Coronavirus - General Chat - No statistics

[XFool]

It can be argued, especially if the objective was to "Protect the NHS", and not to save lives, that it might have been "better" to have reopened sooner, and allowed the disease to exist at a higher, and hopefully manageable level, in the Summer/Autumn period. More would have had it, passed it on, been treated, and died as a result in those months, but arguably the Winter peak would have been lower. Some argue catching it in Winter is worse than at other times (so presumably individuals would rather get it in Summer given the choice), and the resource pressure on the NHS from non-Covid sources is already stretch and eating into Covid capacity in Winter.

OTOH, it could be argued that allowing it to spread further in the initial wave might have led to the evolution of more infectious varieties earlier, with far more serious consequences later on.

In practice do we think it really was about protecting the NHS and not saving lives? I don't think so.

I do. Mainly because it was!

Why do you think "protecting the NHS" and "saving lives" are alternative choices? It reminds me of the similarly simplistic dichotomy of "lockdown" versus "economy and wellbeing".

[johnhemming]

Heard last night on Newsnight that the latest estimate for compliance with self isolation is 30%.

When I hear these headline figures I always wonder what this actually means. Does it mean that 70% of people don't self isolate at all, does it mean that measured by the time people should be self isolating only 30% of the time they stay isolated or does it mean only 30% of people are fully compliant.

That is one of the reasons why I have not really watched Newsnight for decades (or many of these programmes) they don't give enough information to understand what they mean. I also know from personal experience that the skew the news agenda in various random ways that prevents people getting knowledge. It is more about entertainment and if we remember the "big things" they were things like Jeremy Paxman asking the same question lots of times (possibly 12) which in restrospect did not add an iota of understanding of a wrongful thing that may have, but in fact did not occur.

When I hear this figure it gives me some more information that I didn't have before hearing the figure. I am now reasonably confident that most people do not self isolate when required to. I could of course ignore this information since I have not read a double blind randomised crossover study reporting it but life's too short.

To me is it not news that a proportion of people won't follow the rules. I would find it quite helpful to know if they are mainly complaint or not. However, each to their own.

[dealtn]

Why do you think "protecting the NHS" and "saving lives" are alternative choices?

To me "Protecting the NHS" is allowing the NHS to continue to function, within its capacity, and not be under additional stress or strain. That might not be the same definition or understanding held by others, of course.

"Saving lives" would be attempting to ensure, as far as possible, that nobody will die. Now I am, of course not saying that any individual doctor, or NHS administrator, wouldn't be looking to provide the best care to any individual sufferer.

I do, however, see these as different objectives.

Analogies aren't always helpful, but if we consider say the Second World War (as it has been brought up before in an analogous context), our leaders then might have had different objectives. Such as "Win The War", "Limit the Number of Deaths", "Save All Lives Where Possible". It can be seen how these different objectives won't fully overlap. It would be difficult to win the war, without simultaneously sacrificing both military and civilian lives. Ultimately the war in the far east was ended with nuclear explosions killing multiple thousands, but probably ultimately not just bringing the war to an end sooner, but saving lives too.

So what I am trying to say, by way of distinction, is that if "Protecting the NHS" was the genuine objective it would be sufficient to ensure it didn't become overloaded, and within that if a "few hundred" were dying daily, the "Protecting the NHS" objective would be met, despite those deaths. Now if concurrent to this it could be argued that a "few hundred" dying daily through the summer meant by winter society was closer to herd immunity, then the "Protect the NHS", in winter when strains are more naturally felt, that objective was being prioritised, despite not "saving lives" (in summer).

Now I am not making a value judgement on whether that alternative was preferable, doable even, or not. I am simply drawing the distinction between the two objectives, demonstrating where they are different, and would have required different policy responses.

I still maintain I don't think in practice any government, democratically accountable in the Western world would have been able to commit to a policy of "sacrificing" citizens through summer, as part of a grander plan to save lives over the pandemic cycle. (A dictatorship might have been able to, perhaps.) So, my feeling is a "Save (all) Lives" policy was pursued, but under a label, if you like, of "Protect the NHS".

[Bubblesofearth]

Why do you think "protecting the NHS" and "saving lives" are alternative choices?

