Exit strategy predictions

[Mogster]

I don't disagree with anything you've said here, but my measure would have to be deaths. According to Johns Hopkins, that's 183,559 so far for covid-19, and we know that's understated because for many countries only hospital deaths are included in the official stats. There's also the fact that most deaths so far are in the Western Democracies with strong healthcare, whereas Ebola deaths were largely in West Africa, which is clearly not as well-placed to deal with viruses.

A more comparable pandemic would be H1N1 Flu in 2009 (swine flu) that caused around 284,000 deaths. However, as this was a variant on a know flu strain, developing a vaccine was relatively rapid (and perhaps more importantly success would have been expected from the off) and the death rate per infection was much lower (0.02%). I think it's clear that, unchecked, covid-19 would cause a lot more deaths than H1N1.

The WHO estimate seasonal flu kills up to 650,000 people a year. Even though the WHO generated mass panic over H1N1 in 2009 2009 turned out to be a very average flu year. The vaccine wasn’t ready in volume until the number of cases had dropped to about 1/4 of the peak so didn’t really have an effect on reducing case numbers. The demographics were very different to CoV2 though, 2009 H1N1 mostly affected younger people.

I got sad news today that my remaining great aunt is in hospital with a severe stroke, she is still alive but it is not believed she will regain consciousness. This isn't something I wanted to hear, but at 90 it wasn't unexpected, and the upside is that it was very quick (certainly I personally want to be fine but old then one day just keel over and die, not live in a home for many years - she was living at home and looking after herself and her dog just fine with occasional family visits and them dropping off her shopping once the shielding started).

If she is tested and tests positive for COVID (doubt they will, but if they did), she'll be down on the figures, even though this seems clearly not to be a COVID death in reality.

What you've also got with people in that position is, let's say she caught COVID 3 months ago and died as a result of that, that has just moved a given death 3 months earlier. So we might well see, along those lines, a reduced general death rate once this is over, because a fair number of the people who would die over the next 12 months of age related issues are dying now of COVID instead.

Sorry to hear about your Aunt.

I think your logic could very well be correct though regarding overall deaths for 2020. I have thought the same.

 

[Bletchleyite]

Sorry to hear about your Aunt.

Thanks, much appreciated (and to others who have said that). It wasn't unexpected at her age but it's still a bit sad.

 

[edwin_m]

Well indeed. There isn't even an attempt at original thought. They should be looking to China, South Korea etc who have either not had to lockdown or who have emerged from lockdown several weeks ago and seem to managing to contain it to very low levels of infection.

Those countries acted very quickly to impose some restrictions, and kept (S Korea) or drove down (China) the numbers to a level where testing and contact tracing by teams of humans was viable. If we want to do the same then we'd have to knock down the new infections to maybe 100 per day. At the moment we have around 4000 hospital admissions per day, so maybe 10000 per day (a guess on my part) new cases with identifiable symptoms. At R0 of 0.7 as currently believed, that would take 13 rounds of re-infection at about a week each.

 

[111-111-1]

I would be absolutely amazed if this was not ongoing. To me the obvious measures are:
- Tables spaced out more than 2m (fortunately in the good weather people can spread into the beer garden)
- Advance reservation
- A request (not enforceable, I know) of only one household per table, so it still won't really work to meet your mates but that's off the agenda for a while anyway
- Table service only, no bar service
- No cash

I don't see that there'd be a huge risk at all with all of those in place.

Pubs tend to be more about groups of friends meeting for a social rather than a household going out for a drink whereas restaurants are a mixture of both so pubs maybe a lot harder to reopen.

Many establishments will be down to around, at a guess, 25% capacity traditional pubs possibly less. I wonder whether some of these places would be viable at that sort of occupancy? Although some staffing levels could be reduced a lot of other costs could well be similar to full occupancy

 

[Mogster]

Those countries acted very quickly to impose some restrictions, and kept (S Korea) or drove down (China) the numbers to a level where testing and contact tracing by teams of humans was viable. If we want to do the same then we'd have to knock down the new infections to maybe 100 per day. At the moment we have around 4000 hospital admissions per day, so maybe 10000 per day (a guess on my part) new cases with identifiable symptoms. At R0 of 0.7 as currently believed, that would take 13 rounds of re-infection at about a week each.

I do wonder if there are other social, genetic, climatic factors at play than the obvious.

Basic hand hygiene and distancing are the things I wonder about. It’s clear from the way cases dropped when we started hand washing and distancing that those measures had a large effect and a big change in peoples behaviour occurred. If people in the large Asian cities were doing these things already, I’ve never travelled there but distancing seem to be a cultural norm with East Asian people, then their public health system had that cultural assistance already.

