Coronavirus epidemiology II

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 Stichtplate 15 Mar 2020

> Some interesting points. I shall reply later when I have time. For the moment, I shall just say that, while there are some technical details which need clarifying (none of which, of course, Stichtplate would have been aware of!) and so, yes, a class of 13 year olds would have to take my word for it, I do not believe the graphs are in any way misleading.

Well, you've decided I'm the slow kid in the class, maybe you're right (despite 3 years attaining a respectable BA, 2 more years acquiring a more than respectable DipHE and currently working towards a BSc). You're the maths teacher, apparently with a healthy sideline in epidemiology (qualifications unknown), so undoubtedly you're best placed to explain a few things to me. I'll lay them out point by point and since you keep referring to me in your posts, you'll leap at the opportunity to educate me on each item, point by point...

1. You insist the UK is exactly replicating the spread of the virus in Italy. OK then. Please explain why the UK and Italy started 31/1 with two cases each and then, by yesterday, had reached: Italy- 24,747 and UK- 1,140. You've said this can be easily understood by a twelve year old but I'm struggling to see how these two trajectories are identical?

2. Another poster insists it's not the entire trajectory, it's actually that the UK is 13.5 days (precisely) behind Italy. Well, I dutifully wound back the clock and here's what I found...

Italy, March 1st: 34 deaths, 1694 confirmed cases

UK, March 14th: 11 deaths, 798 confirmed case 

as you've kindly pointed out, I'm obviously some sort of mathematical retard so forgive me, but those two figures don't seem to match up?

3. You, and other posters have repeatedly insisted that I'm wrong in pointing out that the UK and Italy are different. Different demographics, different geography, different containment strategies, different healthcare systems, even differing cultural standards for personal space. I, apparently wrongly, thought these differences would impact contagion rates; please could you explain why we're all on tramlines? why every country is bound to experience the same rate of spread? Perhaps you should tell the government and the NHS, because they're both labouring under the misapprehension that what they're doing makes a difference.

4. Finally (my real point all along), could you explain why you, and others kept telling us all, that the UK (some of the lowest infection rates in the developed world), and Italy (highest infection rates in the entire world) are exactly the same. No comparisons with say France or Germany, just Italy. I saw this as fear mongering, but obviously, the truth is I'm just a bit thick.

I eagerly await a thorough schooling. 

7
 MG 15 Mar 2020
In reply to Stichtplate:

In reply to my original OP, turns out there is something, albeit rather clunky

http://www.public.asu.edu/~hnesse/classes/sir.html?Alpha=0.4&Beta=0.9&a...

 MG 15 Mar 2020
In reply to Stichtplate:

On 4, I suspect there are various reasons. However getting from German numbers, say, to Italy numbers  is potentially very easy given the exponential nature of spread. I’m happy to believe the CMO etc are following a rational policy but it wouldn’t have to be more than fractionally off to lead to a horrible situation.

 MG 15 Mar 2020
In reply to thespecialone

Sure! Absolutely none. As clear from my OP.

 wintertree 15 Mar 2020
In reply to Stichtplate:

1.  The time from 1-2 cases to the exponential growth phase are irrelevant because they were (a) small number statistics and (b) imported and segregated cases not the result of local-local transmission. An analogy is many small bushfires that get put out vs the one that lets rip.  It’s the rate the big bush fire grows at that matters, and what various posters are discussing here.

This has been covered before but you haven’t apparently engaged with it and keep returning to this invalid comparison of “time from first imported cases to exponential growth phase”.  Perhaps you missed it?  I say “invalid” because nobody else is making that comparison so you’re arguing against a point nobody has made.  Things may have been read that way but - in my view of posts from others - they were not written that way.

2. That other poster (me) said “about” or some such, not “precisely”.

> Italy, March 1st: 34 deaths, 1694 confirmed cases

> UK, March 14th: 11 deaths, 798 confirmed case 

Italy, Feb 29th: 29 deaths, 889 confirmed cases.

I’m happy to include a 2 day variation in “about”.  13.5 was the best fit over some range of time, the .5 isn’t meant to imply “precisely”.  I did in a later post give a bracket of 2 days on that, perhaps you missed it.  

You’ll note how Italy’s confirmed cases roughly doubled in 2 days in the figures above.   Guess how long it’s taking to double in the U.K. right now? Roughly 2 days.  That’s what we mean with the Italy comparison, not that it was a few weeks different from when the first random imported cases was detected to when control was lost...  

3 and 4.  Nobody is saying the U.K. is like Italy, just that the numbers are increasing as per Italy in terms of day-on-day fractional growth rates.  That’s largely continuing to be born out.  You are right to point out all the differences, several others posters are correct to point out the very similar growth curves with a time lag of about 14 days, and to point out why your arguments against this are incorrect (see 1 above).

> please could you explain why we're all on tramlines? why every country is bound to experience the same rate of spread?

I’m curious - have you read the article Robert Duran linked to?  Nobody has said we are in tramlines - it’s in all our power to change growth rates.  It’s certainly noteworthy than many countries with similar cultures and demographics have similar growth rates, and other countries don’t.  Eg Japan and Korea, where things are going much more slowly...

I’ve taken a lot of time to expand points here because I think you’re arguing against different things to what other people are saying, and that there’s a lot of frustration and cross-purposes talking going on everywhere.  Nobody needs that today do they?

Post edited at 20:00
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In reply to wintertree:

Well reasoned and helpful post.

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 wintertree 15 Mar 2020
In reply to wintertree:

Here are the day-on-day growths expressed as percentages for the six Western European nations with the most cases, ranked most cases first (absolute number not per-capita).

So, looked at today, the UK isn't much like Italy in terms of growth - it's worse.  But these numbers fluctuate day to day and detection rates (and hence percentage growth in detected cases) are dropping the UK with policy now I think being only to test hospital admissions, and I'd imagine they're dropping in Italy because they also have other things to focus on now rather than contact tracing.  Not sure what's up with Switzerland, I hadn't been paying any attention to their numbers until 2 minutes ago... 

  • Italy - 17.0%

  • Spain - 22.7%

  • German - 26.4%

  • France - 20.1%

  • Switzerland - 61.2%

  • UK - 22.0%

There is neither anything in the recorded numbers of the publicly stated policy and actions with regards the Western European nations to suggest things are going to go much better in the UK than the other countries with whom we are currently sharing a trajectory.

1
 Robert Durran 15 Mar 2020
In reply to wintertree:

Thanks for taking the trouble to explain it all again to him and saving me the trouble. I'm not sure I have the patience any more anyway. I must say I am baffled because I'm sure he is not really as dim as he is making himself look for some reason.

Post edited at 21:00
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OP Stichtplate 15 Mar 2020
In reply to wintertree:

Current cases per million population:

Italy- 409.3

Spain- 167.7

Germany- 69.4

France- 83.1

Switzerland- 256.2 

UK- 20.5

https://www.worldometers.info/coronavirus/

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 wintertree 15 Mar 2020
In reply to Robert Durran:

Now is the time to cut everyone a lot of slack.  There’s a lot more reasons to be stressed than normal. 

Stitchplate has explained where they’re coming from - concern over undue panic causing more problems than help - and I’m totally onboard with that.  As I said elsewhere the problem is people are panicking too much about bog roll and not enough about taking personal responsibility for slowing transmission.  It’s tough to get the “right” response through a tool as blunt as 21st century media and social media.

OP Stichtplate 15 Mar 2020
In reply to Robert Durran:

> Thanks for taking the trouble to explain it all again to him and saving me the trouble. I'm not sure I have the patience any more anyway. I must say I am baffled because I'm sure he is not really as dim as he is making himself look for some reason.

I'll take that as roughly translated to "No I can't explain my reasoning".

8
 Weekend Punter 15 Mar 2020
In reply to Stichtplate:

Since we're in the epidemiology thread for coronavirus. Slightly off topic but rather than starting a new thread a question. Reports suggest that around 10% of people who have caught the virus have required oxygen therapy. Has anyone seen an age breakdown of the requirement?

