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Possible reasons why the R value is lower than expected in some places

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brad465

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It also doesn't tally with Italy and Spain, Southern European countries that are typically considerably warmer than any part of the UK.
Most of the deaths in Italy were in Lombardy and in Spain were in Madrid, neither of which are very warm or sunny in February or early March. Numbers in both are down very significantly since then.
Ditto takno, believe it or not the maritime influence in our climate means we are as warm or only slightly colder than northern med areas, where Portugal tends to be milder than much of Europe. Madrid is also on a 650-700m high plateau in central Spain, which while not as extreme as highland climates in places like Mexico and Ethiopia, this makes a difference to temperatures in central Spain, especially in winter, so a cold thriving virus can still easily spread here.
 
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MarkyT

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Most of the deaths in Italy were in Lombardy and in Spain were in Madrid, neither of which are very warm or sunny in February or early March. Numbers in both are down very significantly since then.
After extremely strict lockdowns and only recent easing with strict conditions on distancing and face covering. I assume comprehensive testing and contact tracing arrangements are in place by now as well.
 

Qwerty133

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Could it be that the level of infrastructure (shops etc) in London is such that it is currently functioning as a large number of smaller localities with little crossover of people between localities meaning the virus has little chance to cross into new parts of the capital and the parts where it is already established are reaching heard immunity. In other parts of the country people have no choice but continue to shop several miles away from home and in many cases the direction in which people choose to travel to go shopping is not homogeneous meaning it doesn't take many transmissions for the virus to spread hundreds of miles.
 

Mikey C

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As London was first part of the country to be badly affected, it makes sense to me that 2 months down the line, the R0 value will now be lower in London now than in many other parts of the country which got it later

My part of NW London was very badly affected in March, at a time when in the regions there were virtually no cases
 

yorksrob

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As London was first part of the country to be badly affected, it makes sense to me that 2 months down the line, the R0 value will now be lower in London now than in many other parts of the country which got it later

My part of NW London was very badly affected in March, at a time when in the regions there were virtually no cases

It seems counterintuitive to me though. Because the lockdown was imposed across the country at the same time, I would have thought that London should have taken longer to come down from a higher level and rate of infection than everywhere else.
 

Mikey C

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It seems counterintuitive to me though. Because the lockdown was imposed across the country at the same time, I would have thought that London should have taken longer to come down from a higher level and rate of infection than everywhere else.
But then you imagine that many London care homes will already have suffered infection already (and the horrible death rate) whereas care homes elsewhere in the country are still in that phase.
 

yorksrob

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But then you imagine that many London care homes will already have suffered infection already (and the horrible death rate) whereas care homes elsewhere in the country are still in that phase.

I suppose that may be the case - if the infection rate is mainly driven by care homes. I'm assuming that there's still a higher rate of transmission in the wider community outside London though.
 

DynamicSpirit

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It seems counterintuitive to me though. Because the lockdown was imposed across the country at the same time, I would have thought that London should have taken longer to come down from a higher level and rate of infection than everywhere else.

We're talking about London having a lower rate of transmission per person (the R number). The R number has (to a first approximation) nothing to do with how many people who currently have the disease [*]: It's a measure of how many people each infected person passes the virus to, on average.

[*] More accurately, if a large number of people in an area had already been infected, that is likely to reduce (not increase) the R number because those previously infected people are likely to be immune, and that tends to reduce the numbers of people that one infected person can pass the virus on to.
 

yorksrob

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We're talking about London having a lower rate of transmission per person (the R number). The R number has (to a first approximation) nothing to do with how many people who currently have the disease [*]: It's a measure of how many people each infected person passes the virus to, on average.

[*] More accurately, if a large number of people in an area had already been infected, that is likely to reduce (not increase) the R number because those previously infected people are likely to be immune, and that tends to reduce the numbers of people that one infected person can pass the virus on to.

Exactly. Therefore if everyone locks down at the same time, you would expect transmission to fall at the same rate due to fewer opportunities to transmit. In that scenario, you wouldn't expect somewhere with higher transmission to overtake somewhere with lower transmission in slowing down.
 

DynamicSpirit

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Exactly. Therefore if everyone locks down at the same time, you would expect transmission to fall at the same rate due to fewer opportunities to transmit. In that scenario, you wouldn't expect somewhere with higher transmission to overtake somewhere with lower transmission in slowing down.

