, the susceptible subpopulation declines causing the rate at which new infections occur to slow down. Variation in individual susceptibility or exposure to infection exacerbates this effect. Individuals that are more susceptible or more exposed tend to be infected and removed from the susceptible subpopulation earlier. This selective depletion of susceptibles intensifies the deceleration in incidence. Eventually, susceptible numbers become low enough to prevent epidemic growth or, in other words, the herd immunity threshold is reached. Here we fit epidemiological models with inbuilt distributions of susceptibility or exposure to SARS-CoV-2 outbreaks to estimate basic reproduction numbers (R0) alongside coefficients of individual variation (CV) and the effects of containment strategies. Herd immunity thresholds are then calculated as 1-(1/R0)1/(1+CV2) or 1-(1/R0)1/(1+2CV2), depending on whether variation is on susceptibility or exposure. Our inferences result in herd immunity thresholds around 10-20%, considerably lower than the minimum coverage needed to interrupt transmission by random vaccination, which for R0 higher than 2.5 is estimated above 60%. We emphasize that the classical formula, 1-(1/R0), remains applicable to describe herd immunity thresholds for random vaccination, but not for immunity induced by infection which is naturally selective. These findings have profound consequences for the governance of the current pandemic given that some populations may be close to achieving herd immunity despite being under more or less strict social distancing measures.

 

[TheGrandWazoo]

There is evidence that only a low herd immunity is needed, due to the nature of previous CoV infections. This paper here from a couple of weeks ago estimates that the herd immunity threshold could be between 10-20% https://www.medrxiv.org/content/10.1101/2020.07.23.20160762v2

Think evidence is perhaps overstating it. It's a non-peer-reviewed piece that is certainly out of step with the vast majority of expert analysis and, assuming that I'm reading this correctly, the line " We emphasize that the classical formula, 1-(1/R0), remains applicable to describe herd immunity thresholds for random vaccination, but not for immunity induced by infection which is naturally selective." would suggest that you are doing something more selective (and theoretical) than the Swedish experience and that the 60%+ is still a valid measure?

But again, so what? It's less than 1% of the population - that is herd immunity.

No it isn't. You just have a circulating virus in Chicken Pox that is widely transmitted. Just once you get it, you are very unlikely to get it again. However, the incidence and cases remain the same as we don't vaccinate.

Herd immunity occurs when a large portion of a community (the herd) becomes immune to a disease, making the spread of disease from person to person unlikely. As a result, the whole community becomes protected — not just those who are immune. You have a 1 in a 100 chance of getting Chicken Pox. For measles, you have a 1 in 65000 chance. That's herd immunity, not being immune from reinfection.

 

[DB]

No it isn't. You just have a circulating virus in Chicken Pox that is widely transmitted. Just once you get it, you are very unlikely to get it again. However, the incidence and cases remain the same as we don't vaccinate.

Herd immunity occurs when a large portion of a community (the herd) becomes immune to a disease, making the spread of disease from person to person unlikely. As a result, the whole community becomes protected — not just those who are immune. You have a 1 in a 100 chance of getting Chicken Pox. For measles, you have a 1 in 65000 chance. That's herd immunity, not being immune from reinfection.

Yes it is!

Herd immunity is where a sufficient proportion of the population has immunity (by whatever means) that the spread is significantly reduced to a small proportion of the population.

e.g. Wikipedia (https://en.wikipedia.org/wiki/Herd_immunity):

Herd immunity (also called herd effect, community immunity, population immunity, or social immunity) is a form of indirect protection from infectious disease that occurs when a sufficient percentage of a population has become immune to an infection, whether through vaccination or previous infections, thereby reducing the likelihood of infection for individuals who lack immunity.

Loads more sources giving pretty much the same definition.

The key part is that sufficient numbers are immune that the result is 'reducing the likelihood of infection for individuals who lack immunity' - which is what happens with chicken pox (below 1% of the population is low, by any definition). The fact that measles has a better level of immunity does not mean that anything with a sligtly higher spread doesn't count.