This in my mind is quite a significant point when considering the UK governments approach. Is it that the 10% is across all age groups and it just so happens the younger age groups respond better?

 wintertree 15 Mar 2020
In reply to Stichtplate:

> Current cases per million population:

In my post:

> ranked most cases first (absolute number not per-capita). [The UK was bottom of the list]

So, I hope it is clear to you that I totally agree with you that the UK has fewer cases per person than any of the other countries I listed.

A few months ago there were 0 cases in any of these countries.  In a few months time there will be a lot of dead people in all of them.  Currently I have seen no compelling evidence that the story is going to be much different for the UK than for any of these other countries.  I’ve never wanted to be proved more wrong in my life, and the reason I object so strongly to the case being made that it’s better here (whilst neglecting that really we just lucked out for longer and are worsening just as fast - in terms of day on day fractional growth) is that I’ve heard it used time and again to justify inaction that might have prevented what now looks to be inevitable.

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 Offwidth 15 Mar 2020
In reply to Weekend Punter:

Nearly all old people and or those with existing conditions.

Latest news

https://www.theguardian.com/world/2020/mar/15/uk-coronavirus-crisis-to-last...

 Robert Durran 15 Mar 2020
In reply to Stichtplate:

> I'll take that as roughly translated to "No I can't explain my reasoning".

No, it means you are either stupid or pig-headed. Sorry, I tried to put it politely in my last post but enough's enough. I, like others, have explained it all perfectly clearly already. I'd now rather spend my time responding to Offwidth's thoughtful points in the other thread.

Post edited at 21:19
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OP Stichtplate 15 Mar 2020
In reply to wintertree:

> > Current cases per million population:

> In my post:

> > ranked most cases first (absolute number not per-capita). [The UK was bottom of the list]

> So, I hope it is clear to you that I totally agree with you that the UK has fewer cases per person than any of the other countries I listed.

> A few months ago there were 0 cases in any of these countries.  In a few months time there will be a lot of dead people in all of them.  Currently I have seen no compelling evidence that the story is going to be much different for the UK than for any of these other countries.  I’ve never wanted to be proved more wrong in my life, and the reason I object so strongly to the case being made that it’s better here (whilst neglecting that really we just lucked out for longer and are worsening just as fast - in terms of day on day fractional growth) is that I’ve heard it used time and again to justify inaction that might have prevented what now looks to be inevitable.

I don't know where we're going to end up and (unlike many others on here) I don't pretend to know. All I can do is look at the current stats we do have access to and thank my lucky stars that me and my family are in the UK.

Here's something I do know about though. The current situation is that lots of people are getting very ill and the last place you want to go to get checked out is a hospital, cos the current situation is that hospitals are filling up with horribly contagious patients. So what are your options? In the UK you can ring 111 and you'll be triaged over the phone. If you're struggling to breath (and it's respiratory issues that are killing people) they'll send out an ambulance. Most of the UK's ambulances will have either an emergency medical technician and a paramedic, two paramedics or, in a minority of cases two techs. So what? you may ask, well an NHS tech has 14 weeks of clinical training plus 4 weeks driver training. A recently qualified NHS para will have done a minimum of 2 years at uni and 1500 hours training in hospitals and the back of ambulances and many will be working part time towards their BSc. These crews are trained to assess, triage and treat with a wide range of interventions and drug therapies, right up to the sort of procedures that in many countries are firmly in doctor territory. Crucially they can do all this without taking people in to hospital.

Contrast this with Italy. Their ambulances are crewed on an ad hoc basis, some employed by local authorities and municipalities others directly by hospitals. Some crews are volunteers with minimal training but, as far as I can gather, the vast majority have had 120 hours of training and a further 80 hours of courses. They're trained to provide basic life support and 'scoop and shoot' into hospital. A hospital that is currently infection central.

This is one small area where Italy and the UK diverge hugely, I'm sure there are many others. Perhaps it doesn't matter, perhaps other posters are right and every country is currently hurtling towards the same end point. But then again, maybe not. Reign in the fear cos it does far more harm than good. Concentrate on the positives, help each other out and hope for the best.

1
 wintertree 15 Mar 2020
In reply to Stichtplate:

> Reign in the fear cos it does far more harm than good.

I’ve seen no fear on UKC.  

> Concentrate on the positives, help each other out and hope for the best.

Absolutely agree.  

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 wercat 15 Mar 2020
In reply to Offwidth:

The figure of 531000 deaths mentioned in you latest news link is the closest to the figure I had last week, 532000 when I was talking about WW2.  The really horrible thing is that that figure is not supposed to be over 6 years of war but perhaps one year or so.

I really hope that the real infection rate is far higher and that mortality will be a lower rate and that a significant number of immune "neutrons" can slow down the infection and consequent death rate among the vulnerable

almost no one alive has seen anything like this in Europe - my grandparents generation did in 1918-19.  There might be a few people who were babies then and still alive now.

It really does feel like a "phoney war" period.

Post edited at 21:56
In reply to Stichtplate:

> Current cases per million population:

> Italy- 409.3

> Spain- 167.7

> Germany- 69.4

> France- 83.1

> Switzerland- 256.2 

> UK- 20.5

I don't think anyone wants to argue with you about numbers. The point is that it doesn't matter what the current numbers, or % of the population, if you have exponential growth you are in the shit unless you take some pretty drastic measures to change this or you have some very good reason as to why the current rate of growth will not continue exponentially.

Are you doubting that cases are growing in an exponential manner? Or if agree that they are can you explain why the government shouldn't take drastic measures to slow this growth?

1
OP Stichtplate 15 Mar 2020
In reply to Robert Durran:

> No, it means you are either stupid or pig-headed. Sorry, I tried to put it politely in my last post but enough's enough. I, like others, have explained it all perfectly clearly already. I'd now rather spend my time responding to Offwidth's thoughtful points in the other thread.

That's 6 posts in 24 hours where you've variously referred to me as stupid, pig-headed, daft and thick.  Lots of time for chucking out the insults but no time to actually address the questions I've put to you directly.

and you're a teacher? you must be great at your job.

5
 Mark Edwards 15 Mar 2020
In reply to Stichtplate:

Imagine a headline that said the Chinese were trying to poach German virologists to produce a patented vaccine to CV for Chinese use only.

Now replace Chinese with American, and you get:

https://www.france24.com/en/20200314-us-germany-battle-for-virus-vaccine-su...

1
OP Stichtplate 15 Mar 2020
In reply to mountain.martin:

> Are you doubting that cases are growing in an exponential manner? Or if agree that they are can you explain why the government shouldn't take drastic measures to slow this growth?

I'm not disagreeing with growth rates, I'm saying; this is where we were, this is where we are now and it's massively different from other countries.

Maybe all countries are heading to the same end point but why are a few posters so insistent that it's a cast iron certainty?

1
 wintertree 15 Mar 2020
In reply to Stichtplate:

> I'm saying; this is where we were, this is where we are now and it's massively different from other countries.

The point made by various posters is that it’s not “massively different”, it’s 14 days away from being where other countries are now *unless we start taking much more serious measures now than those other countries did 14 days ago*.  This is why I see it as taking absolutely false comfort in our lower number of cases at a frozen moment in time; that lower number is a result of luck and happenstance not of our being better prepared.  

This conversation has been going on so long that UK case numbers have gone up phenomenally since it started, as they have elsewhere.  Yet we remain an order of magnitude lower than elsewhere, because we remain about 14 days behind.

> Maybe all countries are heading to the same end point but why are a few posters so insistent that it's a cast iron certainty?

I don’t think anyone here thinks it’s a certainty but it’s certainly looking probable with the U.K. government approach.  We’re being much more like Italy/France/Spain than Japan/South Korea.