But as far as I'm aware there's no reason to believe that London ever did have a higher transmission rate per person than the rest of the country. Back in March, it had a higher absolute number of infections (per person), (probably) NOT a higher transmission rate per person.
 

yorksrob

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But as far as I'm aware there's no reason to believe that London ever did have a higher transmission rate per person than the rest of the country. Back in March, it had a higher absolute number of infections (per person), (probably) NOT a higher transmission rate per person.

Then after the lockdown, you would expect the transmission rate to decline at the same rate. London didn't have a lower transission rate than the NE in March.
 

DynamicSpirit

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Then after the lockdown, you would expect the transmission rate to decline at the same rate. London didn't have a lower transission rate than the NE in March.

Yep. And that's then where the puzzle is. A few people in this thread have mad suggestions for why London might see the transmission rate decline faster, and most of those suggestions seem plausible as minor factors, but none of them seem to me to explain the very substantial difference that's been reported, so I'm somewhat puzzled. Maybe it's a combination of those factors. As other possibilities, mMaybe also the relatively cosmopolitan, well educated, population in London has responded to the lockdown more enthusiastically on average than other places? Maybe the reported difference between London and the rest of the country is an overestimate?

EDIT: Also just occurred to me.... I wonder if London has a higher proportion of office workers and people in IT who can easily work from home compared to the rest of the country? Also, a higher proportion of single people who therefore can't transmit it to their families (although balanced by a higher proportion of people in shared houses).
 

yorksrob

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Yep. And that's then where the puzzle is. A few people in this thread have mad suggestions for why London might see the transmission rate decline faster, and most of those suggestions seem plausible as minor factors, but none of them seem to me to explain the very substantial difference that's been reported, so I'm somewhat puzzled. Maybe it's a combination of those factors. Maybe also the relatively cosmopolitan, well educated, population in London has responded to the lockdown more enthusiastically on average than other places? Maybe the reported difference between London and the rest of the country is an overestimate?

Exactly - it is to me as well.

And I can't speak for the whole country because I haven't been anywhere else for the past two months, but in my Yorkshire town the streets have been dead.
 

Bantamzen

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As London was first part of the country to be badly affected, it makes sense to me that 2 months down the line, the R0 value will now be lower in London now than in many other parts of the country which got it later

My part of NW London was very badly affected in March, at a time when in the regions there were virtually no cases

This may not be totally accurate:


Dr John Wright of Bradford Royal Infirmary is intrigued by a group of amateur singers who experienced a viral illness with familiar symptoms long before the first recorded case in the UK.

One of the unexpected benefits of Covid-19 is that, finally, everyone knows what an epidemiologist does. I no longer get mixed up with a dermatologist and asked to look at people's skin rashes.

An epidemiologist is a medical detective, and like all detectives, the three key clues we are looking for are always: person, place and time.

So when I got an email out of the blue from a Bradford resident saying that she and her friends may have been infected with Covid-19 in January - nearly two months before the first confirmed case of transmission in the UK - I looked for these clues and decided to investigate further.

Jane Hall is a member of two choirs - the Voices of Yorkshire choir and the All Together Now Community Choir - and she says that Covid-like symptoms affected members of both, starting in early January.

Among the first singers to get ill was the partner of a man who returned from a business trip to Wuhan on 17 or 18 December and developed a hacking cough.

"My friend from the choir became ill mid-January. Then my best friend, Christine, became ill, and then I became ill in the first weekend of February," Jane said.

She went on to describe her symptoms.

"I had a throat that felt like I had swallowed broken glass, a high temperature, headaches... I was totally fatigued - I slept for two whole days which was totally unlike me. I had a high temperature and a dry unproductive cough."

With the passing of time, a new symptom emerged.

"It was like breathing through treacle - I was really struggling to breathe and it felt like there was a lot of gunk I was trying to breathe through."

Prof John Wright, a medical doctor and epidemiologist, is head of the Bradford Institute for Health Research, and a veteran of cholera, HIV and Ebola epidemics in sub-Saharan Africa. He is writing this diary for BBC News and recording from the hospital wards for BBC Radio 4's The NHS Front Line

And later Jane noticed yet another symptom - an impaired sense of smell. Already on the mend, she visited her friend, Simon, a member of the All Together Now Community choir, who was also ailing. She made him a hot drink.

"And the milk curdled when I put milk in the tea. And I said, 'Oh, isn't the milk off?' And he said, 'Oh well, I had some this morning and it did the same but I couldn't taste any different.' So I smelled the milk, and I couldn't smell anything. And I couldn't understand how come I couldn't smell it - the milk was off."