 

[kristiang85]

Think evidence is perhaps overstating it. It's a non-peer-reviewed piece that is certainly out of step with the vast majority of expert analysis and, assuming that I'm reading this correctly, the line " We emphasize that the classical formula, 1-(1/R0), remains applicable to describe herd immunity thresholds for random vaccination, but not for immunity induced by infection which is naturally selective." would suggest that you are doing something more selective (and theoretical) than the Swedish experience and that the 60%+ is still a valid measure?

Well yes it is theoretical, but so are all the other models of future COVID spread (and most of these are non-peer reviewed too).

I have actually worked with one of the authors over time, and I know they would have been pretty meticulous about this research - certainly one of the more reputable ones out there.

If it isn't true, then why are places like Sweden, London and Manaus, who all suffered a big peak in Spring, all showing no sign of a significant second wave of deaths despite what many believe is far below the 60% HI threshold? This is one explanation.

As usual, time will tell, but we cannot discount it right now.

 

[Bletchleyite]

I think London will be interesting to watch on this one. Logically it should be on the up...but it isn't apart from odd places.

 

[Yew]

I think London will be interesting to watch on this one. Logically it should be on the up...but it isn't apart from odd places.

Indeed, if cases in London do not increase, that suggests that immunity may be much easier to reach than we have thought.

 

[Bikeman78]

Yes it is!

Herd immunity is where a sufficient proportion of the population has immunity (by whatever means) that the spread is significantly reduced to a small proportion of the population.

e.g. Wikipedia (https://en.wikipedia.org/wiki/Herd_immunity):



Loads more sources giving pretty much the same definition.

The key part is that sufficient numbers are immune that the result is 'reducing the likelihood of infection for individuals who lack immunity' - which is what happens with chicken pox (below 1% of the population is low, by any definition). The fact that measles has a better level of immunity does not mean that anything with a sligtly higher spread doesn't count.

Most people have chicken pox when they are children. By all accounts, it's pretty nasty if you have it as an adult. That said, the chances of an adult catching it are minimal unless they have kids I guess. Airlines don't let people fly with chicken pox though.

 

[MDB1images]

In terms of the OP.
I think you can now find an 'expert' (be it scientific or medical)to support whatever way you think about the virus so people will trust the experts they agree with and not trust the experts they disagree with!

 

[TheGrandWazoo]

Yes it is!

Herd immunity is where a sufficient proportion of the population has immunity (by whatever means) that the spread is significantly reduced to a small proportion of the population.

e.g. Wikipedia (https://en.wikipedia.org/wiki/Herd_immunity):



Loads more sources giving pretty much the same definition.

The key part is that sufficient numbers are immune that the result is 'reducing the likelihood of infection for individuals who lack immunity' - which is what happens with chicken pox (below 1% of the population is low, by any definition). The fact that measles has a better level of immunity does not mean that anything with a sligtly higher spread doesn't count.

I tend not to use Wikipedia as a reputable source.

This from John Hopkins https://www.jhsph.edu/covid-19/articles/achieving-herd-immunity-with-covid19.html explains:

What is herd immunity?
When most of a population is immune to an infectious disease, this provides indirect protection—or herd immunity (also called herd protection)—to those who are not immune to the disease.

For example, if 80% of a population is immune to a virus, four out of every five people who encounter someone with the disease won’t get sick (and won’t spread the disease any further). In this way, the spread of infectious diseases is kept under control. Depending how contagious an infection is, usually 50% to 90% of a population needs immunity to achieve herd immunity.


Herd immunity would see the spread of a virus reduced as there are fewer available people to infect and as we can see with Measles, that has dropped via immunisation from 500k p.a. to about 1k p.a. Chicken pox is still at 600k p.a. so no evidence of any herd immunity to stop spread.

Measles notifications and deaths in England and Wales: 1940 to 2020

www.gov.uk

Well yes it is theoretical, but so are all the other models of future COVID spread (and most of these are non-peer reviewed too).

I have actually worked with one of the authors over time, and I know they would have been pretty meticulous about this research - certainly one of the more reputable ones out there.

If it isn't true, then why are places like Sweden, London and Manaus, who all suffered a big peak in Spring, all showing no sign of a significant second wave of deaths despite what many believe is far below the 60% HI threshold? This is one explanation.

As usual, time will tell, but we cannot discount it right now.