Post edited at 22:17
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 wercat 15 Mar 2020
In reply to Mark Edwards:

Vile

In reply to Stichtplate:

> I'm not disagreeing with growth rates, I'm saying; this is where we were, this is where we are now and it's massively different from other countries.

> Maybe all countries are heading to the same end point but why are a few posters so insistent that it's a cast iron certainty?

I don't think anyone is pretending they know with 100% certainty, but i don't think you have yet clearly and logically explained why you think we should be different to other countries. It would seem sensible to look at other countries and as a starting point assume our country will behave similarly unless we have good reasons to assume otherwise.

Current numbers are markedly different, but current growth rates aren't. Unless growth rates change we are heading to the same point as other countries just 2 weeks behind Italy, maybe 1 week behind Spain? 

Looking at other countries the ones that have been most successful at slowing the growth rates seem to be the ones that have imposed the most severe restrictions. 

I understand that will have some severe economic and social consequences, but it looks like the alternative could be even worse.

1
 jethro kiernan 15 Mar 2020
In reply to Stichtplate:

2. Another poster insists it's not the entire trajectory, it's actually that the UK is 13.5 days (precisely) behind Italy. Well, I dutifully wound back the clock and here's what I found...

Italy, March 1st: 34 deaths, 1694 confirmed cases

UK, March 14th: 11 deaths, 798 confirmed case 

As of today

Total confirmed cases

1391

New UK cases

330

Total UK deaths

35

that puts us in line with Italy 14 days ago statistically were on track with Italy  give or take 24 hrs 😕

 TobyA 15 Mar 2020
In reply to Stichtplate:

I was just listening to a US radio programme from NPR that covered how the media in Italy and it leakiness of official institutions impacted badly on their lockdown - basically large numbers of people left the closing areas before they were closed.

In a few years time there will be  hopefully the opportunity for some interesting sociology to be done on this, and I'm sure you are right that there are differences. If we are somehow delaying a sudden rise in cases, I hope we are using that time wisely... 

 Robert Durran 15 Mar 2020
In reply to Stichtplate:

> That's 6 posts in 24 hours where you've variously referred to me as stupid, pig-headed, daft and thick.  Lots of time for chucking out the insults but no time to actually address the questions I've put to you directly.

FFS I have addressed them repeatedly and exhaustively (as has wintertree). As I said, any thirteen year old I teach could have got it. 

> and you're a teacher? you must be great at your job.

I think I do OK on the whole. Of course I am paid to be (ideally) infinitely patient with the recalcitrant and mathematically challenged on weekdays, so I'm afraid I set myself slightly lower standards of patience in a UKC thread which was originally about recreational modelling!

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OP Stichtplate 15 Mar 2020
In reply to jethro kiernan:

> Italy, March 1st: 34 deaths, 1694 confirmed cases

> UK, March 14th: 11 deaths, 798 confirmed case 

> As of today

> Total confirmed cases

> 1391

> New UK cases

> 330

> Total UK deaths

> 35

> that puts us in line with Italy 14 days ago statistically were on track with Italy  give or take 24 hrs 😕

Except for one rather major point, by March 1st Italy had tested 21,127 patients and confirmed 1694.

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Italy

In the UK, as of today we've tested 40,279 with just 1372 confirmed cases.

https://www.bbc.co.uk/news/uk-51901818

So that actually represents roughly half of Italy's infection rate.

Edit: Looks to me that all these mathematical certainties people keep banging on about aren't certainties at all.

Post edited at 23:18
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OP Stichtplate 15 Mar 2020
In reply to Robert Durran:

You've twice now said you can't be bothered with me. How about you actually stop bothering me?

5
 wintertree 15 Mar 2020
In reply to Stichtplate:

> So that actually represents roughly half of Italy's infection rate.

Only if you assume the tested:infected rate is representative of the whole population

1. You extensively explained previously how disinterested you were in the estimates of undetected infections and I believe l drew an analogy between considering undetected cases and believing in the Loch Ness monster but are now depending on them to make your case.

2. If the testing is done by contract tracing etc, it’s not valid to extrapolate that ratio to the population - rather it tells you how deep and wide the contact tracing goes.

Post edited at 23:24
2
In reply to TobyA:

> If we are somehow delaying a sudden rise in cases, I hope we are using that time wisely... 

How could we be delaying a rise in cases by imposing no restrictions? 

In reply to Offwidth:

This isn't a plan it is insanity and barely managed disaster.

A plan would be:

Absolute and immediate hard social distancing like is used in Hong Kong, Singapore, China.   Don't just stomp on the sombrero absolutely flatten it before we get where Italy is.

That puts us into an economically unpleasant and socially unpleasant extended period of near lockdown with not that many new cases of coronavirus.  Which means hospitals can not only cope they have time to research and implement better treatment protocols.

During the lockdown phase work like hell and spend money like it was going out of fashion on new technologies to deal with coronavirus by forcing tech and engineering companies to second staff or propose programs themselves.  Not just vaccines it is also:

a, Wearable health monitors and people tracking technologies.  We can easily produce wearable devices which continually monitor someone's health and also track any close contacts with other people carrying the devices.   If the device also has a display which gives you a 'green' / 'red' status for whether you are allowed to go out then you can immediately get anyone with symptoms into home or fever hospital quarantine and immediately have a list of all their recent contacts.    This will let you safely and gradually lift the restrictions of the quarantine while keeping it suppressed.   It will let you have more subtle policies about who can go out when since it is all controlled online.   Nobody has used this kind of tracking and wearable monitoring tech to deal with an epidemic before and it could be a game changer.

b. Better hygiene products specific to corona virus e.g. products with surfaces the virus can't live on that can be attached to door handles, work tops etc.  Better PPE.

c. Better habits and protocols to avoid infection.

d. Better drugs and protocols to treat it.

e. Lining up medical supplies to be ready for when the restrictions are lifted.

Six months out we could be massively better equipped to deal with this than we are now, even without a vaccine.   This is why the 'oh but if we clamp down there will just be a second wave in the autumn which is worse' argument is bollocks.  It is pre-supposing that the world's tech and bio companies can't get us a substantial edge in six months of massively funded development.

What is needed is for government to accept and deal with the economic consequences of an extended shut down so as to give the time for science and tech to react.  

6
 Robert Durran 15 Mar 2020
In reply to Stichtplate:

> You've twice now said you can't be bothered with me. How about you actually stop bothering me?

Probably just frustration at your refusal to admit you are wrong/confused.

But yes, probably the first sensible post you have made in this exchange!

12
OP Stichtplate 15 Mar 2020
In reply to wintertree:

> > So that actually represents roughly half of Italy's infection rate.

> Only if you assume the tested:infected rate is representative of the whole population

Why does that matter? It's still a hard figure and not just a guess? A figure of 40,000 plus is more than big enough to count as statistically significant in the assessment of the wider population.

> 1. You extensively explained previously how disintereste you were in the estimates of undetected infections and I believe l drew an analogy between counting undetected cases and believing in the Loch Ness monster but are now depending on them to make your case.

No, I was discounting future extrapolations and current guess work as hard facts. That isn't at all the same thing as actual people tested.

> 2. If the testing is done by contract tracing etc, it’s not valid to extrapolate that ratio to the population - rather it tells you how deep and wide the contact tracing goes.

What you seem to be saying is that my figure isn't as good as yours because you're unsure of exact methodology, but your Italian data is cast iron certain... because what? are you certain of the methodology used in Italy?

or is it just the case that you're actually now taking a faith position on your data?

Post edited at 23:31
2
In reply to tom_in_edinburgh:

Now that's a plan.

1
 The New NickB 15 Mar 2020
In reply to TobyA:

I was talking to my mother today, her 93 year old mother-in-law is in Southern Spain and circumstances are pretty much forcing her back to the UK. Spain is pretty much fully locked down, but my understanding is that the vast majority of the cases are in Madrid. Apparently, many in Madrid have fled the city for their holiday homes on the coast, making it much more of a nationwide issue.

 wintertree 15 Mar 2020
In reply to Stichtplate:

> Why does that matter? It's still a hard figure and not just a guess? A figure of 40,000 plus is more than big enough to count as statistically significant in the assessment of the wider population.

