Has the COVID Crisis changed our attitude to risk?

[Bletchleyite]

Sweden would disagree.

Does Sweden have an exit strategy? I've not seen one. They do, despite what people are saying, have some restrictions in place.

 

[MikeWM]

Does Sweden have an exit strategy? I've not seen one. They do, despite what people are saying, have some restrictions in place.

Indeed they did/do have some (relatively minor) restrictions, and there was significant compliance further than legally necessary (our Stockholm office closed for a while, for example, though it has reopened now).

I'm not sure if they have an exit strategy. Presumably when hospitalisations/deaths fall below a certain level they will feel it is ok to remove the remaining restrictions.

Looking at where they are now is very interesting. ICU use and deaths continue to fall, whereas cases are continuing to increase, which has been the case for many weeks now. I guess that shows the impact of increased testing, and/or testing picking up less severe cases, and/or the virus weakening.

 

[DB]

Indeed they did/do have some (relatively minor) restrictions, and there was significant compliance further than legally necessary (our Stockholm office closed for a while, for example, though it has reopened now).

I'm not sure if they have an exit strategy. Presumably when hospitalisations/deaths fall below a certain level they will feel it is ok to remove the remaining restrictions.

Looking at where they are now is very interesting. ICU use and deaths continue to fall, whereas cases are continuing to increase, which has been the case for many weeks now. I guess that shows the impact of increased testing, and/or testing picking up less severe cases, and/or the virus weakening.

Surely, the Swedish approach is aimed at building a herd immunity, which is itself an exit strategy?

 

[Starmill]

I wish that the risks from pollution and road traffic accidents were taken more seriously and tolerated less. Unfortunately, Covid-19 seems to be having next to no effect on our tolerance for these risks. Indeed, many people who demand the right to drive where and when they please (rather than only as they really need to) thus causing a great deal of harm to themselves and other people, are the same ones who demanded people should stay at home.

 

[DB]

I wish that the risks from pollution and road traffic accidents were taken more seriously and tolerated less. Unfortunately, Covid-19 seems to be having next to no effect on our tolerance for these risks. Indeed, many people who demand the right to drive where and when they please (rather than only as they really need to) thus causing a great deal of harm to themselves and other people, are the same ones who demanded people should stay at home.

And the policy of discouraging use of public transport is only making that particular issue worse!

 

[Tetchytyke]

Indeed, it's so severe that lots of people have symptoms so mild that they don't even notice that they've had it!

If you'd bothered to quote my next sentence in that post, which said precisely that, it would aid your understanding.

As I've repeatedly said, it's hard to model risk for a disease that might give you no or few symptoms, or might leave you in a medically-induced coma fighting for your life.

mitigation-without-lockdown plan that Sweden has followed.

You keep mentioning Sweden, yet the death rate in Stockholm (80 per 100,000) is significantly higher than that in the UK (about 55 per 100,000). It's also way more than in neighbouring Nordic countries.

Sweden also locked down far more than you seem to believe, with declines in mass transport usage broadly the same as the rest of Europe.

I wouldn't expect a UK model to transpose neatly on to other countries, with different healthcare systems, different underlying wellbeing, and different levels of poverty. So what happened elsewhere doesn't change the effect of what would have happened here.

You can't seriously believe that the death rate would have been the same in the UK if the government had just said "do what you want"?

 

[MikeWM]

You keep mentioning Sweden, yet the death rate in Stockholm (80 per 100,000) is significantly higher than that in the UK (about 55 per 100,000). It's also way more than in neighbouring Nordic countries.

Not sure it is especially helpful to compare a city with a country. We have a good idea now that pollution, for example, affects outcomes.

Sweden also locked down far more than you seem to believe, with declines in mass transport usage broadly the same as the rest of Europe.

I'm not sure that's the case, eg.
https://covidgraph.com/#mobility
covers car usage.

Public transport use seems harder to find, but eg.
https://www.apple.com/covid19/mobility
shows a much smaller fall than anywhere else - and back to normal now.

I wouldn't expect a UK model to transpose neatly on to other countries, with different healthcare systems, different underlying wellbeing, and different levels of poverty. So what happened elsewhere doesn't change the effect of what would have happened here.

I think that's partly true, but I think you're giving the model more credit than it is due if you think it took many of those things into account. From what I saw of Ferguson's model, it did try to take into account population density, but not much else.

You can't seriously believe that the death rate would have been the same in the UK if the government had just said "do what you want"?

I think if we'd properly protected care homes, hospitals, the vulnerable, and those working with and caring for the vulnerable, and told everyone else to 'do what you want', we'd be in no worse a position at the end of this than we will be. Probably better, because there would have been fewer deaths in care homes, and many fewer deaths from the side-effects of lockdown.