Indeed, and I'm sure that the other studies are equally as meticulous.

As has been said, the reasons behind Sweden's figures need to be established. However, it is still recording (per capita) twice as many deaths per month than it's neighbours so the raw statistics are also contradictory. We cannot simply highlight Sweden against "Europe" and then ignore that it is actually worse than 2 of its 3 immediate and most comparable neighbours.

In terms of Manaus, it is a good question. Likewise, having achieved "herd immunity" then why are hospitalisations and deaths increasing once more? It is far from straight forward. Not discounting anything but similarly, we cannot view things through the prism of what we all desperately would like to happen...a return to normality.

 

[kristiang85]

As has been said, the reasons behind Sweden's figures need to be established. However, it is still recording (per capita) twice as many deaths per month than it's neighbours so the raw statistics are also contradictory. We cannot simply highlight Sweden against "Europe" and then ignore that it is actually worse than 2 of its 3 immediate and most comparable neighbours.

In terms of Manaus, it is a good question. Likewise, having achieved "herd immunity" then why are hospitalisations and deaths increasing once more? It is far from straight forward. Not discounting anything but similarly, we cannot view things through the prism of what we all desperately would like to happen...a return to normality.

Sweden had a very low flu season in 2019, thus had significantly less deaths than average compared to its neigbours. Thus there are a lot more susceptible people in Sweden to COVID-19, and when you look at excess death graphs for all the countries, Sweden is just regressing to the mean this year. Epidemiologists call it "dry tinder", but I find that term somewhat heartless!

Also, as I said, Sweden's big faux pas was screwing up on care home shielding - as we, and many other countries, did. The rest of Scandanavia did well on this, as far as I'm aware. So this has inflated their stats significantly. But overall that should not take away from learning from their overall strategy.

For Manaus, the graph is very similar to London as far as I can tell right now - only a slight uptick in hospitalisations. Herd immunity at this point does not mean no infections (and that is a fantasy, even with vaccination), but it will go up at a slower rate.

 

[TheGrandWazoo]

In terms of the OP.
I think you can now find an 'expert' (be it scientific or medical)to support whatever way you think about the virus so people will trust the experts they agree with and not trust the experts they disagree with!

Never a truer word said!

Sweden had a very low flu season in 2019, thus had significantly less deaths than average compared to its neigbours. Thus there are a lot more susceptible people in Sweden to COVID-19, and when you look at excess death graphs for all the countries, Sweden is just regressing to the mean this year. Epidemiologists call it "dry tinder", but I find that term somewhat heartless!

Something that Tegnell's Norwegian equivalent was less than convinced about given that Norway had a similarly low flu season and more severe seasons than Sweden the year before.

It's something that needs a lot more research before, as a planet, we adopt any model.

 

[DB]

I tend not to use Wikipedia as a reputable source.

This from John Hopkins https://www.jhsph.edu/covid-19/articles/achieving-herd-immunity-with-covid19.html explains:

What is herd immunity?
When most of a population is immune to an infectious disease, this provides indirect protection—or herd immunity (also called herd protection)—to those who are not immune to the disease.

For example, if 80% of a population is immune to a virus, four out of every five people who encounter someone with the disease won’t get sick (and won’t spread the disease any further). In this way, the spread of infectious diseases is kept under control. Depending how contagious an infection is, usually 50% to 90% of a population needs immunity to achieve herd immunity.


Herd immunity would see the spread of a virus reduced as there are fewer available people to infect and as we can see with Measles, that has dropped via immunisation from 500k p.a. to about 1k p.a. Chicken pox is still at 600k p.a. so no evidence of any herd immunity to stop spread.

Measles notifications and deaths in England and Wales: 1940 to 2020

www.gov.uk

Well, clearly we will never agree on this (there is nothing in what you have quoted which disagrees with anything I have said - and as I also pointed out there are many sources which say similar to WIkipedia, as indeed the one you have quoted does!).

If you regard an infectious disease which affects less than 1% of the population in any year as not having herd immunity (a view which I'm afraid I regard as utterly ridiculous), then it seems unlikely that you will regard the best that is likely to be achieved with Covid as having reached herd immunity.