Jane was describing some of the classical symptoms people can experience with Covid-19. On most occasions when people contact me to say they had an illness like this last year, I reassure them that it was probably a different viral infection. But Jane's story, with the link to Wuhan in mid-December, is very interesting.

Chris Kemp, who runs the All Together Now Community Choirs, was also among the first to get ill, with a cough and a feeling of exhaustion. He says he first felt poorly on 27 December, and didn't feel properly better until early February.

A singer in the choir, Suzanne Smith, points out that its "Christmas" party takes place in January, and that people could have infected one another with the mystery illness there. She herself came down with it later in the month. But at that point, awareness of Covid-19 was low.

"We didn't really know about Covid," she says. "I work in a doctor's surgery but this was before it was widely talked about. I think it could have been what we had. It is intriguing."

Simon Rochester, who drank the tea Jane made with sour milk on 8 February, says choir members had noticed how many of them were coming down with a similar illness, but didn't make a connection with the coronavirus.

"If it was something we'd heard of it was in the news, like 'China had this problem and blah, blah, blah,'" he says. "So we didn't really recognise that there was any possibility that we would have anything."

By all accounts, the members of the choir are very friendly. They socialise as well as sing, and there is plenty of hugging. Simon Rochester describes it as "an ideal breeding ground" for infection. And it's likely they passed their virus to some outside the choir as well.

Juanita Kearns runs the Bulls Head pub in Baildon, just north of central Bradford, the destination for Altogether Now choir members after their weekly practice session in a church hall nearby. Towards the end of January she collapsed, barely able to breathe, and went to bed, sweating profusely. Her doctor called an ambulance.

"My doctor asked if I'd been to China, the ambulance people asked if I'd been to China and the hospital asked me the same. I said no, and explained again about being a pub landlady. They said I appeared to have a lung condition and sent me home," she says.

"I think they need to test us all, so many of us have been so ill. It's like nothing I've ever known. The entire choir are always in here, we are all friendly together. I'm only 53, no underlying health conditions and never ill. This was really strange and I'm convinced we all had it."

These experiences are fascinating. We have to be cautious about assuming that this is Covid-19 - there will have been lots of other seasonal viral illnesses circulating - but what interests me in this case is the pattern of transmission, the timeframe and what's been described about the initial link to what we think was happening in Wuhan.

In all epidemics, when you start tracking back, you find that there were cases much earlier than expected. The nature of epidemics is they do start very, very slowly - one or two people, gradually increasing - and before it hits people's radar it's been lurking just below it for some time.

So I'm sure there will be cases where people have travelled to Wuhan, who have been exposed to the virus before it was officially announced by the Chinese government, and who have come back and had symptoms (or have been infected but asymptomatic).

The test for Covid-19 we have at present only tells us whether someone is infected at the time the test is carried out. We haven't yet, in the NHS, got a reliable test that reveals whether someone had it in the past, but we hope to have one in the next few weeks.

When we do, it will be very interesting to see whether Juanita and Jane and her choral friends had a normal winter virus - or were among the first in the UK to experience the Covid-19 pandemic.

If this outbreak, which by the way was right on my doorstep, was indeed covid-19, then this indicates that the virus was around and spreading much earlier, and much more widespread than originally thought. And it may also explain why in the Bradford NHS Trust area, there are currently only 1,192 confirmed cases out of a population of 537,173. Because if the virus was spreading much earlier, perhaps as early as late December, then many people that have been infected have simply been missed out of the statistics because no testing for it was done & anyone with the symptoms would have classed it as influenza.

All of which begs the question, if the virus was spreading earlier than thought, then could it be that the drop in the R value in certain places is as a result of many more people having been exposed to the virus and thus having developed some immunity to it? Its only a supposition, but we might be further down the herd immunity road than we actually believe. What we actually need to understand the rate of infection is more data, and that will only come with an effective antibody test & large scale testing of it.
 

Bald Rick

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This may not be totally accurate:




If this outbreak, which by the way was right on my doorstep, was indeed covid-19, then this indicates that the virus was around and spreading much earlier, and much more widespread than originally thought. And it may also explain why in the Bradford NHS Trust area, there are currently only 1,192 confirmed cases out of a population of 537,173. Because if the virus was spreading much earlier, perhaps as early as late December, then many people that have been infected have simply been missed out of the statistics because no testing for it was done & anyone with the symptoms would have classed it as influenza.

