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Coronavirus Health - Health and Wellbeing

The home for all non-political Coronavirus (Covid-19) discussions on The Lemon Fool
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This is the home for all non-political Coronavirus (Covid-19) discussions on The Lemon Fool
Bouleversee
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Coronavirus Health - Health and Wellbeing

#291253

Postby Bouleversee » March 16th, 2020, 12:48 pm

JohnB wrote:Which is why BJ is warning people that many of their loved ones will die...often without access to the high dependency care they need. I loathe him, but he's hardly irresponsible here.


For once, I think BJ is telling the truth and we need to face up to the risk and self-isolate sooner rather than later if we are in the at-risk category. It is deplorable that there are not enough beds, staff or equipment to cope with all the serious cases which might arise. Better to be aware of the risks and do our best to mitigate them than pretend they are not there.

But hey, the news is not all bad: I've just heard that the BBC are not going to charge the over 75s for their TV licence after all, for the time being anyway. With any luck I might find a few minutes to watch the odd programme worth watching in between doing my own gardening, cleaning etc. etc. now I daren't let anyone on the premises.
Last edited by csearle on October 7th, 2020, 7:36 pm, edited 2 times in total.

Dod101
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Re: Coronavirus Health - Health and Wellbeing

#291254

Postby Dod101 » March 16th, 2020, 12:52 pm

Bouleversee wrote:
JohnB wrote:Which is why BJ is warning people that many of their loved ones will die...often without access to the high dependency care they need. I loathe him, but he's hardly irresponsible here.


For once, I think BJ is telling the truth and we need to face up to the risk and self-isolate sooner rather than later if we are in the at-risk category. It is deplorable that there are not enough beds, staff or equipment to cope with all the serious cases which might arise. Better to be aware of the risks and do our best to mitigate them than pretend they are not there.

But hey, the news is not all bad: I've just heard that the BBC are not going to charge the over 75s for their TV licence after all, for the time being anyway. With any luck I might find a few minutes to watch the odd programme worth watching in between doing my own gardening, cleaning etc. etc. now I daren't let anyone on the premises.


Very good on the TV Licensing issue. That will help in my drive to reduce my expenses by 25% this year.

Dod

ReformedCharacter
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Re: Coronavirus Health - Health and Wellbeing

#291261

Postby ReformedCharacter » March 16th, 2020, 1:04 pm

Bouleversee wrote:It is deplorable that there are not enough beds, staff or equipment to cope with all the serious cases which might arise.

Deplorable? Unfortunate, certainly but is it reasonable to expect the NHS to have many times (eg. 7.5 times the number of beds normally required, according to a recent estimate) kept ready or capable of being ready along with ventilators and so forth just in case? I'm sure lessons will be learnt for next time but the economic cost of being completely ready for unknown future pandemics would be huge and I think many would agree that the continuous cost of funding that would be better spent elsewhere.

RC

Bouleversee
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Re: Coronavirus Health - Health and Wellbeing

#291275

Postby Bouleversee » March 16th, 2020, 1:54 pm

ReformedCharacter wrote:
Bouleversee wrote:It is deplorable that there are not enough beds, staff or equipment to cope with all the serious cases which might arise.


Deplorable? Unfortunate, certainly but is it reasonable to expect the NHS to have many times (eg. 7.5 times the number of beds normally required, according to a recent estimate) kept ready or capable of being ready along with ventilators and so forth just in case? I'm sure lessons will be learnt for next time but the economic cost of being completely ready for unknown future pandemics would be huge and I think many would agree that the continuous cost of funding that would be better spent elsewhere.