 

[bramling]

If you'd bothered to quote my next sentence in that post, which said precisely that, it would aid your understanding.

As I've repeatedly said, it's hard to model risk for a disease that might give you no or few symptoms, or might leave you in a medically-induced coma fighting for your life.



You keep mentioning Sweden, yet the death rate in Stockholm (80 per 100,000) is significantly higher than that in the UK (about 55 per 100,000). It's also way more than in neighbouring Nordic countries.

Sweden also locked down far more than you seem to believe, with declines in mass transport usage broadly the same as the rest of Europe.

I wouldn't expect a UK model to transpose neatly on to other countries, with different healthcare systems, different underlying wellbeing, and different levels of poverty. So what happened elsewhere doesn't change the effect of what would have happened here.

You can't seriously believe that the death rate would have been the same in the UK if the government had just said "do what you want"?

The above I think expresses well why it’s ultimately quite hard to assess risk when there are so many unknowns about the virus itself, and how it behaves.

 

[Tetchytyke]

I think if we'd properly protected care homes, hospitals, the vulnerable, and those working with and caring for the vulnerable, and told everyone else to 'do what you want', we'd be in no worse a position at the end of this than we will be.

But that depends where you draw the line. Locking down care homes, yep. But what about staff? What about their partners? Children?

Locking down a care home doesn't do much if the kids have to go to school, and the care staff catches it off their kids. Or their partner catches it at work from the lad at the next desk and brings it home. And the more it's in general circulation, the bigger chance of spread.

This is the dilemma, and I'm not sure where the line is. I don't necessarily disagree with you, I'm just not sure it's quite that simple.

The above I think expresses well why it’s ultimately quite hard to assess risk when there are so many unknowns about the virus itself, and how it behaves.

Thank you.

As a man in my 30s I'm low risk, but I'm overweight. My weight puts me more at risk, but how much more? I think I'd be ok if I caught it, but can I be sure? Really sure? I've got two kids and a wife to think about.

I'm comfortable with the risk after sensible mitigation- wash my hands, don't lick the door handles, the usual. Just as I am with driving (don't go too fast, wear a seatbelt, check the tyres) and cycling (wear a helmet, wear a hi-viz cycling jacket). But presumably all the other men my age were doing the same thing, and they still caught it, and still died of it. It's hard to assess risk sometimes.

I can't think of many other viruses that spread without symptoms so much. You generally know if you've got flu, even a common cold. @MikeWM mentioned norovirus. I've had that a few times, I really knew about it each and every time.

 

[Yew]

I think if we'd properly protected care homes, hospitals, the vulnerable, and those working with and caring for the vulnerable, and told everyone else to 'do what you want', we'd be in no worse a position at the end of this than we will be. Probably better, because there would have been fewer deaths in care homes, and many fewer deaths from the side-effects of lockdown.

Unfortunately, to paraphrase Peter Drucker, what gets measured gets done, and the only thing we're measuring is deaths.

 

[MikeWM]

But that depends where you draw the line. Locking down care homes, yep. But what about staff? What about their partners? Children?

Locking down a care home doesn't do much if the kids have to go to school, and the care staff catches it off their kids. Or their partner catches it at work from the lad at the next desk and brings it home. And the more it's in general circulation, the bigger chance of spread.

This is the dilemma, and I'm not sure where the line is. I don't necessarily disagree with you, I'm just not sure it's quite that simple.

I think you lock them down as hard as possible - offer massive financial incentives for the staff to bubble for a few months. Hard on them, but enough money should persuade most. Would be much cheaper than the money we've spent on furloughing. It wouldn't be perfect but much better than what we did. And when the healthy population get to herd immunity, you can let them get back to normal too.

As a man in my 30s I'm low risk, but I'm overweight. My weight puts me more at risk, but how much more? I think I'd be ok if I caught it, but can I be sure? Really sure? I've got two kids and a wife to think about.

I'm in my early 40s with (controlled) high blood pressure, mild asthma and a slightly odd immune system. So I'm at higher risk than many others my age. But what happens, happens. As long as you're not being actively reckless I've always believed you just have to get on with life and see what happens. I've changed nothing about what I do, apart from the things I've been forced to do (such as no longer commuting on the railway).

I can't think of many other viruses that spread without symptoms so much. You generally know if you've got flu, even a common cold.

It would be helpful, but I'm not sure that's actually the case, with flu at least. I posted this in a different thread yesterday:

https://www.influenza.org.nz/sites/default/files/Asymptomatic influenza transmission 20170421.pdf

Influenza transmission by infected but asymptomatic people

Influenza is caused by different strains of influenza viruses. The ability to spread influenza viruses and infect others is usually equated to how much influenza virus is shed by an infected person.

Exposure to influenza virus can lead to infection but not every infected person will have symptoms or feel unwell.