Here it seems serious cases are biased towards the UK BAME community and there may be genetic factors behind this. If that’s the case are there genetic factors that make East Asians less susceptible?

 

[HH]

As I understand it the ONS 10 day stats include everything, even suspected but unconfirmed Covid cases from care home and community deaths.

For those 10 days, yes. See the problem?

 

[HH]

The WHO estimate seasonal flu kills up to 650,000 people a year.

True, but of course the estimates for unmitigated deaths in this country alone were 250-500k, so we have an excellent reason for the lockdowns.

 

[takno]

True, but of course the estimates for unmitigated deaths in this country alone were 250-500k, so we have an excellent reason for the lockdowns.

The estimates for unmitigated deaths were 450k. 250k was with just social distancing. Of course the figures are from a single report, which is a long way from being robust or peer-reviewed, and is based on a static model of NHS provision. The 250k deaths includes a large number (around 50k) of people dying from other conditions due to lack of access to hospital facilities.

It made a reasonable if rather excitable case for starting a lock-down four weeks ago based on the information and NHS resources available then. In practice, effective triage and pre-intensive care treatment as well as a huge increase in intensive care capability means we haven't run out of NHS capacity. Contrary to the 50k deaths caused by lack of access to the NHS being caused by lack of lockdown, lockdown has actually exacerbated the problems of people not being able to access the NHS for other purposes. The report and the figures in it aren't a month down the line an accurate assessment of what we now think would have happened without lockdown, and they certainly don't tell us anything about maintaining lockdown.

 

[HH]

The estimates for unmitigated deaths were 450k. 250k was with just social distancing. Of course the figures are from a single report, which is a long way from being robust or peer-reviewed, and is based on a static model of NHS provision. The 250k deaths includes a large number (around 50k) of people dying from other conditions due to lack of access to hospital facilities.

It made a reasonable if rather excitable case for starting a lock-down four weeks ago based on the information and NHS resources available then. In practice, effective triage and pre-intensive care treatment as well as a huge increase in intensive care capability means we haven't run out of NHS capacity. Contrary to the 50k deaths caused by lack of access to the NHS being caused by lack of lockdown, lockdown has actually exacerbated the problems of people not being able to access the NHS for other purposes. The report and the figures in it aren't a month down the line an accurate assessment of what we now think would have happened without lockdown, and they certainly don't tell us anything about maintaining lockdown.

All arguably correct, but do you disagree that the number of deaths would have been much larger than normal flu deaths if no action had been taken?

 

[takno]

All arguably correct, but do you disagree that the number of deaths would have been much larger than normal flu deaths if no action had been taken?

There's reason to believe that the numbers won't be much different by the end of the year irrespective of lockdown, because people who have avoided infection so far will inevitably be exposed over the coming months. Our most vulnerable people are in nursing homes anyway, and the massive death rates in nursing homes across the UK and Europe suggest that lockdown is utterly useless in protecting them.

It's possible that actions in the UK bought enough time for the NHS to adapt, although even that may not have as essential as was assumed.

Ultimately my biggest fear at the moment is that governments will find it impossible to climb down. It will be too much to admit that they've utterly crashed their economies and consigned millions across the world to starvation for no gain whatsoever

 

[Meerkat]

There's reason to believe that the numbers won't be much different by the end of the year irrespective of lockdown, because people who have avoided infection so far will inevitably be exposed over the coming months. Our most vulnerable people are in nursing homes anyway, and the massive death rates in nursing homes across the UK and Europe suggest that lockdown is utterly useless in protecting them.

It's possible that actions in the UK bought enough time for the NHS to adapt, although even that may not have as essential as was assumed.

Ultimately my biggest fear at the moment is that governments will find it impossible to climb down. It will be too much to admit that they've utterly crashed their economies and consigned millions across the world to starvation for no gain whatsoever

The gain was to prevent a collapse of the NHS.
It would be bold to say “sod it, we‘ll all get it anyway before a vaccine appears” - the game changer would be effective treatment cutting ICU usage and death rate, and any delay makes containment more viable.
Not locking down was totally politically unviable - remember the outrage that the schools weren’t being closed

 

[HH]

There's reason to believe that the numbers won't be much different by the end of the year irrespective of lockdown, because people who have avoided infection so far will inevitably be exposed over the coming months. Our most vulnerable people are in nursing homes anyway, and the massive death rates in nursing homes across the UK and Europe suggest that lockdown is utterly useless in protecting them.

It's possible that actions in the UK bought enough time for the NHS to adapt, although even that may not have as essential as was assumed.