RC


Oh come on, the NHS has deteriorated enormously over recent years (fewer beds, fewer staff, longer waiting lists) due to lack of funding and ill conceived pension provision and taxation and I think it is rather late in the day to be starting discussions on how to get more ventilators manufactured. There is always the possibility of an epidemic or pandemic and there should be adequate contingency plans and arrangements in place. Post hoc lessons learnt will be of little comfort to the families who are bereaved because appropriate treatment was not available. I dare say that there are some who think money was better spent on a fantasy bridge over the Thames which was never built or HS2 etc but I very much doubt it will be many. However, I think we are on the wrong board for this argument and had better leave it there.

dspp
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Re: Coronavirus Health - Health and Wellbeing

#291286

Postby dspp » March 16th, 2020, 2:33 pm

Bouleversee wrote:
ReformedCharacter wrote:
Bouleversee wrote:It is deplorable that there are not enough beds, staff or equipment to cope with all the serious cases which might arise.


Deplorable? Unfortunate, certainly but is it reasonable to expect the NHS to have many times (eg. 7.5 times the number of beds normally required, according to a recent estimate) kept ready or capable of being ready along with ventilators and so forth just in case? I'm sure lessons will be learnt for next time but the economic cost of being completely ready for unknown future pandemics would be huge and I think many would agree that the continuous cost of funding that would be better spent elsewhere.

RC


Oh come on, the NHS has deteriorated enormously over recent years (fewer beds, fewer staff, longer waiting lists) due to lack of funding and ill conceived pension provision and taxation and I think it is rather late in the day to be starting discussions on how to get more ventilators manufactured. There is always the possibility of an epidemic or pandemic and there should be adequate contingency plans and arrangements in place. Post hoc lessons learnt will be of little comfort to the families who are bereaved because appropriate treatment was not available. I dare say that there are some who think money was better spent on a fantasy bridge over the Thames which was never built or HS2 etc but I very much doubt it will be many. However, I think we are on the wrong board for this argument and had better leave it there.


BV,

I think you are wrong on this one, do the maths.

There are about 130,000 beds in the NHS (1). I am struggling to find how many of these are ICU beds, but the best typical number I could find was 7% (2, 3) so let's be generous and use 10%. That means 13,000 intensive care beds in the NHS.

There are 66 million people in the UK. Assume a fatality rate of about 1% and an infection rate of 50%, so 330,000 additional deaths. To keep maths simple assume peak epidemic period lasts 10-weeks and 80% of deaths happen in that period, i.e. 264,000 deaths, so 26,400 deaths/week. But we need to know how many need ICU treatment, and that number is slightly unclear but 5% seems to be a reasonable working number (4) for critical cases and 16% for severe cases (i.e. the lower level of intensive care). Assume critical phase lasts one week, so you have 132,000 of the acute cases in hospital requiring the most intensive ICU beds, and about 400,000 of the severe cases also requiring lower level care (but still quite intensive).

Assume for a moment that we could throw everyone out of the hospitals who is in there (which would be a near-death sentence for many of them), and convert every single bed into a intensive care bed (and magic up the relevant trained staff, who take several years to train, and who cannot be defrosted just to suit BV). We could only just manage even then. More realistically there are 13,000 intensive care beds and we can probably increase that to about 10x in terms of equipment (oxygen supplies, machinery) which gets us to 60,000. But it doesn't meet the demand that is projected in the more central cases (there are worse cases) which are for 132,000 acute, and 400,000 severe beds.

By the way, the paradox is that the more efficient an organisation (such as the NHS) gets, and therefore the cheaper per person it gets, so the lower the surge capacity becomes. There is an infinite amount of healthcare that people want other people to pay for, so that they can consume it. Reality is it must be paid for.

regards, dspp


1. https://www.bma.org.uk/-/media/files/pd ... .pdf?la=en
2. https://www.accjournal.org/journal/view.php?number=630
3. https://www.ficm.ac.uk/sites/default/fi ... .1%20(2013).pdf
4. https://www.ncbi.nlm.nih.gov/books/NBK554776/

Midsmartin
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Re: Coronavirus Health - Health and Wellbeing

#291288

Postby Midsmartin » March 16th, 2020, 2:38 pm

There are currently around 4000 critical care beds.. which appear to be what most of us call "intensive care"
https://www.hsj.co.uk/workforce/nhs-see ... 04.article

dspp
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Re: Coronavirus Health - Health and Wellbeing