If the testing is done at random then, yes, you have a good statistical sample of the population.  If it's done on those that present with symptoms, and then on contacts traced from those found to be infected, it is not a valid sample of the wider population at all.   Let's reduce the possibilities to two absurd limits.

(a) Only infected people present at hospital, and all contacts traced are clear; then this "hard figure" only tells me about the number of contacts traced.  

(b) If I take the opposite extreme and the measurement is random, it's a useful "hard figure" that estimates the population level infection ratio with some accuracy.

(c) From all the data I've seen, reality is closer to (a) than to (b) 

> No, I was discounting future extrapolations and current guess work as hard facts. That isn't at all the same thing as actual people tested.

It is, because by linking people tested from non-random sampling to an infection rate you are making the implicit assumption that the ratio tested:infected somehow scales to the population.  It's whimsical and in my view utterly insupportable.  

> What you seem to be saying is that my figure isn't as good as yours

Yes

> because you're unsure of exact methodology, but your Italian data is cast iron certain... because what? are you certain of the methodology used in Italy?

No.  My position is that

(a) the number of detected infections is factual, and the population of the country is factual, and the two taken together are meaningful data. 

(b) the number of people tested is anything but random sampling and - as you note - depends on different methodologies in different countries, and is, if we assume (untested and failing more by the day in both countries I suspect) that most cases are detected, almost totally irrelevant.

(c) That you have apparently now recognised that the scaling ratios are similar in both countries, so you are now moving the goalposts to discussing the ratio of infected:tested instead of infected at day X : infected at day X+14. 

(d) That your moving of the goalposts makes a factor of 2 difference, which would shift our lag to Italy from ~ 14 days to ~ 17 days.

> or is it just the case that you're actually now taking a faith position on your data?

Absolutely not.

With regards (c) above - it's okay to accept that you were wrong on something, even on UKC.  I myself have occasionally been known to do so.  However, the intent of the original long disrupted discussion on scaling was not to promote "fear", and was not to suggest that we are locked in to the same rut as Italy - it was to illustrate why as individuals, as organisations and as a nation we needed to act fast to break out of that rut.  Since this ruck started that moment has passed perhaps and it's all academic now.  There are no points to be won on this - we are all of us losers.   I can feel the downvotes brewing as I prepare to say this - normally I wouldn't put this much effort in to arguing a point (honest) but you're one of the relatively few UKC posters whose opinions I take seriously, and who I feel always adds positivity to a discussion.  I may loose my new business to the uncertainty ahead and my main employer could face an existential crisis, but I would rather that than your job.  This argument is not worth having - you have throughout presented highly valid points but they're getting lost in the noise.

Post edited at 00:01
1
In reply to Stichtplate:

> Except for one rather major point, by March 1st Italy had tested 21,127 patients and confirmed 1694.

> In the UK, as of today we've tested 40,279 with just 1372 confirmed cases.

> So that actually represents roughly half of Italy's infection rate.

It seems you are cherry picking your data to suit your argument. We don't know why Italy tested less people than the UK. Possibly because on the 1st march there was less awareness of the prevalence of the virus, compared to the awareness in the UK on the 15th? Or possibly because of the capacity to administer the tests?

So if your figures represent the total number of infections then as a % of population we are in a very similar situation 14 days apart. 

If those UK figures are 50% less than Italy ,as you are speculating with no conclusive reasoning, with exponential growth we are still f*cked.

 wintertree 16 Mar 2020
In reply to tom_in_edinburgh:

> Better drugs [...] to treat it.

The average successfully licensed drug takes something like on the order of 12 years and $US 1 Bn (including the costs of failed alternatives, which must be paid) to come to market.

The process is this long and expensive for good reason.  It can be shortened when the alternative is certain death, and it can be rushed - but even a factor 10 improvement is too long for the current crisis.

You're arguing for a biotech response - it's out there and its happening far faster than is usual in the field.  There are > 60 vaccine candidates in development and a dozen or so therapeutics.  Some of these are going to Phase 1 clinical trials in near-record time.  This coronavirus is one of the nasties that kills partly by causing an immune system over-response.  The immune system is scary in terms of its computational ability and non-linear responses; our knowledge of these is poor and a good idea can rapidly snowball out of control - the clinical trial of the MAB Theralizumab being an example of immune related therapy crossing over into "messing with forces we don't understand".  I don't use this as an example of much relevance to the coronavirus but to illustrate why things must move slowly in pharma research - this thing was lethal at 0.002x the lethal dose from the animal models due to a human-specific immune over-reaction.  It's that sort of over-reaction that needs to be slowed with the coronavirus, yet sometimes the immune system reacts more aggressively the second time it sees something, meaning an immunisation could just prime the immune system to go in to total meltdown over this coronavirus.  These things have to be understood and tested, and then a physical product has to be produced that is robust enough to be shipped around the world from manufacture sites.  We don't know enough to model it, we don't know enough to get it right first time (>98% of therapeutic candidates fail at some point in the testing and licensing pipeline) and when we get it wrong we kill people.  It's terrifying really how far we are from mastery of the field.

https://www.biocentury.com/article/304515

> Better [...] protocols to treat it.

Agree.  

>  If the device also has a display which gives you a 'green' / 'red' status for whether you are allowed to go out then you can immediately get anyone with symptoms into home or fever hospital quarantine and immediately have a list of all their recent contacts. 

Unless you give the device the ability to electro-shock the wearer senseless and you make it impossible to remove without blowing their head of (think the exploding neck collars in The Running Man's perimeter fence) it won't work because there are enough people out there who just don't care.

Post edited at 00:08
OP Stichtplate 16 Mar 2020
In reply to mountain.martin:

> It seems you are cherry picking your data to suit your argument. We don't know why Italy tested less people than the UK. Possibly because on the 1st march there was less awareness of the prevalence of the virus, compared to the awareness in the UK on the 15th? Or possibly because of the capacity to administer the tests?

It's hardly cherry picking data. Those are the only actual confirmed figures related to infection rates I can find for the respective countries on those respective dates. If you can find other data to support your own position then cherry pick away.

> So if your figures represent the total number of infections then as a % of population we are in a very similar situation 14 days apart. 

Hardly, UK testing is showing less than half the hit rate than their Italian counterpart.

> If those UK figures are 50% less than Italy ,as you are speculating with no conclusive reasoning, with exponential growth we are still f*cked.

My reasoning is that more than 40,000 patients tested is a whopping great sample size and to discount it as irrelevant would seem absurd. Yes we're still screwed but not as screwed as many are saying we are. it's entirely possible our infection rate is half of what everyone is insisting it should be, meaning spread is slower than Italy and we've got a better chance at managing the huge caseload heading our way. 

4
 wintertree 16 Mar 2020
In reply to Stichtplate:

> it's entirely possible our infection rate is half of what everyone is insisting it should be, meaning spread is slower than Italy and we've got a better chance at managing the huge caseload heading our way. 

This is a misunderstanding.   Our spread is the same speed as Italy expressed as a day-on-day fractional increase.  That's the measure that matters.

If we measure a different but fixed fraction of total infections compared to Italy, that does not affect the average in the day-on-day increase expressed as a ratio, it shifts the time lag (around 14 days) between us and Italy.  

If as you theorise Italy is measuring 2x the fraction of total infections as us, given the fact that total detected infections have about the same doubling time in both countries, what it actually means is that we have another ~3 days grace on Italy.

What gives us a better chance of managing our case is:

(1) Increased social distancing from people explained/scared/induced in to it - which is hard to do against the loud backdrop of people saying "It's not bad here because it's worse elsewhere (*)"

(2) Being more capable than elsewhere in building field hospitals, building ventilators, re-training vets, dentists and animal research lab anaesthesiologists into doing human care under supervision and scaling our supply of medical gaseous/liquid oxygen including storage and transport containers 

What increases our chance of managing our cases and does so for everyone else is:

(3) Developing and promoting clinical advances specific to this disease

(4) Going flat out on anti-virals and vaccines specific to this disease.