Studies have compared viral shedding by asymptomatic individuals, i.e. those who are infected but have no symptoms, with symptomatic individuals, i.e. those who are infected and have symptoms such as fever, sore throat, muscles aches and pains. Viral shedding by asymptomatic persons occurs for around 3–4 days and by symptomatic persons for around five days. The amount of virus shed by asymptomatic persons was only slightly less than that shed by those with symptoms.

Asymptomatic persons shed influenza virus and can infect others despite a seemingly more robust immune response to infection that stops development of symptoms.

(emphasis mine)

@MikeWM mentioned norovirus. I've had that a few times, I really knew about it each and every time.

Only once in my case - but yes, I certainly knew about it!

 

[Bletchleyite]

I can't think of many other viruses that spread without symptoms so much. You generally know if you've got flu, even a common cold. @MikeWM mentioned norovirus. I've had that a few times, I really knew about it each and every time.

Chickenpox is the classic. Not quite as deadly, though.

 

[scarby]

Does Sweden have an exit strategy? I've not seen one. They do, despite what people are saying, have some restrictions in place.

The exit happens when the outbreak curbs itself/dies out - which is what is happening.

Otherwise less strategy is needed as most things didn’t close to begin with.

 

[AdamWW]

No, it isn't present on your island, it is not eradicated. In order to guarantee it never returns, you will have to stay completely isolated, i.e. no movement on or off it, until the virus in declared extinct globally. For reference only 2 viruses have been completely wiped out of the eco-system, Smallpox & Rinderpest. So you may be stuck for some time.....

Movement off New Zealand is fine, so long as nobody comes back...

If you can't describe it as being eradicated in an area because someone might bring it in later, the word has no meaning except when applied to the entire planet.

 

[Bletchleyite]

Movement off New Zealand is fine, so long as nobody comes back...

You don't need to do that, you just need a robust quarantine system including multiple tests during that period.

Would you not say the UK has effectively eradicated rabies by way of, er, a quarantine system?

 

[DB]

You don't need to do that, you just need a robust quarantine system including multiple tests during that period.

Would you not say the UK has effectively eradicated rabies by way of, er, a quarantine system?

Rabies doesn't spread easily, so keeping it out by quarantining potential carriers is fairly straightforward. That simply doesn't apply to this type of virus.

 

[Skymonster]

Would you not say the UK has effectively eradicated rabies by way of, er, a quarantine system?

UK has not eradicated rabies - it has merely prevented it from getting here (I.e. it is rabies free at the moment). Likewise New Zealand has not eradicated the virus - it has merely prevented it from getting into the country so far. But that comes as the expense of effectively imprisoning it’s population until a vaccine is found because the moment it opens its doors its at risk, which could be never. Some restrictions are just not worth it...

 

[Bletchleyite]

UK has not eradicated rabies - it has merely prevented it from getting here (I.e. it is rabies free at the moment). Likewise New Zealand has not eradicated the virus - it has merely prevented it from getting into the country so far. But that comes as the expense of effectively imprisoning it’s population until a vaccine is found because the moment it opens its doors its at risk, which could be never. Some restrictions are just not worth it...

I suppose where we differ is that I think it is worth it, because if we could fully restart our domestic business and social activities to "the old normal" I would accept the inability to travel internationally for a few years.

 

[Djgr]

But that depends where you draw the line. Locking down care homes, yep. But what about staff? What about their partners? Children?

Locking down a care home doesn't do much if the kids have to go to school, and the care staff catches it off their kids. Or their partner catches it at work from the lad at the next desk and brings it home. And the more it's in general circulation, the bigger chance of spread.

This is the dilemma, and I'm not sure where the line is. I don't necessarily disagree with you, I'm just not sure it's quite that simple.



Thank you.

As a man in my 30s I'm low risk, but I'm overweight. My weight puts me more at risk, but how much more? I think I'd be ok if I caught it, but can I be sure? Really sure? I've got two kids and a wife to think about.

I'm comfortable with the risk after sensible mitigation- wash my hands, don't lick the door handles, the usual. Just as I am with driving (don't go too fast, wear a seatbelt, check the tyres) and cycling (wear a helmet, wear a hi-viz cycling jacket). But presumably all the other men my age were doing the same thing, and they still caught it, and still died of it. It's hard to assess risk sometimes.

I can't think of many other viruses that spread without symptoms so much. You generally know if you've got flu, even a common cold. @MikeWM mentioned norovirus. I've had that a few times, I really knew about it each and every time.

The number of deaths in your age band with no pre-existing health condition is virtually nil. You are almost certainly more at risk crossing a busy road.

 

[AdamWW]

UK has not eradicated rabies - it has merely prevented it from getting here (I.e. it is rabies free at the moment). Likewise New Zealand has not eradicated the virus - it has merely prevented it from getting into the country so far. But that comes as the expense of effectively imprisoning it’s population until a vaccine is found because the moment it opens its doors its at risk, which could be never. Some restrictions are just not worth it...