#291562

Postby dspp » March 17th, 2020, 11:16 am

https://www.imperial.ac.uk/media/imperi ... 3-2020.pdf

16 March 2020 Imperial College COVID-19 Response Team
DOI: Page 1 of 20
Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand

"Two fundamental strategies are possible: (a) mitigation, which focuses on slowing but not necessarily
stopping epidemic spread – reducing peak healthcare demand while protecting those most at risk of
severe disease from infection, and (b) suppression, which aims to reverse epidemic growth, reducing
case numbers to low levels and maintaining that situation indefinitely. Each policy has major
challenges. We find that that optimal mitigation policies (combining home isolation of suspect cases,
home quarantine of those living in the same household as suspect cases, and social distancing of the
elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and
deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of
thousands of deaths and health systems (most notably intensive care units) being overwhelmed many
times over. For countries able to achieve it, this leaves suppression as the preferred policy option. "


Image

Even taking the extreme suppression case modelled, note how far above the red line (the care capacity) the peak is.

- dspp

feste
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Re: Coronavirus Health - Health and Wellbeing

#293185

Postby feste » March 22nd, 2020, 2:20 pm

Moderator Message:
Thanks. An interesting link moved to the this thread rather than the resource post


Hi John,

This https://www.epicentro.iss.it/coronaviru ... zo_eng.pdf

drills down into the Italian numbers and gives info re (1) demographics and (2) co-morbidities that may (speaking brutally) be of some comfort to the -otherwise-unaffected.

ATB

feste
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Re: Coronavirus Health - Health and Wellbeing

#293193

Postby feste » March 22nd, 2020, 3:24 pm

Hi John

The worldometer updates continue to highlight the anomalous numbers from the quarantined Diamond Princess, which has so far shown 8 deaths out of 3,711 pax and crew on board.

This study https://cmmid.github.io/topics/covid19/ ... mates.html, showed that of the 7 deaths at time of report, there were 6/1015 in the 70-79 age group and 1/216 in the 80+ age group, that's 0.59% and 0.46% respectively.

Granted the cohort pax/crew may (1) all have been atypically healthy (not my understanding of cruise-ship profile) , and (2) may have received all the desirable monitoring and ICU resources/attention needed, but it's an interesting outlier...

ATB

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Re: Coronavirus Health - Health and Wellbeing

#293195

Postby feste » March 22nd, 2020, 3:27 pm

Hi John,

On the Italian stats issue, here's a link to the horse's mouth :
https://www.epicentro.iss.it/coronaviru ... zo_eng.pdf

look at (1) demographics and (2) co-morbidities.

ATB

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Re: Coronavirus Health - Health and Wellbeing

#293203

Postby PinkDalek » March 22nd, 2020, 3:59 pm

From the World Health Organization Coronavirus disease (COVID-19) advice for the public: When and how to use masks
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

Extract only:

If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.

Wear a mask if you are coughing or sneezing.

Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water.

If you wear a mask, then you must know how to use it and dispose of it properly.


Opinions may differ!

sg31
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Re: Coronavirus Health - Health and Wellbeing

#293265

Postby sg31 » March 22nd, 2020, 7:45 pm

I use an American board which is running a special thread on Coronavirus, it's not available to non members. A doctor posted the latest information that is available to doctors on the site in full. It was a very long post because it's detailed on all the current information.

He couldn't post a link because it wasn't accessible to the public. I've been in contact with the doctor and he now tells me that the information has been made open source. Here's the link

https://www.uptodate.com/home/covid-19-access

The document I've read is the first on the list, the others may also be of interest. I think this is gold dust. We are fortunate to have it.