>  Yes we're still screwed but not as screwed as many are saying we are. it's entirely possible our infection rate is half of what everyone is insisting it should be,

To return to an earlier analogy of mine; if you've just fallen off a cliff, it doesn't matter how you got to the cliff top.  The doubling rate (the time taken for the number of cases to double) is similar for us and other Western European countries; even if we were measuring 10x more cases than Italy, assuming that measurement bias is a fixed ratio of actual cases invariant of time, the fact the doubling rate is comparable means we're both in free-fall off the same cliff; Italy is just closer to the sea.

Post edited at 00:22
 jethro kiernan 16 Mar 2020
In reply to Stichtplate:

“So that actually represents roughly half of Italy's infection rate.

Edit: Looks to me that all these mathematical certainties people keep banging on about aren't certainties at all.”

but that was my point, you posted one set of figures as a certainty 24 hrs later the figures had changed significantly 

we can be very certain the figures are going to go up and very shortly they will go up exponentially the rest is just quibbling,  

Post edited at 00:29
In reply to Stichtplate:

> we are still screwed but not as screwed as many people are saying we are.

Great so we are now discussing whether we are f*cked or really f*cked? 

it seems that which ever is correct the important thing is we do whatever we can to slow the spread.

i think, a few days ago this discussion started with you saying some people were scaremongering? I think a few days ago I might have agreed with that but I wouldn't now.

What's your thoughts on that and what do you think the government should do now?

Post edited at 00:29
 profitofdoom 16 Mar 2020
In reply to wintertree:

> Now is the time to cut everyone a lot of slack.....

Nice one

This is a good and useful thread

But let's all keep civil

I am not an expert needless to say but can I please just say about these 3 very different places:

*Rates are dropping fast in China, great to see. Seems to be stabilising

*Rates are dropping fast in Hong Kong, great to see. Seems to be stabilising

*Rates are dropping in South Korea, great to see. Might be stabilising

OP Stichtplate 16 Mar 2020
In reply to wintertree:

> With regards (c) above - it's okay to accept that you were wrong on something, even on UKC.  I myself have occasionally been known to do so.  However, the intent of the original long disrupted discussion on scaling was not to promote "fear", and was not to suggest that we are locked in to the same rut as Italy - it was to illustrate why as individuals, as organisations and as a nation we needed to act fast to break out of that rut.  Since this ruck started that moment has passed perhaps and it's all academic now.  

Christ, I'm wrong on loads of stuff, I've said plenty of times on this thread that I might be wrong, but at the same time I just cant see that the raw data we've got supports an absolute certainty that we're the next Italy.

>There are no points to be won on this - we are all of us losers.   I can feel the downvotes brewing as I prepare to say this - normally I wouldn't put this much effort in to arguing a point (honest) but you're one of the relatively few UKC posters whose opinions I take seriously, and who I feel always adds positivity to a discussion.  I may loose my new business to the uncertainty ahead and my main employer could face an existential crisis, but I would rather that than your job.  This argument is not worth having - you have throughout presented highly valid points but they're getting lost in the noise.

Thanks for the sentiment mate and genuinely, best of luck (we're all going to need it). It was my Dad's 80th Birthday dinner today and I couldn't even hug him. Hand sanitiser and 1 metre separation all round. No cuddles from grandma for my kids, just half jokey half tragic elbow bumps... all at my insistence. Looking to the future, I'm expecting the schools to shut down soon, at which point the Mrs and me have decided that the best option is for her to take the kids to her folks in rural Wales, cos I'm not likely to be too healthy to be around given what I'll be exposed to. It's all a bit shit really, but it's only going to be really shit for our elderly rellies and all the poor sods with pre existing health issues. Sad times.

In reply to wintertree:

I would like to nominate you as poster of the year (so far) for you contributions on this thread that have kept it interesting, informative and civilised.

Thank you.

 wintertree 16 Mar 2020
In reply to Stichtplate:

> but at the same time I just cant see that the raw data we've got supports an absolute certainty that we're the next Italy.

Agreed, the data doesn’t support that.  The future isn’t written yet.  But we’re not doing anything different and what from my perspective contributes to that is a public perception taking undue solace in our absolute numbers being so much lower than Italy’s.  This will continue to be the case for some time perhaps but the eventual outcome could be the same.


> It was my Dad's 80th Birthday dinner today and I couldn't even hug him.

My dad would have been 73 this year; he passed a few years ago and I’m grateful that he did so in his own house with family present and  with a bloody big supply of oramorph for his pain  He saw the way things were going and worried about his grand child’s future.  I’m glad he passed before now.  Two weeks ago I was telling the young people at work to consider going home to their parents whilst they probably weren’t infected.  It’s all so desperately sad yet most of them seemed to think I was some doomsaying nutter.

The very best wishes to you and your family; I can’t imagine staying to work whilst sending mine away somewhere safer - I’ve never doubted you were the better of us but now I know it.

Post edited at 00:52
In reply to wintertree:

> Unless you give the device the ability to electro-shock the wearer senseless and you make it impossible to remove without blowing their head of (think the exploding neck collars in The Running Man's perimeter fence) it won't work because there are enough people out there who just don't care.

They already use a cellphone app like this in China.   It is easy to enforce because the situation it is used in is a state of lockdown, you don't just walk into apartment buildings, shops or public transport.   The cops/doorman asks to see your phone and if the screen is the wrong colour you don't get in or you get lifted and taken to a fever hospital.

If you take off a watch that is monitoring your pulse it will know.  There will be a break in the data and the algorithm might decide you need to go back into quarantine.  The other reason most people won't take it off is that the early detection of an infection is in their own interest, it could mean faster treatment.

The system could potentially be fooled by a healthy, determined person with relevant skills but it doesn't have to be 100% perfect, because the alternatives are so bad.  If it provides as good or better suppression of the virus than a total lockdown while allowing more freedom of movement than a total lockdown it's a big step forward.

This kind of tech will allow experimentation with gradually lowering the degree of lockdown with immediate early warning so it can be restored fast if things go wrong.

Post edited at 01:42
6
In reply to wintertree:

> > Better drugs [...] to treat it.

> The average successfully licensed drug takes something like on the order of 12 years and $US 1 Bn (including the costs of failed alternatives, which must be paid) to come to market.

It doesn't need to be a new drug.   There are a huge number of drugs already licensed for other conditions that may be useful in this one.   For example the Chinese were prescribing HIV drugs and there are all kinds of drugs being prescribed to treat symptoms some of which are working better than others.   In six months with thousands of hospitals all over the world trying slightly different things they will be much further along in determining which existing drugs are useful and the best protocols for using them.

Also, in a condition like this governments aren't going to be following the same protocols.  It's like a war, there will be shortcuts.

 RomTheBear 16 Mar 2020
In reply to profitofdoom:

> *Rates are dropping fast in China, great to see. Seems to be stabilising

> *Rates are dropping fast in Hong Kong, great to see. Seems to be stabilising

> *Rates are dropping in South Korea, great to see. Might be stabilising

They managed but only with strong, committed response though.

I’m not seeing much willingness to do that in UK yet but that may change quickly. The U.K. bought valuable time though through very good contact tracing on the onset, so we could avoid bulk of the death if we were to take the same kind of actions now.

The South Korean response is the most impressive, essentially they’ve said we are going to test as many people as possible, repeatedly, even if asymptomatic. If you are healthy you can go out and about, if not stay home. By doing this they’ve avoided locking down everything.

In UK we’ve decided to stop testing outside hospitals which in my opinion seems a rather fatalistic strategy.

Post edited at 04:45
 RomTheBear 16 Mar 2020
In reply to wintertree:

I command your epic patience on this thread.