I think they are slightly different objectives. If you made the assumption that the NHS would be able to cope regardless of the strategy then that could lead to a different vaccine prioritisation. Instead of putting care home residents at the top of the list they might, instead, prioritise younger, but still vulnerable, people who have a significantly longer life-expectancy and quality of life.

Consider the following situation - let's say you were in a boat and could rescue either an 85 year old with 2 years to live or a 60 year old with a life expectancy of 25 years. If you don't rescue the 85 year old they have a 15% chance of dying. If you don't rescue the 60 year old they have a 2.5% chance of dying. Who do you try to rescue?

Protecting the NHS tilts things towards protecting the most vulnerable because that's where the greatest numbers of hospitalisations are likely to come from. ISTM that making sure the NHS can cope could be a big part of the decision making behind vaccine prioritisation.

BoE

[Newroad]

Hi All.

This appears good news

https://www.ft.com/content/929ef3cd-8611-49b2-9f23-918dc3470166

"People who have already contracted coronavirus are as protected against reinfection as those who have received the best Covid-19 vaccines, according to a survey of 20,000 UK healthcare workers, the largest study in the world so far ..."

Regards, Newroad

PS Also, the new J&J vaccine is allegedly promising, 1 shot only and possibly available from next month

[Mike4]

The whole slogan was:

Stay at home > Protect the NHS > Save lives

I hold that in the early day and even now, the great mass of people don't understand why or how this follows, and it makes little sense. The government and the media never really explained how staying at home protects the NHS, they just stated it as a rule to be obeyed.

Similarly, "Save lives" is not a particularly powerful message. Whose lives? This was never explained until latterly, when in a vague way it was turned into 'don't kill granny'. But people being fundamentally selfish don't really care that much if other people are dying, especially when it's people they don't know.

Also, "Protect the NHS > Save lives" is far to big and vague a goal for individuals to feel they can have any influence over.

"What difference does it make if I nip to the shops? It's only me and I need some milk. I really don't see how me going without milk in my tea protects the NHS or saves any lives. Besides I'm allowed to go out for exercise so its obviously not that big a deal."


Edit to add: Forgot to say, this is also the reason for minimal self-isolation compliance. People self-isolating simply don't understand or accept that going out makes any difference to them personally, and they are probably right!

[tjh290633]

"What difference does it make if I nip to the shops? It's only me and I need some milk. I really don't see how me going without milk in my tea protects the NHS or saves any lives. Besides I'm allowed to go out for exercise so its obviously not that big a deal."

Both are within the rules, and you can combine them. I see from today's figures for Kent and Sussex that the case rate in most districts is falling. A few are still rising.

As stated above, the only comparison that we have to judge the effectiveness of lockdown is the Swedish experience in the first wave of infections. Given that there is a seasonality to susceptibility to the virus, it may well be that the first coincided with a seasonal fall, and the latest two have coincided with a seasonal uplift and the onset of a more virulent mutation. We shall never know what would have happened without a lockdown, just relying on the general social distancing, hand washing and mask wearing directions.

What we have at the moment is a nationwide experiment with no control sample.

TJH

[johnhemming]

and the onset of a more virulent mutation.

I don't think this thesis from the government is proven as yet.

[XFool]

and the onset of a more virulent mutation.

I don't think this thesis from the government is proven as yet.

And yet, it is "proven" that the original(?) virus is "more virulent" in the winter... Hmm.

Plus, I don't myself believe the virology is being carried out by "the government". i.e. Politicians. Where am I going wrong?

[gryffron]

If you can catch it twice, would it be possible to have an effective vaccine?

YES!

It is wrong to think of either the vaccine or previous infection providing "immunity".
It is not a binary. Not that you're either vulnerable or you're immune.
Rather, both provide increased protection from further infection. Increased ability to fight off the virus after infection, and reduced onward transmission.

Let me try and explain with some made up numbers.