 

[TheGrandWazoo]

If you regard an infectious disease which affects less than 1% of the population in any year as not having herd immunity (a view which I'm afraid I regard as utterly ridiculous), then it seems unlikely that you will regard the best that is likely to be achieved with Covid as having reached herd immunity.

Again, that's a false equivalence on two levels. Good day to you, sir.

 

[DB]

Again, that's a false equivalence on two levels. Good day to you, sir.

False equvalence how exactly?

Yes, go on, have another good sneer...

 

[Yew]

Chicken pox is still at 600k p.a. so no evidence of any herd immunity to stop spread.

That's just under the number of new births per year in the UK. Indicating that the existing population doesn't have much in the way of issues.

 

[Bletchleyite]

False equvalence how exactly?

Yes, go on, have another good sneer...

The term "herd immunity" refers to a situation where sufficient of a population have natural immunity (or vaccine based immunity) that R ends up below 1 and the disease dies out.

If there are 1000 cases a year in the long term, this has not happened. Something has happened, but it isn't described by the term "herd immunity".

 

[TheGrandWazoo]

That's just under the number of new births per year in the UK. Indicating that the existing population doesn't have much in the way of issues.

Indeed it is and it highlights that if most people who are born then get it, then herd immunity isn't doing much to stop the spread of chickenpox! Meanwhile, Measles has gone from 500k cases p.a. in 1968 to thankfully very low levels. Of course, measles is much more serious so the benefit of vaccination was more compelling and led to that program.

False equvalence how exactly?

Yes, go on, have another good sneer...

Please stop bandying terms like ridiculous and sneer.

If you believe that herd immunity means you don't get reinfected once you've been ill (as with chickenpox) then it fails to recognise that herd immunity would also limit the incidence and spread of a virus. Chickenpox, unlike measles that has been massively reduced in incidence through herd immunity, has not markedly decreased in the UK and that is why the US introduced chickenpox vaccination in the mid 1990s.

Just because I disagree with your view on herd immunity and chickenpox doesn't mean that I will disagree that herd immunity could be achieved with Covid via a vaccine. That is a false equivalence.

 

[Yew]

Indeed it is and it highlights that if most people who are born then get it, then herd immunity isn't doing much to stop the spread of chickenpox!

Apart from the other 99.9% of the population that don't get it every year due to herd immunity.

I'd suggest that there is an equilibrium, as the R goes below 1 due to herd immunity, the immunity starts to wear off due to death and birth in the population. Then the R increases above one, due to the lower percentage of immune individuals, immunity increases and the cycle starts again.

 

[TheGrandWazoo]

Apart from the other 99.9% of the population that don't get it every year due to herd immunity.

No, they get it from immunity because they have had it, not because the virus is not circulating.

 

[Bletchleyite]

Apart from the other 99.9% of the population that don't get it every year due to herd immunity.

Due to individual immunity. It's still circulating.

Herd immunity describes the specific situation where the number of immune people means R<1 and as such it basically dies out.

 

[Yew]

Due to individual immunity. It's still circulating.

Herd immunity describes the specific situation where the number of immune people means R<1 and as such it basically dies out.

No it doesn't look at this one https://academic.oup.com/cid/article/52/7/911/299077

The term “herd immunity” is widely used but carries a variety of meanings [1–7]. Some authors use it to describe the proportion immune among individuals in a population. Others use it with reference to a particular threshold proportion of immune individuals that should lead to a decline in incidence of infection. Still others use it to refer to a pattern of immunity that should protect a population from invasion of a new infection. A common implication of the term is that the risk of infection among susceptible individuals in a population is reduced by the presence and proximity of immune individuals (this is sometimes referred to as “indirect protection” or a “herd effect”). We provide brief historical, epidemiologic, theoretical, and pragmatic public health perspectives on this concept.

The word of elimination seems not to feature.

And anyway, what is herd immunity but the sum of individual immunity?

 

[TheGrandWazoo]

No it doesn't look at this one https://academic.oup.com/cid/article/52/7/911/299077



The word of elimination seems not to feature.

And anyway, what is herd immunity but the sum of individual immunity?

Have you read the rest of the article?? It is about vaccination...