Post edited at 04:46
1
 profitofdoom 16 Mar 2020
In reply to RomTheBear:

> They managed but only with strong, committed response though............. > The South Korean response is the most impressive, essentially they’ve said we are going to test as many people as possible, repeatedly, even if asymptomatic. If you are healthy you can go out and about, if not stay home. By doing this they’ve avoided locking down everything. > In UK we’ve decided to stop testing outside hospitals which in my opinion seems a rather fatalistic strategy.

Thanks for your reply - good points and helpful

I am in South Korea (a place I know well) now, and your description of what's happening here is exactly spot on IMO

 deacondeacon 16 Mar 2020
In reply to tom_in_edinburgh:

That all sounds great, although a little close to having a a little yellow star shaped badge on one's lapel. 

The problem is that the bankruptcy and unemployment from struggling businesses is going to affect us much more severely than the extra deaths from the virus (obviously not to the actual people doing the dying   ) 

1
 Robert Durran 16 Mar 2020
In reply to RomTheBear:

> I command your epic patience on this thread.

Yes, I thought I was being pretty patient but wintertree's superhuman performance leaves me in awe!

7
 Neil Williams 16 Mar 2020
In reply to MG:

> Herd immunity not an aim 

I think it actually still is and they're changing the publicity because they've upset people.  That sentence is very carefully worded.

As an aside, it is a fact that a large number of deaths of over-70s, particularly those with serious conditions, will save the welfare state/NHS a lot of money and probably resolve the care crisis (and I think more older people acknowledge that than younger people based on people I've spoken to at least, family in particular).  I don't see why people are suggesting that fact is denied, because it is a fact.  No fact should be denied or hidden.

However, what we do need to be clear on is that pursuing that as policy isn't the way to go, that is, we should not be looking to write off over 70s and should look to protect them, and I've not seen any evidence that this is not the case - people suggesting otherwise seem just to be playing party politics and shouting "evil Tory", which is all very well but this is not the time.

That is "we accept that that would be an easy choice from a Government perspective but we are not choosing it".

Post edited at 08:23
In reply to MG:

so the government is saying

 "we must protect the vulnerable, and protect the NHS and flatten the curve"

But they are not enforcing measures that would surely flatten the curve the most by maximising isolation. 

I think most people would agree that flattening the curve is the best aim, but we don't seem to be working towards this aim by taking a very different approach to nearly every other country with significant infections and not enforcing reductions in human interaction. 

Are they talking bollocks? Or am I missing something?

 MG 16 Mar 2020
In reply to mountain.martin:

I agree the strategy isnt clear and communications vague. However, that is also true elsewhere. How long can Italy and Spain realistically shutdown? SK seem the only country so far to successfully balance medical and economic requirements. 

 RomTheBear 16 Mar 2020
In reply to mountain.martin:

> so the government is saying

>  "we must protect the vulnerable, and protect the NHS and flatten the curve"

> But they are not enforcing measures that would surely flatten the curve the most by maximising isolation. 

> I think most people would agree that flattening the curve is the best aim, but we don't seem to be working towards this aim by taking a very different approach to nearly every other country with significant infections and not enforcing reductions in human interaction. 

> Are they talking bollocks? Or am I missing something?

We don’t know because the government is being quite secretive about their strategy and the rationale for their decision making.

But at the age of social media they’ll have a big big problem trying to hide the consequences of their decisions.

1
 wbo2 16 Mar 2020
In reply to deacondeacon: Sadly re. the eonomic impact - there has been a lot of worry that a recession was coming anyway, and so a lot of this damage was going to happen at some if/when there was a big credit squeeze..  It's particularly harsh on the poor as the economy is so biased to services,  and the move to 'gig' jobs (be that Uber or a building site) exaggerates the problems.

  But it's hard to see that even a combination of a global recession and Brexit will be as damaging as this.

But this is another thread....

Post edited at 08:40
 Coel Hellier 16 Mar 2020
In reply to Neil Williams:

> As an aside, it is a fact that a large number of deaths of over-70s, particularly those with serious conditions, will save the welfare state/NHS a lot of money and probably resolve the care crisis ...

Not necessarily, there are indications that it could leave a large number of people with permanent lung damage, and long-term disabled people are always expensive.

 Coel Hellier 16 Mar 2020
In reply to mountain.martin:

> But they are not enforcing measures that would surely flatten the curve the most by maximising isolation. 

To assess policies like closing schools, one has to ask what the kids would be doing instead.  Isolating active 10-to-15-yr-olds for ten weeks is not really practical. 

 Neil Williams 16 Mar 2020
In reply to Coel Hellier:

> Not necessarily, there are indications that it could leave a large number of people with permanent lung damage, and long-term disabled people are always expensive.

Fair point.  But in any case, people are still seeking to suppress the point I made, which is the wrong way to deal with it - accepting that it might be the case (subject to what you say) but explaining why we aren't wilfully going that way is the way to go there.

 Offwidth 16 Mar 2020
In reply to MG:

"I agree the strategy isnt clear and communications vague. However, that is also true elsewhere. How long can Italy and Spain realistically shutdown? SK seem the only country so far to successfully balance medical and economic requirements. "

What about Japan, Singapore, Taiwan, Hong Kong, and of course China.  Maybe even a few other developing countries like Thailand. Where is your state information on vagueness and economic damage given their decisive actions that appear to be working?

Italy has already changed the exponential rate of the mortality graph and there are signs it may be starting to flatten out in the north.

Post edited at 09:10
 MG 16 Mar 2020
In reply to Offwidth:

Well China stopped a large chunk of its economy. I know less about the others but city states Id guess are a bit different to manage 

In reply to Coel Hellier:

> To assess policies like closing schools, one has to ask what the kids would be doing instead.  Isolating active 10-to-15-yr-olds for ten weeks is not really practical. 

Well, most other countries think closing schools, bars, restaurants will slow the spread and it would seem to make sense. Yes it won't completely stop social interaction. But it will surely greatly reduce it?

I think if our government is choosing to take a very different path to most other countries, and to one that most scientists say will do most to flatten the curve then they should explain their thinking to us. 

1
 neilh 16 Mar 2020
In reply to RomTheBear:

There is an article in the Economist behind the paywall explaining that South Korea’s position may not be as good as people make out.too early to say if it’s successful.  

 neilh 16 Mar 2020
In reply to MG:

Stopped the Economy in one area. It’s a pretty big country. 
 

I have had orders from China via japan in the so called shutdown 

 MG 16 Mar 2020
In reply to neilh:

Yes.

They are already having to deal with newly imported cases I see. Was it a long term success? Will the UK do better long term? We don't know but I see the case.for a different approach. 

 Neil Williams 16 Mar 2020
In reply to MG:

> They are already having to deal with newly imported cases I see. Was it a long term success? Will the UK do better long term? We don't know but I see the case.for a different approach.

The issue with simply stopping it (with no herd immunity) is that it'll come back.  Countries that do wipe it out on that basis are going to need to keep borders very firmly closed until a vaccine arrives.

 wercat 16 Mar 2020
In reply to wintertree:

> Two weeks ago I was telling the young people at work to consider going home to their parents whilst they probably weren’t infected.

Our son at Leicester has taken the decision not to come home for the Easter vacation as a precaution against the risk of using the trains.  I thought that quite grown up of him and it saved me making the gentle suggestion myself, even though we'll miss him being here for Easter.

 MG 16 Mar 2020
In reply to Neil Williams:

Indeed, which is why I see the potential benefits in the UK approach. I dont really see how it works however when other countries take thr wipe it out approach - can we never visit them!? 

 freeflyer 16 Mar 2020
In reply to wintertree:

Please would you consider attending the ongoing COBRA meetings!

 Graeme G 16 Mar 2020
In reply to wercat:

That’s just very gently prompted me to change my travel plans today. Was going to have to use the train but on 2nd thoughts I’ll drive.