Part 1 - Catching the virus

Suppose we consider 100 possible transmission scenarios which you might encounter:
Think about how many virus particles are floating around in the air, that you might breathe in in each of these scenarios.
1) Walking in an open field - negligible virus
2) Staying at home indoors - miniscule quantity of virus
...
20) Walking down a crowded high street - very small quantity of virus
....
40) A schoolroom full of pupils - small quantity of virus
...
60) A large supermarket - starting to get significant quantities of virus now
...
80) A restaurant or pub - more virus
...
90) A crowded bus full of people - large quantity of virus
....
99) Nursing an infected relative in a small bedroom - huge quantity of virus
100) Working on a covid ward with several infected patients - massive quantity of virus

Now take 1000 people selected at random from the whole population. Random ages, gender, ethnicity, general health, fitness. And place each one of them randomly in one of the above situations. Remember, the younger and fitter individuals can fight off a big incoming dose. The older and weaker may be infected by only a very light dose.

Unprotected, suppose 20 people catch covid.

Now give all our 1000 sample a course of your vaccine and put them back in the random scenarios. We reduce that 20 by 60/90/95%. In effect, that's exactly what the trials did. Exactly what they tested. Of course, their "random" was simply real everyday life. They can't know that any one individual was "immune". Maybe ALL the people under scenario 100 still catch the disease? It's possible. But the proportion of people catching the virus during random exposures reduced by the protection factor of the vaccine.

So it's not that 90% (or whatever) are "immune". It's just that each individual's probability of catching the disease during normal everyday life are reduced by that proportion.

Part 2 - Onward spread

But a vaccine (or previous infection) does something else. By helping the body fight off the disease AFTER infection, it also reduces the quantity of virus that the infected person is spreading. Hence, the actual quantity of viruses in the air is reduced too, in ALL the 100 scenarios. Meaning others, even those who haven't had the jab, are less likely to catch it.

Unfortunately, vaccine trials can't test this. It would require a huge (and controlled) population of vaccinated individuals with a few unvaccinated walking amongst them. By the time we have that situation, it's likely the disease will be nearly extinct, making study of its spread impossible.

But without doubt, vaccines reduce both catching AND spread. Both sides of the equation. This is why it is so important to get as many people vaccinated as possible. If you can improve BOTH the vulnerability AND the spread, you get an improvement squared. If a vaccine could halve your vulnerability AND halve the quantity of virus that sick people are spreading to the air, you'd get a 25% reduction in transmission, that's a 75% reduction in R number, from a 50% effective vaccine. This is why vaccines with low efficacy (such as typical winter flu jabs at 50%) are still useful and can still wipe out the disease.

People keep asking for links about this. I can't provide any numbers for quantities of virus. It's all theory. We don't really have the numbers. Whilst detecting the presence or absence of virus is quite easy, Measuring the quantity is really hard. You'd have to identify every individual microscopic virus and then count them. Simply not possible. We simply don't know whether the onward spread is reduced by 10% or 99%. But the theory of microbe spread has been studied at great length for many years.

Part 3 - Longevity

We also know that the increased protection provided by either prior infection or vaccines wanes slowly over time. This is why diseases recur. Of course, we won't know whether or how fast this happens with covid until we've had decades to study it. But even if this is the case, vaccines are still useful.

Gryff

[88V8]

We're being awful slow in requiring negative tests from incomers. Should have begun tomorrow, now a 'period of grace' until Monday.
Period of grace, god elp us.

And another new variant in South America. How long to stop flights. Zzzzzzz.

Wasn't there a popular music combo called Asleep at the Wheel?

Hard to avoid blaming Bojo for this. He is on the whole, supposed to be in charge.

V8 (Tory supporter)

[zico]

Can you convincingly demonstrate how much better/same/worse they would be if we hadn't had that lockdown?

That is exactly the problem - you can never know if what you didn't do would have been better or worse. It is all speculation.

All i know is that we had a severe lockdown for 3 months last year and ultimately it did not work, other than delaying many infections until the weather was worse.

Since the March lockdown, medical staff have discovered more effective ways to treat the virus, so reducing the death rate.
Most people in UK still haven't had the virus (or the variant) and we have now vaccinated 2.5m people (most vulnerable + NHS workers).

Thanks to the March lockdown there were fewer cases in the UK, so it took much longer for the new more infectious variant to develop.
We also had the chance for thinking time about the best strategies to combat the pandemic - in particular, to get on top of the virus with a proper track/test/isolate regime. Government wasted this chance, by following a "focus group" approach, but they wouldn't have had it without the March lockdown.