Ultimately my biggest fear at the moment is that governments will find it impossible to climb down. It will be too much to admit that they've utterly crashed their economies and consigned millions across the world to starvation for no gain whatsoever

If that's your biggest fear then you're a lucky man.

Meanwhile I compare Sweden, who have taken a "do minimum" approach and have over 2000 deaths and compare to Norway, who have taken the common 'lockdown' approach and have less than 200; as neighbours with very similar societies they are a good comparison of the different strategies. Or compare the USA, who had a President in as much denial about covid-19 originally as he does about climate change, and compare them to anybody.

Maybe all these countries will even out in the end, but I don't think so. At some point we will be able to come out of lockdown using test & trace, or we will have a vaccine, or we will find a drug that reduces the mortality rate. Minimising deaths before that time feels like the best strategy.

Care homes are a different matter; by their very nature they are not really locked down. There are lots of staff, some of which (agency) move between homes. Once the virus gets in, their nature again ensures that it will spread rapidly, with inevitable results. I feel that testing is the answer here; hopefully with our new improved capacity that will finally happen. Even then it will be weeks before the effect is seen in numbers of deaths.

 

[takno]

The gain was to prevent a collapse of the NHS.
It would be bold to say “sod it, we‘ll all get it anyway before a vaccine appears” - the game changer would be effective treatment cutting ICU usage and death rate, and any delay makes containment more viable.
Not locking down was totally politically unviable - remember the outrage that the schools weren’t being closed

I do remember that. Mostly led by the press and a few showboating medical types who couldn't get enough of themselves in the papers tearing into the government's response based on essentially nothing. It was hopeless from the government because they annoyed most people by resisting in the first place, and then annoyed people who'd listened to them in the first place with the u-turn

Yes, a treatment that improved ICU outcomes would be a good thing, but we don't appear to be anywhere near having one, and the likely sad death rate suggests that the cure we are so ardently pursuing is worse than the disease. It possibly is bold to say it, but probably shouldn't be

 

[Cowley]

If that's your biggest fear then you're a lucky man.

Meanwhile I compare Sweden, who have taken a "do minimum" approach and have over 2000 deaths and compare to Norway, who have taken the common 'lockdown' approach and have less than 200; as neighbours with very similar societies they are a good comparison of the different strategies. Or compare the USA, who had a President in as much denial about covid-19 originally as he does about climate change, and compare them to anybody.

Maybe all these countries will even out in the end, but I don't think so. At some point we will be able to come out of lockdown using test & trace, or we will have a vaccine, or we will find a drug that reduces the mortality rate. Minimising deaths before that time feels like the best strategy.

Care homes are a different matter; by their very nature they are not really locked down. There are lots of staff, some of which (agency) move between homes. Once the virus gets in, their nature again ensures that it will spread rapidly, with inevitable results. I feel that testing is the answer here; hopefully with our new improved capacity that will finally happen. Even then it will be weeks before the effect is seen in numbers of deaths.

Well said @HH.

 

[takno]

If that's your biggest fear then you're a lucky man.

Meanwhile I compare Sweden, who have taken a "do minimum" approach and have over 2000 deaths and compare to Norway, who have taken the common 'lockdown' approach and have less than 200; as neighbours with very similar societies they are a good comparison of the different strategies. Or compare the USA, who had a President in as much denial about covid-19 originally as he does about climate change, and compare them to anybody.

Maybe all these countries will even out in the end, but I don't think so. At some point we will be able to come out of lockdown using test & trace, or we will have a vaccine, or we will find a drug that reduces the mortality rate. Minimising deaths before that time feels like the best strategy.

Care homes are a different matter; by their very nature they are not really locked down. There are lots of staff, some of which (agency) move between homes. Once the virus gets in, their nature again ensures that it will spread rapidly, with inevitable results. I feel that testing is the answer here; hopefully with our new improved capacity that will finally happen. Even then it will be weeks before the effect is seen in numbers of deaths.

Noteworthy of course that Norway is more like the rural parts of Sweden than it is Sweden in general, and has a significantly smaller population. Norway also has much smaller nursing homes which are less open to the wider world than those in Sweden. Since, as with most of Europe, a huge proportion of Sweden's deaths have been in nursing homes, that is an important factor. In the real world Sweden is doing reasonably well out of its do-nothing policy, and certainly better than us, while Norway and Denmark are trying to figure out how to back out of the corner they've painted themselves into

 

[HH]

Noteworthy of course that Norway is more like the rural parts of Sweden than it is Sweden in general, and has a significantly smaller population. Norway also has much smaller nursing homes which are less open to the wider world than those in Sweden. Since, as with most of Europe, a huge proportion of Sweden's deaths have been in nursing homes, that is an important factor. In the real world Sweden is doing reasonably well out of its do-nothing policy, and certainly better than us, while Norway and Denmark are trying to figure out how to back out of the corner they've painted themselves into

The population of Sweden is not even double that of Norway, Sweden is 450k sqkm vs Norway's 385k sqkm, plus it has much more space in the more temperate south, so your claim is somewhat disingenuous. Equally Denmark has a considerably higher population density than Sweden and <400 deaths.