Ta 😀

 RomTheBear 16 Mar 2020
In reply to Coel Hellier:

> To assess policies like closing schools, one has to ask what the kids would be doing instead.  Isolating active 10-to-15-yr-olds for ten weeks is not really practical. 

There is a great invention called « the iPad ».  I can guarantee you that you can keep a 10 year old glued to it and not get of his/her arse of the couch for years on end; no problem.

Post edited at 10:00
1
 RomTheBear 16 Mar 2020
In reply to MG:

> Indeed, which is why I see the potential benefits in the UK approach. I dont really see how it works however when other countries take thr wipe it out approach - can we never visit them!? 

You could visit but would need to go on a short quarantine and take a test.

Everybody seems to say we can’t stop this but when you look at the numbers of active cases in China and other places, actually it doesn’t look that impossible at all. But yes you would need strict tests and quarantine on entry into countries to maintain it.

As long as we take the base reproduction rate below 1, then in theory without new cases coming in from abroad you go to zero.

Can anybody think of a reason this wouldn’t work ?

Post edited at 09:59
 Coel Hellier 16 Mar 2020
In reply to mountain.martin:

> Well, most other countries think closing schools, bars, restaurants will slow the spread

There's quite a big difference between schools, and bars/restaurants.  If we close the latter there's a reduction in social activity and little downside (except to the viability of those businesses).  Closing schools has far more knock-on consequences. 

 Neil Williams 16 Mar 2020
In reply to wercat:

> Our son at Leicester has taken the decision not to come home for the Easter vacation as a precaution against the risk of using the trains.  I thought that quite grown up of him and it saved me making the gentle suggestion myself, even though we'll miss him being here for Easter.

I've been on the trains on Saturday, Sunday and today, they're empty, you'll easily sit 2m from someone else.  Risk: low.

The risk (in so far as it exists) is probably more that he'll catch it at uni and give it to you.

Post edited at 10:08
In reply to Neil Williams:

> The issue with simply stopping it (with no herd immunity) is that it'll come back.  Countries that do wipe it out on that basis are going to need to keep borders very firmly closed until a vaccine arrives.

I think the doctors have got this wrong because they're not taking sufficient account of new technology.  The thing we can do now that we could never do to anything like the same extent at any point in the past is track people.   We need to leverage that to get infectious people out of circulation almost instantly i.e. move back to the contact tracing phase but with vastly improved capability.  That could be as big a breakthrough in stopping infectious diseases as vaccines.

This is about how Taiwan has controlled the virus using big data and cellphone based tracking https://www.eetasia.com/news/article/Covid-19-The-Success-Story-of-Taiwan

What Taiwan has now is only the start of what is possible and unlike with the vaccines and drugs there's no theoretical difficulty in building the necessary electronics and software.  It's all well understood and can build on already existing products like iWatch.  We could make wearable devices to monitor people's health continuously and to continuously track who people had been in close contact with.  We could design software to use that data to implement an incredibly efficient system for getting people into quarantine before they have a chance to infect multiple others and that will stop infectious diseases - not just COVID-19 but quite likely normal flu as well as a side effect - or at least keep it at an acceptable level of control with less restriction than a physical lock down so we can hold out until we have a vaccine.

3
In reply to Coel Hellier:

> There's quite a big difference between schools, and bars/restaurants.  If we close the latter there's a reduction in social activity and little downside (except to the viability of those businesses).  Closing schools has far more knock-on consequences. 

I can understand your reasoning, but this isn't at the moment the government plan, they haven't yet closed anything or banned social gatherings of any size.

 Neil Williams 16 Mar 2020
In reply to tom_in_edinburgh:

You know what?  If you want to live in a surveillance society like that, can I suggest you investigate the possibilities of emigrating to China?  I don't.

Using it to stop coronavirus is a fairly noble use, but you can be sure that isn't all it would be used for.

Post edited at 10:31
In reply to Neil Williams:

> You know what?  If you want to live in a surveillance society like that, can I suggest you investigate the possibilities of emigrating to China?  I don't.

It is way past what I want.  The government is talking about hundreds of thousands of people dying and a 14 month lockdown for old people.  Nobody is going to be living in a situation that they want for a long time.   Physical lockdowns with no intelligence or tracking will be even more intrusive.

Covid-19 isn't the first disease with pandemic potential in the last decade and there is no reason to think it will be the last.  In fact strains of it which we might not have immunity to even if we go through the multiple hundred thousand death scenario will appear.   We need to get technologies in place with a general capability to manage infectious disease outbreaks.  The vaccine guys don't seem to be able to turn it around fast enough.  Electronics could.

> Using it to stop coronavirus is a fairly noble use, but you can be sure that isn't all it would be used for.

Hopefully, after this gets sorted we would kick the Tories out, turn this system off and put the trackers away until there was another pandemic and we would be living in a society without Covid-19 and possibly also without the flu.

This technical genie is not going back in the bottle even if we choose not to use it for disease prevention.  If we get a government that is nasty enough to want to do this kind of tracking for political reasons they will build this kind of system anyway.   The only protection is to not elect people like that.

Post edited at 10:41
3
In reply to Neil Williams:

It's an infringement of my civil liberties that I would be perfectly happy to accept for 6 months if it saved lives and kept society running more smoothly. 

My business being closed and having to lay off most of my staff will be a much bigger problem/inconvenience. If that can be avoided or minimised it would seem like a sensible step.

 Neil Williams 16 Mar 2020
In reply to mountain.martin:

> It's an infringement of my civil liberties that I would be perfectly happy to accept for 6 months if it saved lives and kept society running more smoothly.

I'd accept it for 6 months or even 12, or even 2 years (which is the length of the emergency legislation going through tomorrow), but once the genie is out of the bottle...

Post edited at 10:59
 jkarran 16 Mar 2020
In reply to tom_in_edinburgh:

> This isn't a plan it is insanity and barely managed disaster.

It is a plan, it's just not the delay to soften the peak so the NHS can cope plan we're lead to believe it is. It looks now like there is no serious expectation the NHS will cope with CV patients so instead the young and well have to get infected fast while the old and sick isolate as best and briefly as they can. That is 'a' plan and I don't think it's the worst but it's not looking much like the plan we heard last week.

It does mean a lot of us will die where we wouldn't were a more measured, precautionary approach taken whereby we basically stop transmission now, briefly to build resilience and capability. I expect it won't survive serious contact with the enemy, once the public sees hospitals overwhelmed it'll be a race for government to get back in step with public sentiment. How we go back to semi-normality from there is a challenge I can totally understand the government hoping to avoid, lifting restrictions will be far more costly politically than imposing them. Even more so if we get to those restrictions via a glimpse of chaos.

jk

 Robert Durran 16 Mar 2020
In reply to Coel Hellier:

> To assess policies like closing schools, one has to ask what the kids would be doing instead.  Isolating active 10-to-15-yr-olds for ten weeks is not really practical. 

Indeed. Not to mention the impact on parents. It is a trade off with no easy answers.

 brunoschull 16 Mar 2020

Aside from all the personal back and forth, I'm learning from this thread--thanks. 

I'm on day one of school closures and work at home here in Switzerland.  I'm actually also about 7 days into a strong cold/flu/corona virus infection....with no testing available it's impossible for me to know.  Anyway, I seem to be on the mend, and my wife and 10-year old daughter are doing great.

Two points:

First, one possible factor that might effect different death numbers in different countries is the population age structure.  Check out:

https://www.populationpyramid.net

You can quickly see differences between countries.  In countries with a greater proportion of older people, it stands to reason (I think) that more people might suffer more severe symptoms and consequences.  And vice versa. 

Second, I can see from just one day at home, that people seem to be trying to ignore social distancing as much as possible--I don't think it's sunk in yet how important this may me--and also that long term (2 weeks, 4 weeks, 8 weeks, and so on) it will be a real challenge to keep schools and businesses closed, maybe impossible.  How can we define essential and non-essential services?  How can we enforce these guidelines?  Does the military need to get involved?  And so on. 