Am I the only person here who thinks that "Country X has eradicated virus Y" means that it has been completely removed from Country X, even though it could come back in again from elsewhere?

By that logic surely we never eradicate a virus unless every single copy of the RNA/DNA sequence is destroyed, because otherwise somebody could recreate it and let it loose?

The UK hasn't eradicated rabies worldwide, but it's eradicated it in the UK. by my definition.

 

[AdamWW]

You don't need to do that, you just need a robust quarantine system including multiple tests during that period.

Would you not say the UK has effectively eradicated rabies by way of, er, a quarantine system?

I wasn't the one suggesting banning movement; someone said that to keep coronavirus out of NZ you'd need to ban all travel in and out and I was just being pedantic and pointing out that letting people out isn't a problem in itself.

 

[LAX54]

The number of deaths in your age band with no pre-existing health condition is virtually nil. You are almost certainly more at risk crossing a busy road.

Think deaths in most band groups are in reality really minimal, unless you have a pre-existing issue that may affect it, BUT that would also affect you if you had a cold or flu ! there was a documentary on Tv last week, or maybe the week before, that Italy have said they may have over egged the reaction, and that many of those 'elderly' that died would have died with flu too.

 

[AdamWW]

Think deaths in most band groups are in reality really minimal, unless you have a pre-existing issue that may affect it, BUT that would also affect you if you had a cold or flu ! there was a documentary on Tv last week, or maybe the week before, that Italy have said they may have over egged the reaction, and that many of those 'elderly' that died would have died with flu too.

I do not believe that the pre-existing conditions which seem to result in Covid-19 deaths are likely to kill someone if they just get a cold.

I'd be very interested in evidence to the contrary.

If so it doesn't really explain why we've seen so many deaths.

 

[LAX54]

I do not believe that the pre-existing conditions which seem to result in Covid-19 deaths are likely to kill someone if they just get a cold.

I'd be very interested in evidence to the contrary.

If so it doesn't really explain why we've seen so many deaths.

Maybe not a cold, but normal flu definately, as for why so many, there is only 1 country in Europe that has a higher poulation, France is close, but Spain is miles away 46 million to our 68 milltion, the bigger the population the higer the score.

 

[AdamWW]

Maybe not a cold, but normal flu definately, as for why so many, there is only 1 country in Europe that has a higher poulation, France is close, but Spain is miles away 46 million to our 68 milltion, the bigger the population the higer the score.

Do you have something you can link to in order to substantiate that?

I thought the Covid fatality rate was somewhat higher than for flu.

 

[bramling]

I do not believe that the pre-existing conditions which seem to result in Covid-19 deaths are likely to kill someone if they just get a cold.

I'd be very interested in evidence to the contrary.

If so it doesn't really explain why we've seen so many deaths.

I’ve heard it suggested that the last couple of winters have had fairly benign flu seasons, thus carrying over excess deaths from these years to 2020. I don’t claim to know enough about this to offer my own opinion as to whether that’s true or not.

 

[LAX54]

I’ve heard it suggested that the last couple of winters have had fairly benign flu seasons, thus carrying over excess deaths from these years to 2020. I don’t claim to know enough about this to offer my own opinion as to whether that’s true or not.

2018: 50,000

 

[LAX54]

Do you have something you can link to in order to substantiate that?

I thought the Covid fatality rate was somewhat higher than for flu.

Google gives in millions: FRANCE: 66. GERMANY: 83. HOLLAND: 11: USA: 330. AUSTRIA: 9. ITALY: 60 UK: 68

 

[MikeWM]

I’ve heard it suggested that the last couple of winters have had fairly benign flu seasons, thus carrying over excess deaths from these years to 2020. I don’t claim to know enough about this to offer my own opinion as to whether that’s true or not.

See table on page 51 of this official document:
https://assets.publishing.service.g...tory_viruses_in_the_UK_2018_to_2019-FINAL.pdf

2014-15 : 28,330
2015-16 : 11,875
2016-17 : 18,009
2017-18 : 26,408
2018-19 : 1,692

So the previous winter was *very* low historically.

 

[LAX54]

See table on page 51 of this official document:
https://assets.publishing.service.g...tory_viruses_in_the_UK_2018_to_2019-FINAL.pdf

2014-15 : 28,330
2015-16 : 11,875
2016-17 : 18,009
2017-18 : 26,408
2018-19 : 1,692

So the previous winter was *very* low historically.

Whilst not deaths, I see part of that report is quite revealing: "The peak activity in 2018 to 2019 was much lower compared to the previous season in 2017 to 2018 (54.1 per 100,000 in week 03 2018)".