All of which begs the question, if the virus was spreading earlier than thought, then could it be that the drop in the R value in certain places is as a result of many more people having been exposed to the virus and thus having developed some immunity to it? Its only a supposition, but we might be further down the herd immunity road than we actually believe. What we actually need to understand the rate of infection is more data, and that will only come with an effective antibody test & large scale testing of it.

Yep I know a couple who were unwell late Dec / early Jan with exactly the symptoms of Covid. They thought nothing of it at the time but on reflection are fairly certain.
 

Camden

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The virus was clearly spreading like wildfire in London at the time of lockdown. Despite the photos of the crowded tube, I think over time many people have been scared into compliance, including a reasonable percentage of those who tend to not follow rules.

Outside of London, to varying degrees, the sense of danger may have been lower. While most people will have been following the rules, some, in particular those who tend not to follow the rules, not so much.

If you're staying indoors and not mixing with others, you physically cannot spread the virus except by fluke.

As such, places with an R rate not now in line with a declining presence of virus need to have their compliance and policing looked at.
 

yorkie

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I find it difficult to believe that compliance is higher in London than elsewhere; indeed I recall people claiming the opposite was true (though much of that was based on photos of people doing things that were against the rules, but now are within the rules, that would accelerate the spread of the virus, such as sunbathing)

I do think it is more likely that London has reached a sufficient level of herd immunity for the virus to be slowed down. If loads of people have had it and if a lower rate of infection is required to gain herd immunity than previous thought, that could be very good news. But it really is impossible to be certain on anything at this stage, due to a lack of data. Things should become clearer in a few weeks.
 

Camden

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I find it difficult to believe that compliance is higher in London than elsewhere; indeed I recall people claiming the opposite was true (though much of that was based on photos of people doing things that were against the rules, but now are within the rules, that would accelerate the spread of the virus, such as sunbathing)

I do think it is more likely that London has reached a sufficient level of herd immunity for the virus to be slowed down. If loads of people have had it and if a lower rate of infection is required to gain herd immunity than previous thought, that could be very good news. But it really is impossible to be certain on anything at this stage, due to a lack of data. Things should become clearer in a few weeks.
That would not explain why the R rate is higher elsewhere.

If one cannot physically spread the virus other than by some form of contact, then logically, if the R is not declining, contact must be occurring.
 

Belperpete

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If this outbreak, which by the way was right on my doorstep, was indeed covid-19, then this indicates that the virus was around and spreading much earlier, and much more widespread than originally thought.
While I also suspect that the virus was here earlier than we realised, I find it hard to believe that it could have been widespread. We know when the number of hospital admissions started to rise, so it is easy to backtrack to see when the virus started becoming widespread. If you believe that the virus was widespread before then, then you need an explanation as to why it wasn't causing an increase in hospitalisations before then.
 

yorksrob

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That would not explain why the R rate is higher elsewhere.

If one cannot physically spread the virus other than by some form of contact, then logically, if the R is not declining, contact must be occurring.

I don't doubt that.

I just don't believe that non-compliance and contact was that great an extent more widespread elsewhere than London.
 

Belperpete

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That would not explain why the R rate is higher elsewhere.

If one cannot physically spread the virus other than by some form of contact, then logically, if the R is not declining, contact must be occurring.
Agreed. I think the point Yorkie is making about London is that the more immune people there are in the pool of contacts, the slower the rate of infection. Effectively, each immune person acts as a barrier to transmission. That could explain why the R rate is lower in London, if London has a greater proportion of people who have had the virus. In areas where very few people have had the virus, the infection rate is not being reduced by this means.

While the scientists keep saying that there is no definitive evidence that those who have had the virus will be immune, intuition says that they must have built up some resistance in order to have recovered (how long they retain that immunity is another matter).
 

Mikey C

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I find it difficult to believe that compliance is higher in London than elsewhere; indeed I recall people claiming the opposite was true (though much of that was based on photos of people doing things that were against the rules, but now are within the rules, that would accelerate the spread of the virus, such as sunbathing)

I do think it is more likely that London has reached a sufficient level of herd immunity for the virus to be slowed down. If loads of people have had it and if a lower rate of infection is required to gain herd immunity than previous thought, that could be very good news. But it really is impossible to be certain on anything at this stage, due to a lack of data. Things should become clearer in a few weeks.
And there were all those photos of people jammed onto the tube going to work DURING the lockdown, I don't recall seeing the same level of overcrowded public transport elsewhere in the country
 

Bantamzen

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While I also suspect that the virus was here earlier than we realised, I find it hard to believe that it could have been widespread. We know when the number of hospital admissions started to rise, so it is easy to backtrack to see when the virus started becoming widespread. If you believe that the virus was widespread before then, then you need an explanation as to why it wasn't causing an increase in hospitalisations before then.