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Re: Coronavirus Health - Health and Wellbeing

#293409

Postby redsturgeon » March 23rd, 2020, 11:56 am

Losing sense of smell may be a sign of Covid in absence of other symptoms

AAO-HNS: ANOSMIA, HYPOSMIA, AND DYSGEUSIA SYMPTOMS OF CORONAVIRUS DISEASE

Anecdotal evidence is rapidly accumulating from sites around the world that anosmia and dysgeusia are significant symptoms associated with the COVID-19 pandemic. Anosmia, in particular, has been seen in patients ultimately testing positive for the coronavirus with no other symptoms. We propose that these symptoms be added to the list of screening tools for possible COVID-19 infection. Anosmia, hyposmia, and dysgeusia in the absence of other respiratory disease such as allergic rhinitis, acute rhinosinusitis, or chronic rhinosinusitis should alert physicians to the possibility of COVID-19 infection and warrant serious consideration for self-isolation and testing of these individuals.

https://www.entnet.org/content/coronavi ... -resources

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Re: Coronavirus Health - Health and Wellbeing

#293422

Postby redsturgeon » March 23rd, 2020, 12:28 pm

https://www.iconplc.com/services/clinic ... ronavirus/

A resource from ICON, a clinical research company that my friend works for. I will think about whether to add it to the resource post.

John

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Re: Coronavirus Health - Health and Wellbeing

#293658

Postby sg31 » March 24th, 2020, 11:21 am

Imperial College study which is informing Government policy on mitigation and suppression strategies.

https://www.imperial.ac.uk/media/imperi ... 3-2020.pdf

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Re: Coronavirus Health - Health and Wellbeing

#297185

Postby zico » April 2nd, 2020, 11:42 pm

Daily hospital death figures from the Dept of Health are quite lumpy. By now the numbers are large enough that there should be a smooth curve, but government is getting permission from next of kin before adding the numbers to the statistics. Office for National Statistics published a weekly total of all deaths from Covid-19, showing there's an extra 20% non-hospital death figures.

Assuming there's an average 10 day lag between new cases & deaths (which looks reasonable for the figures) then there would be 20,000 deaths in 10 days time, even if there were no further new cases starting tomorrow (obviously an extremely optimistic assumption). I hope I'm wrong but it looks pretty bad.

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Re: Coronavirus Health - Health and Wellbeing

#297187

Postby servodude » April 3rd, 2020, 12:11 am

zico wrote:Daily hospital death figures from the Dept of Health are quite lumpy. By now the numbers are large enough that there should be a smooth curve, but government is getting permission from next of kin before adding the numbers to the statistics. Office for National Statistics published a weekly total of all deaths from Covid-19, showing there's an extra 20% non-hospital death figures.

Assuming there's an average 10 day lag between new cases & deaths (which looks reasonable for the figures) then there would be 20,000 deaths in 10 days time, even if there were no further new cases starting tomorrow (obviously an extremely optimistic assumption). I hope I'm wrong but it looks pretty bad.


Is that assuming that around half of those that test positive (with the current testing/sampling methodology) die?

The entries for the 1st & 2nd April in (https://docs.google.com/spreadsheets/d/ ... Y/htmlview)
- show new cases at ~4300 and deaths ~560
- going back about 10 days there were only ~1000 people testing +ve (implying these might be "exiting" the model one way or another about now)

I am a bit surprised that the last daily death count was not more given the lag between the two counts
- having dug a bit from the ONS down to https://www.gov.uk/guidance/coronavirus ... the-public, and seeing that the total figures match with those in the google doc, it appears this does exclude e.g. deaths in care homes!

- sd

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Re: Coronavirus Health - Health and Wellbeing

#297353

Postby zico » April 3rd, 2020, 1:08 pm

servodude wrote:
Is that assuming that around half of those that test positive (with the current testing/sampling methodology) die?

- sd


My initial thought was "no, not at all. I'm simply assuming the current 10-day lagged ratio of new cases to deaths remains constant."
But I went back and checked my model, and it's showing a horrifying death rate for new cases of 54%.

Sense-checking this, there were 6,700 total confirmed cases on 22nd March, and we've had 2,900 deaths in total, which would be a 43% death rate even if you assume that no deaths at all have occured from confirmed cases since 22nd March.
(It seems that reported "new cases" are actually hospitalised cases, and the above death rate refers to infected people who are in the 2nd stage of the virus, where it becomes much more serious and hospitalisation is required.)