The "delays" have undoubtedly saved an awful lot of lives.

[Lootman]

We're being awful slow in requiring negative tests from incomers. Should have begun tomorrow, now a 'period of grace' until Monday.
Period of grace, god elp us.

And another new variant in South America. How long to stop flights. Zzzzzzz.

Wasn't there a popular music combo called Asleep at the Wheel?)

But the decision was not just to test incomers but to test returning UK residents. And that is a big deal because you risk British people not being able to return to the UK and being stuck overseas. That was the case for a while back last Spring, but it is highly undesirable to leave British nationals marooned overseas. Especially since we all have to self-quarantine upon arrival anyway.

And even more so if you ban flights which, as far as I am concerned, is borderline unthinkable except in very specific cases. Although, full disclosure, I am currently overseas and so maybe a little biased.

So I think such actions are a very last resort, and not a rushed instant reaction.

[redsturgeon]

But the decision was not just to test incomers but to test returning UK residents. And that is a big deal because you risk British people not being able to return to the UK and being stuck overseas.

Not really, you just put those who test positive into a supervised quarantine for two weeks. Indeed we did that with the Diamond Princess people.

John

[Lootman]

But the decision was not just to test incomers but to test returning UK residents. And that is a big deal because you risk British people not being able to return to the UK and being stuck overseas.

Not really, you just put those who test positive into a supervised quarantine for two weeks. Indeed we did that with the Diamond Princess people.

We could do that but there is no plan to impose a forced quarantine on anyone arriving, British or not. Nor at the departing airport: If you are positive you are sent home from the airport and if you are negative then you can fly. There could easily be a million Brits overseas at the moment and you cannot leave them all stranded like was done with the odd cruise ship.

The UK quarantine is self-enforced.

[gryffron]

The UK quarantine is self-enforced.

Yes, but it's not like that HAS to be the case. We're not short of empty hotels are we?

Indeed, you yourself said you would ignore self-isolation rules if it suited you. So you're a classic example of why perhaps we should have enforced quarantine.

Our inability of enforcing the rules on 8,000 truckers a day passing between UK and France are probably the reason we don't bother with such restrictions.

Gryff

[Lootman]

The UK quarantine is self-enforced.

Yes, but it's not like that HAS to be the case. We're not short of empty hotels are we?

Indeed, you yourself said you would ignore self-isolation rules if it suited you. So you're a classic example of why perhaps we should have enforced quarantine.

Our inability of enforcing the rules on 8,000 truckers a day passing between UK and France are probably the reason we don't bother with such restrictions.

I am fairly sure I never said I would ignore the quarantine rules. In fact last time I substantially adhered to them. But at the margin I would use my judgement whilst taking all reasonable precautions.

There are still about 150,000 passengers a month going through Heathrow, almost all international. That is a lot of hotel rooms!

[johnhemming]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2652751/

Epidemic theory dictates that a reduction in the force of infection by a pathogen is associated with an increase in the average age at which individuals are exposed. For those pathogens that cause more severe disease among hosts of an older age, interventions that limit transmission can paradoxically increase the burden of disease in a population.

July 2008.

[Clitheroekid]

I've said before that prioritising very old people, who can easily be shielded from CV, at the expense of younger people who are facing the public, and are therefore at much higher risk, is stupid and misguided.

I've now heard from the BBC that if you've already had CV it gives you 83% immunity against catching it again.

Would it not therefore be sensible to exclude everyone who's already tested positive for CV from the first round of vaccinations, so that they could be instead given to people who haven't (or more accurately haven't knowingly) already had CV?

Taking it a step further, would it not be sensible to test everyone before vaccinating them and limit the scarce vaccinations to those who test negative?

[johnhemming]

Taking it a step further, would it not be sensible to test everyone before vaccinating them and limit the scarce vaccinations to those who test negative?

The antibodies fade (although immunity doesn't) so you would not necessarily make that much more progress.

I think it is best to start with the people who are most likely to die from the virus. After a point that will materially cut down on deaths from the virus.