Potentially this might have been because the initial spread was through people less at risk, and thus fewer people presented themselves to their doctors or hospitals. But even then at least one person in that report did report to hospital but was diagnosed with a lung infection, so it could be that cases were simply missed in the early days.
 

MotCO

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While the scientists keep saying that there is no definitive evidence that those who have had the virus will be immune, intuition says that they must have built up some resistance in order to have recovered (how long they retain that immunity is another matter).

Has it been proved that people who are immune cannot still be carriers of the disease, and can therefore still pass it on to others?
 

MotCO

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There are also reports that certain ethinic groups are more susceptable to the disease than others. In partcicular, BME groups seem to be worst affected, (https://www.nhsconfed.org/resources/2020/04/the-impact-of-covid19-on-bme-communities-and-staff) and there are probably more BME people in London than elsewhere in the country, so how does this explain the reducing rate in London? One possibility is that Muslims tend to be careful with their hygiene, and may well have been washing their hands better than others before it became official advice.

I've also seen reports that the North East around Sunderland has been badly affected, but the number of BME people there is very low. (https://news.sky.com/story/coronavi...ots-revealed-in-new-hyper-local-data-11985195)
 

Nicholas Lewis

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ONS have run a survey of people to attempt to assess penetration rates of Covid19

Coronavirus (COVID-19) Infection Survey pilot: England, 14 May 2020

They deduced that during period between 27 April and 10 May 2020, it is estimated that an average of 0.27% of the community population had COVID-19 or 148,000 people. So if your were on a rammed tube train probability is only 1 or 2 people may have it!! Of course if Ro is down at 0.4 in London then the probability must reduce further. Thus its hardly a surprise with social distancing the probability of encountering an infected person is pretty small which contributes to Ro falling.

What is evident though, although no data is ever provided to substantiate, is that care homes are seen as major sources of new infections so you have to factor the risk in those people moving around society. I never got why they haven't used the Nightingale facilities as isolation hospitals with staff kept on site or in nearby hotels (pay them double or treble for the sacrifice) so they can contain this. Victorians practised this to good effect in the 19th century albeit much of got discredited over human impact but this is a crisis and we need to protect those vulnerable individuals that haven't got it.
 

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Yep I know a couple who were unwell late Dec / early Jan with exactly the symptoms of Covid. They thought nothing of it at the time but on reflection are fairly certain.

I thought I had (for that very reason) but have now had a private antibody test (a lab one, not cheap but I was really intrigued!) which, assuming it was accurate, said it was not COVID. I think there must have been some other nasty viruses going round this year.

As it was mild there is the possibility that IgM "early" antibodies got it (these can't be tested for very long after the event) but more likely it was just something else.
 

Bletchleyite

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Has it been proved that people who are immune cannot still be carriers of the disease, and can therefore still pass it on to others?

If you're immune the virus doesn't reproduce, therefore you can't pass it on (unless you've got it on your hands or something). Antibodies take it out before it can do.
 

Mikey C

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I thought I had (for that very reason) but have now had a private antibody test (a lab one, not cheap but I was really intrigued!) which, assuming it was accurate, said it was not COVID. I think there must have been some other nasty viruses going round this year.

As it was mild there is the possibility that IgM "early" antibodies got it (these can't be tested for very long after the event) but more likely it was just something else.
I'm slightly sceptical that people with symptoms in December/January actually had COVID, as with no social distancing back then AND being in winter, surely it would have spread like wildfire?
 

DynamicSpirit

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I'm slightly sceptical that people with symptoms in December/January actually had COVID, as with no social distancing back then AND being in winter, surely it would have spread like wildfire?

From the BBC article about the suspected Bradford choirs outbreak in December.

BBC said:
In all epidemics, when you start tracking back, you find that there were cases much earlier than expected. The nature of epidemics is they do start very, very slowly - one or two people, gradually increasing - and before it hits people's radar it's been lurking just below it for some time.
 
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