 

[Yew]

Have you read the rest of the article?? It is about vaccination...

Which is a common application of the principles of herd immunity, but irrelevant for the actual definition of herd immunity.

 

[Tetchytyke]

Herd immunity describes the specific situation where the number of immune people means R<1 and as such it basically dies out.

Herd immunity doesn't necessarily mean eradication- measles isn't eradicated- but it does mean that prevalence of the virus is hugely reduced.

Interesting people mention chickenpox as an example of herd immunity. It isn't- the infection rate is way too high for that, and also immunity declines with age. It is this declining immunity that allows shingles, which is the dormant chickenpox virus reactivating, to happen.

Shingles shows that you can get ill again once you've been infected. Shingles is not a new infection, it's the old infection coming out to play again.

There are countless examples of viruses lying dormant and then reactivating later, causing more misery. It is thought that coronaviruses can't do this, unlike chickenpox and the various herpes viruses, but they don't know as infections are being found in the bits of the body where dormant viruses hide.

To answer the OP's question, as this virus is so new I don't trust any expert who claims to know anything for certain. Sadly this dearth of knowledge means that those voices that profess certainty, such as Prof Gupta, tend to drown out the many more voices that say they don't know.

 

[TheGrandWazoo]

Which is a common application of the principles of herd immunity, but irrelevant for the actual definition of herd immunity.

Sorry but that's not correct. The "definition" paragraph says that there are different definitions used by different authors but they will explore it in a particular way and that is in relation to vaccination as in the following paragraph

Though coined almost a century ago [8], the term “herd immunity” was not widely used until recent decades, its use stimulated by the increasing use of vaccines, discussions of disease eradication, and analyses of the costs and benefits of vaccination programs. An important milestone was the recognition by Smith in 1970 [9] and Dietz in 1975 [10] of a simple threshold theorem—that if immunity (ie, successful vaccination) were delivered at random and if members of a population mixed at random, such that on average each individual contacted R0 individuals in a manner sufficient to transmit the infection [11, 12], then incidence of the infection would decline if the proportion immune exceeded (R0 − 1)/R0, or 1 –1/R0.

 

[Yew]

Sorry but that's not correct. The "definition" paragraph says that there are different definitions used by different authors but they will explore it in a particular way and that is in relation to vaccination as in the following paragraph

Though coined almost a century ago [8], the term “herd immunity” was not widely used until recent decades, its use stimulated by the increasing use of vaccines, discussions of disease eradication, and analyses of the costs and benefits of vaccination programs. An important milestone was the recognition by Smith in 1970 [9] and Dietz in 1975 [10] of a simple threshold theorem—that if immunity (ie, successful vaccination) were delivered at random and if members of a population mixed at random, such that on average each individual contacted R0 individuals in a manner sufficient to transmit the infection [11, 12], then incidence of the infection would decline if the proportion immune exceeded (R0 − 1)/R0, or 1 –1/R0.

That literally argues my point, herd immunity is the effect on spread so that R is less than 0; it makes no guarantees about elimination, nor that once immunity has worn off, we wonldn't see a resurgence.

 

[TheGrandWazoo]

That literally argues my point, herd immunity is the effect on spread so that R is less than 0; it makes no guarantees about elimination, nor that once immunity has worn off, we wonldn't see a resurgence.

Through “successful vaccination’!

 

[yorkie]

Due to individual immunity. It's still circulating.

Herd immunity describes the specific situation where the number of immune people means R<1 and as such it basically dies out.

It's generally accepted that we have [a level of] 'herd immunity' against all sorts of viruses which means they do not spread exponentially, but that doesn't mean they die out.

All the people I know who have been ill recently (including one hospitalisation) tested negative for Sars-Cov-2 but had other viruses probably rhinoviruses (definitely a rhinovirus in the hospitalised case); those who tested positive for Sars-Cov-2 had mild or no symptoms.

All we really need is to get to a point whereby Sars-Cov-2 is just one of the many viruses that circulate at this time of year and it no longer poses a threat of overwhelming hospitals. I wonder if the WHO is still claiming it is not a seasonal virus? I expect they will (perhaps quietly) change their view at some point.

Through vaccination!!!!