Reuters are reporting a Govt source says the UK government has a worst case death toll of 50,000 if social distancing was only 50% adhered to, but they are saying a "good" outcome would be under 20,000. (Obviously "good" is a relative term for a disaster like this.) Source also expects Easter Sunday (April 12th) to be peak day for deaths.

My assumption of a 10-day lag is based on taking a weekly average of new cases % increase (16th-22nd March) and weekly average of death % increase (26th March-1st April). These figures are 24% and 26.5% respectively, showing a reasonable fit. To estimate deaths in future days, I've plugged in %new cases increase from 10 days earlier.

Results -
Adding in 20% from care homes, it seems inevitable that 17,000 deaths will occur based on existing 2nd stage infection cases. Assuming the latest reported %increase in new cases (14.6%) is replicated tomorrow would give 20,000 deaths by Easter Sunday.
To make that the peak day for deaths, I've assumed the %increase in new cases goes down tomorrow to 10%, then 8% the next day, 6% the day after, then 4%, 2% which would give 27,000 deaths by 17th April.

This assumes the social distancing measures start to really kick in from tomorrow (in affecting new cases) and show a dramatic improvement.
It's reasonable to assume social distancing measures should kick in any day now giving an immediate reduction in % increase of new cases.
I've been optimistic in my assumption of how quickly and how sharply social distancing will affect infection growth rates, but more pessimistic assumptions don't change the total deaths by more than about 7,000.
The key driver in the number of deaths is the exponential growth rate. Compared to the actual lockdown date, a lockdown 3 days earlier would have halved the deaths, lockdown 3 days later would have doubled deaths.
I've also assumed the NHS doesn't get overwhelmed by the new cases, and death rate remains unchanged. If this isn't the case, there could be in the region of 5,000 extra deaths.

However, we need to remember this is just the initial stage of the virus. After this first wave, the virus will still be present, and loosening of the social distancing measures will see further waves of new infections and deaths.

I'm afraid this is a very bleak picture, but I'm simply trying to make sense of the numbers, and give some estimate of what may happen, in a dispassionate way.
Social distancing needs to start working very soon, be very effective and also to be very sustained if we are to have any hope of keeping the death total below 50,000 in this first phase.
Today's 2pm figures will be absolutely crucial - we desperately need to see the % increase in new cases reduce from yesterday's 14.6% to below 10% either today or tomorrow.

Please note, there is absolutely no praise/criticism of the government, NHS or public behaviour in my post, and I wouldn't want this thread to descend into any sort of political point-scoring (there's also Polite Discussions for that).
I'd be very interested to see anyone's alternative methodologies and thoughts on this.

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Re: Coronavirus Health - Health and Wellbeing

#297362

Postby servodude » April 3rd, 2020, 1:15 pm

zico wrote:My initial thought was "no, not at all. I'm simply assuming the current 10-day lagged ratio of new cases to deaths remains constant."
But I went back and checked my model, and it's showing a horrifying death rate for new cases of 54%.


Yes. That was my reaction too; it's not often that stuff is cognitively unbelievable, but I think this might be one of those times.

I temper my fear with knowing we're in the phase where the info is subject to quantisation and extrapolation errors.

But I'm used to working in margins of 40dB or so of a system, so when official figures are debating orders of 2 as though they are important I'm inclined to suspect they are clueless, intending to distract or just micturating in to the wind for want of anything else to do.

Stay safe
- sd

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Re: Coronavirus Health - Health and Wellbeing

#297368

Postby zico » April 3rd, 2020, 1:30 pm

Just to clarify, my 54% death rate estimate is for Govt-registered new cases, which appear to be people in the more serious 2nd stage of the virus.
The death rate for the general population will be massively lower.
Having said that, if we assume that 25% of the general population (17 million) have already contracted the disease, then even 20,000 deaths would be a 0.13% death rate amongst the general population.

Assuming 5 million people already have the disease gives a 0.4% overall fatality rate.
Assuming 1 million gives a 2% fatality rate.
This is pure estimation/guesswork, but it seems likely to me that between 1 to 5 million people have now already contracted the virus in the UK.


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