Thankfully the Swedes are sensible enough to be taking some actions themselves, or the numbers would be much worse.

 

[yorksrob]

Ultimately Sweden is undoubtedly worth studying for clues into how we can ease lockdown without crashing the health service.

What Sweden is doing is sustainable over the longer term, which lockdowns obviously aren't.

 

[yorkie]

Ultimately Sweden is undoubtedly worth studying for clues into how we can ease lockdown without crashing the health service.

What Sweden is doing is sustainable over the longer term, which lockdowns obviously aren't.

Yes it sounds promising so far, but still early days. I think that it's too early to say which strategy is going to be best.

Sweden resisted a lockdown, and its capital Stockholm is expected to reach 'herd immunity' in weeks

Sweden went against the grain by keeping public life as unrestricted as possible when the coronavirus hit. Now, it says its strategy appears to be working.

www.cnbc.com

“In major parts of Sweden, around Stockholm, we have reached a plateau (in new cases) and we’re already seeing the effect of herd immunity and in a few weeks’ time we’ll see even more of the effects of that. And in the rest of the country, the situation is stable,” Dr. Anders Tegnell, chief epidemiologist at Sweden’s Public Health Agency, told CNBC on Tuesday...

...″(But) if you look at the exit strategies that now many countries have opted for, they look very much like Sweden’s (strategy and restrictions),” he said....

We should know in a few weeks' time.

 

[duncanp]

I would be absolutely amazed if this was not ongoing. To me the obvious measures are:
- Tables spaced out more than 2m (fortunately in the good weather people can spread into the beer garden)
- Advance reservation
- A request (not enforceable, I know) of only one household per table, so it still won't really work to meet your mates but that's off the agenda for a while anyway
- Table service only, no bar service
- No cash

It is worth noting that the WHO guidelines for social distancing say that a distance of 1 metre is safe, and this is the limit that has been imposed in France. In Germany it is 1.5 metres.

I think that as part of easing the lockdown, it may be appropriate to reduce the social distancing limit to 1 metre or 1.5 metres, or perhaps to have a variable limit depending on the type of establishment.

I think it would be better to re-open pubs, restaurants and cafes in the summer, as the good weather and light evenings mean that people can occupy outside tables, or to drink outside in the street where this is permitted by the licence.

For pubs I would have the following rules:-

• Hand sanitiser to be available at the bar. Customers must use the sanitiser when they enter the pub otherwise they won't get served.
• No standing at the bar
• If standing whilst drinking is allowed, then this must take place in designated standing areas that allow sufficient space away from other customers.
• Tables to be spaced at a minimum distance of 1 metre from each other.
• A system of reservations or tickets at busy times (ie Friday and Saturday nights) similar to what many pubs do on New Year's Eve.
• Each pub to have a maximum number of customers present at any one time.
• Card payment encouraged, but cash still accepted if the customer prefers. Bar staff can wear gloves when serving customers or handling cash, and clean their hands with sanitiser frequently.
• Tables and surfaces to be cleaned when empty glasses are collected. (Many pubs do this already)
• People encouraged to come at less busy times of the day or days of the week, possibly by having a happy hour.

Every pub (and also cafe and restaurant) is different, and what is appropriate for a small village pub may not be appropriate for a busy pub such as the Wetherspoons at Liverpool Street station.

 

[chris11256]

More details from Wales today. First Minister confirmed it'll be a traffic light type system and he hopes that with numbers going the way they are, Wales can loosen to the 'Red' Stage at the end of the current 3 week period.

 

[Mojo]

Guido Fawkes this morning shares its assumptions on the lockdown exit strategy phase one, which sounds quite sensible and in line with what many other commentators are suggesting. In particular the U-turn on masks and allowing some (or all; that bit is not clear) nonessential shops to open, but not pubs etc.