That doesn't preclude the possibility of reaching [a level of] 'herd immunity' by other means, as is the case with rhinoviruses and most coronaviruses circulating in humans.

It sounds like the Government's plan is to achieve herd immunity by a combination of vaccines (for vulnerable people, extending potentially to all people over 50) and infections (for healthy people under 50).

Coronavirus vaccine head: Less than half of the UK population could get vaccinated

The head of the country's vaccine taskforce says the idea of vaccinating the whole population is "misguided".

news.sky.com

"It's an adult-only vaccine for people over 50 focusing on health workers and care home workers and the vulnerable."

So for people under 50, we are effectively being told "try not to get it yet; we'll make millions of you redundant and ruin your mental wellbeing; then we'll let you eventually have your livelihood back (if you're lucky) and you'll be expected to get the virus at that point; and eventually, you will be left with the financial burden too" OK that is a slight exaggeration on my part for dramatic effect, but it's basically true!

 

[Class 33]

Well a few weeks ago Whitty and Valance predicted by mid October the number of daily cases could have reached 50,000. I thought at the time absolutely no way the number of daily cases would be that high in just a few weeks. Here we are in mid October, and thankfully they have been proved very wrong with their predictions! We're no where near 50,000 cases per day! That said, we're perilously close to 20,000 cases per day now. I didn't think we'd get as high as this. My estimate would be we'd reach a peak of about 10,000 cases per day.

Today though "experts" are predicting daily Coronavirus deaths could reach between 240 and 690 by 26th October.

Daily coronavirus deaths could hit 240-690 in just over a week, scientists warn

The Medical Research Council biostatistics unit at Cambridge University has published modelling which is fed to Government scientific advisers.

www.expressandstar.com

Daily coronavirus deaths could hit 240-690 in just over a week, scientists warn

The Medical Research Council biostatistics unit at Cambridge University has published modelling which is fed to Government scientific advisers.


Around 47,000 Covid-19 infections are occurring daily across England, with deaths expected to hit 240 to 690 per day by October 26, according to evidence presented to Government scientists.
The Medical Research Council (MRC) biostatistics unit at Cambridge University published new predictions on October 12 on how fast the epidemic is growing across the country.
They estimate cases are doubling in under seven days, with a “substantial proportion” of those being asymptomatic.
The figures are fed to the Scientific Pandemic Influenza Group on Modelling, which provides real-time information to the Government through the Scientific Advisory Group for Emergencies (Sage), and to regional Public Health England (PHE) teams.

On October 12, the MRC unit published a report saying: “Our current estimate of the number of infections occurring each day across England is 47,000.


“We predict that the number of deaths each day is likely to be between 240 and 690 on October 26.”

They said the daily number of infections was within the range of 28,900 to 74,900 per day, with the best estimate being 47,000.
They added the estimated growth rate for England is 0.09 per day.
“This means that the number of infections grows by 9% each day and it translates into a doubling in number in under one week,” they said.

“The central estimates for the number of new infections is particularly high in the North West and the North East and Yorkshire (17,600 and 10,700 infections per day, respectively), followed by London and the Midlands (5,450 and 5,720, respectively).


“Note that a substantial proportion of these daily infections will be asymptomatic.”
The latest Government figures showed 18,980 lab-confirmed new coronavirus cases as of 9am on Thursday, while a further 138 deaths were reported.
Experts say lab-confirmed cases do not represent the true scale of the epidemic.
Meanwhile, Professor Graham Medley, an expert in infectious disease modelling at the London School of Hygiene and Tropical Medicine and a member of Sage, has said he believes that in terms of healthcare, “some areas are going to be back to the same kind of position they were at the end of March”.
He told BBC Radio 4’s Today programme: “We are struggling at the moment to understand how we’re balancing that imperative of having to prevent healthcare being completely overwhelmed and yet how to mitigate against the damage caused by the intervention, which of course is huge.”

Jesus, I very much hope they're very wrong that daily deaths will reach anywhere near their upper estimate of 690. I can't see us reaching those sort of horrendous figures within just 10 days from now. There are signs that daily deaths and cases may be levelling off this week, though still a chance I think that deaths could unfortunately reach 200 something deaths by 26th October.[/quote]