Lockdown Wind Down Plan To Be Announced By End of Week

This week the Government will respond to mounting pressure to reveal how the lockdown will be wound down. Talks with the Labour Party are due in the next

order-order.com

This week the Government will respond to mounting pressure to reveal how the lockdown will be wound down. Talks with the Labour Party are due in the next couple of days, and the public can expect an announcement of sorts by the end of the week. In yesterday’s Downing Street address, the Prime Minister said:

“the government will be saying much more about [winding down the lockdown] in the coming days and I want to serve notice now that these decisions will be taken with the maximum possible transparency”

Senior figures had previously taken great pains to not reveal wind down thinking in order to not ‘complicate communications’.

Widespread speculation of liberalisation measures include allowing non-essential shops to open, albeit with strict social distancing measures, as well as allowing an expanded definition of a household to facilitate people being able to see some friends and family.

The Government is also expected to U-turn on face masks, perhaps to promote the public wear home made non-medical masks when out and about following the path of many other Western countries. This week Germany went from not recommending masks to fining citizens who do not wear one. The US is notably promoting wearing them too. This morning Matt Hancock emphasised social distancing is more “important” than masks, already a slight shift in tone from the Government’s earlier impression that masks do not work.

 

[Bantamzen]

Guido Fawkes this morning shares its assumptions on the lockdown exit strategy phase one, which sounds quite sensible and in line with what many other commentators are suggesting. In particular the U-turn on masks and allowing some (or all; that bit is not clear) nonessential shops to open, but not pubs etc.

Lockdown Wind Down Plan To Be Announced By End of Week

This week the Government will respond to mounting pressure to reveal how the lockdown will be wound down. Talks with the Labour Party are due in the next

order-order.com

It would certainly be good news if in the near future people would be able to see at least some friends and family. However the "home made mask" idea is a mockery in itself, if a face covering cannot be medicinally proven to work, what exactly is the point? You either go full medical mask requirement, something I don't endorse for a variety of reasons, or you don't bother at all. This solution smacks of some half-way house solution, designed to give the impression of doing something without actually, well doing something.

 

[trebor79]

It would certainly be good news if in the near future people would be able to see at least some friends and family. However the "home made mask" idea is a mockery in itself, if a face covering cannot be medicinally proven to work, what exactly is the point? You either go full medical mask requirement, something I don't endorse for a variety of reasons, or you don't bother at all. This solution smacks of some half-way house solution, designed to give the impression of doing something without actually, well doing something.

Indeed. Flipping from not recommending to fining if you don't with a few days just demonstrates the absurdity of it.

 

[Tomp94]

I wonder when “non essential” travel will be allowed again!
..... I haven’t been on a train in 6 weeks!

 

[Meerkat]

Is there any public consensus behind masks or is it just the noisy vigilantes?
if there was public support I would have thought there would already be more than the minority who currently wear them??

 

[Huntergreed]

I wonder when “non essential” travel will be allowed again!
..... I haven’t been on a train in 6 weeks!

I would sadly imagine that this will be off the cards for quite some time, especially on public transport, as this could encourage a large group of people into a small space which, if occurring regularly throughout the country, could potentially push the 'R' value up, potentially beyond one without some clever intervention. How they will do this though, I'm not quite sure.

 

[Meerkat]

Inessential long distance travel not only puts people into a relatively small area for some time, but mixes them up too, as people get on and off at midpoints. That’s some tricky contact tracing.

 

[yorksrob]

I would sadly imagine that this will be off the cards for quite some time, especially on public transport, as this could encourage a large group of people into a small space which, if occurring regularly throughout the country, could potentially push the 'R' value up, potentially beyond one without some clever intervention. How they will do this though, I'm not quite sure.

Well, I'll need to visit friends and family somehow, so they'll have to come up with the clever intervention.

 

[Bantamzen]

Is there any public consensus behind masks or is it just the noisy vigilantes?
if there was public support I would have thought there would already be more than the minority who currently wear them??

Its totally anecdotal evidence, but like you my view is that most people I see are not wearing them even for supermarkets. If pushed I'd say no more than 10% do, if that. But it is anecdotal.

I'm afraid my suspicions are rather cynically that the #masks4all and similar hashtags that are circulating originate from the mask / clothing industry. The WHO still hold the opinion that masks are not particularly helpful in slowing the spread to healthy people, although there is maybe more merit for people wearing them who are showing symptoms. However home-made ones may not be as effective as medical ones, there really is nowhere near enough evidence that they afford anything like as much protection to others in where people have symptoms.

 

[Mojo]

Is there any public consensus behind masks or is it just the noisy vigilantes?
if there was public support I would have thought there would already be more than the minority who currently wear them??

I noticed in the first month or so of this really kicking off the only people wearing masks looked foreign, but since the lockdown there have been a lot more white British people wearing them as well, although it seems to be the older generation in the latter category.