Interesting, difficult times. 

 Robert Durran 16 Mar 2020
In reply to brunoschull:

> You can quickly see differences between countries.  In countries with a greater proportion of older people, it stands to reason (I think) that more people might suffer more severe symptoms and consequences.  And vice versa. 

I was thinking over the weekend that African countries with poor healthcare systems are going to be screwed, but then I read that there is very little of it so far in Africa, possibly because of the young age profile. But I would have thought  that it might also mean there is a huge amount of it circulating undetected in the young and that the old will be hit very badly in due course.

Post edited at 13:07
 Toerag 16 Mar 2020
In reply to Robert Durran:

I'd say it's because much of Africa is still a 3rd world country, and there is a hint that it might not spread so well in hot places. It's only a matter of time especially for the urban populations - look at the hold AIDS has in the continent compared to elsewhere.

Post edited at 13:31
 Toerag 16 Mar 2020
In reply to Stichtplate:

Check out the graphs here, they'll tell you everything you need to know about how the UK is doing compared to elsewhere.

http://nrg.cs.ucl.ac.uk/mjh/covid19/

You also can't really work from '1st cases' because the data below 100 cases is very erratic.  You also can't really compare countries who change their testing regimes.  This is the major problem with the UK approach, in that the virus is spreading faster than we can keep track of it because testing takes so long and we're not doing it in the first place.  Because we have no idea how many people have it the NHS are running blind, and the government are running blind as to how effective control measures are.  Lockdown is inevitable.  I also read elsewhere that its essentially impossible to go down the 'deliberate herd immunity' route because it needs to be done before next winter and you can't infect enough people without overloading the NHS.  Squashing the curve is the only option, but no-one seems to know what control measures are necessary at what stages because the government isn't telling us the modelling.

2
 Neil Williams 16 Mar 2020
In reply to Toerag:

> Check out the graphs here, they'll tell you everything you need to know

No, it won't.

It even *says on it* that it won't.  I quote:

"The underlying infection and containment processes are complicated, and conclusions you or I may draw from these graphs are not true predictions. For that, you'd need much more data about what is being done in each country, and about how the data is collected. Comments are my interpretation only."

Did you not actually read that or did you deliberately ignore it?

Post edited at 13:44
In reply to Toerag:

> I'd say it's because much of Africa is still a 3rd world country, and there is a hint that it might not spread so well in hot places. 

Maybe their immune systems are coming across infectious agents people in the west do not come across and as a result they are better able to deal with coronavirus without the over-response which causes the lungs to fill up.

In reply to Toerag:

>  I also read elsewhere that its essentially impossible to go down the 'deliberate herd immunity' route because it needs to be done before next winter and you can't infect enough people without overloading the NHS. 

If we delay this one of the things we can do is figure out who actually needs to move about and who can adapt their work to avoid regular contact or can do something else during a lockdown  (e.g. study or watch Netflix).

Then we can take the specific groups who necessarily come into contact with a lot of people and try and get those jobs done by folk who have already caught the virus.

Maybe, by that time as a result of the experience we are collecting we will have a much better understanding of who is likely to react badly to coronavirus and we'll actually able to select people who have almost no chance of severe problems to get infected to build some herd immunity

The whole rushing into doing this quickly rather than locking down, taking our time, learning more and preparing is just crazy.  There's so many different ways we could do better six months from now.

1
 Neil Williams 16 Mar 2020
In reply to tom_in_edinburgh:

> Maybe their immune systems are coming across infectious agents people in the west do not come across and as a result they are better able to deal with coronavirus without the over-response which causes the lungs to fill up.

That certainly raises an interesting question about general "germphobia" outside of the present crisis and whether it's the right thing to do or not.

 Neil Williams 16 Mar 2020
In reply to tom_in_edinburgh:

Are you an academic?  Your theories are great, but they seem to totally ignore human factors entirely, which is not unusual for theories made by people who have only really existed in the sanitised world of academia.

Post edited at 14:08
1
 wercat 16 Mar 2020
In reply to Toerag:

> Check out the graphs here, they'll tell you everything you need to know about how the UK is doing compared to elsewhere.

> This is the major problem with the UK approach, in that the virus is spreading faster than we can keep track of it because testing takes so long and we're not doing it in the first place.

NOW! NOW! NOW!

If you listen to the Secretary of State for Transport at 2hrs 17 minutes into the R4 Today Programme (today's edition) you will hear him say that Britain, after China and Italy, is doing MORE TESTING THAN ANY OTHER COUNTRY IN THE WORLD!

Are you saying this is a porker by any chance?    It would be out of character for this particular Government wouldn't it?

what do UKCers think of this minister's veracity on this?

Post edited at 14:35
 mondite 16 Mar 2020
In reply to wercat:

 

> what do UKCers think of this minister's veracity on this?

Which minister are you talking about?

Michael Green, Sebastian Fox or Grant Shapps?

Has he overly-firmly denied accusations yet?

 wercat 16 Mar 2020
In reply to mondite:

the one who appears on the Today program 2hrs 17minutes into mission

 mondite 16 Mar 2020
In reply to wercat:

> the one who appears on the Today program 2hrs 17minutes into mission

So all three. Look up Shapps. He is a fine example of this government approach to honesty.

 Toerag 16 Mar 2020
In reply to wercat:

> NOW! NOW! NOW!

> If you listen to the Secretary of State for Transport at 2hrs 17 minutes into the R4 Today Programme (today's edition) you will hear him say that Britain, after China and Italy, is doing MORE TESTING THAN ANY OTHER COUNTRY IN THE WORLD!

> Are you saying this is a porker by any chance?   

If you asked him that before the weekend he'd probably have been correct, but now they're only testing people going to hospital.

 Neil Williams 16 Mar 2020
In reply to Toerag:

> If you asked him that before the weekend he'd probably have been correct, but now they're only testing people going to hospital.

The number of which is increasing so it could actually still be true.

 Mike_d78 16 Mar 2020
In reply to Stichtplate:

Any thoughts on this anyone/everyone?

https://www.washingtonpost.com/graphics/2020/world/corona-simulator/

You'll need to do the browse for free thing.

Seems to make sense.......

In reply to Neil Williams:

> Are you an academic?  Your theories are great, but they seem to totally ignore human factors entirely, which is not unusual for theories made by people who have only really existed in the sanitised world of academia.

I'm not an academic.  I have a PhD but have always worked in industry.

The AI systems I'm suggesting are already being discussed in the electronics press.  The only novel part - which I'm sure isn't actually novel, just not in the press yet - is the suggestion of combining wearable electronics and contact tracing using Blutetooth or NFC chips.   DARPA have funded a company that makes implantable health monitoring chips, which is a wee bit more intrusive than an iWatch!   The thing which is already on the market in China is CCTV cameras with extra IR sensors that can pick out faces of people with a fever in a crowd.

https://www.eetimes.com/big-data-and-artificial-intelligent-can-save-the-ea...

 Robert Durran 16 Mar 2020
In reply to mondite:

The trouble with this government is that they are led by a man with a track record of dishonesty. They may well be doing their honest best for the country in this crisis (and I suspect they are) but they are starting with a major trust problem. A classic case of crying wolf at a time when effective leadership is needed. Not looking good........

3
 Neil Williams 16 Mar 2020
In reply to tom_in_edinburgh:

But a technical journal will speak of what is technically possible.  It disregards the societal and other problems with the approach.

(Interesting looking article BTW)

Post edited at 16:28
 neilh 16 Mar 2020
In reply to Toerag:

That is possibly not true. They are testing the elderly in care homes etc.Best be careful on assumptions. Some of which are wild.

In reply to Neil Williams:

> But a technical journal will speak of what is technically possible.  It disregards the societal and other problems with the approach.

Definitely.   The thing I take from it is that there are many promising options for developing technologies to combat this thing, some of them will work out, some won't.   If we can create a breathing space and make sure there's plenty of funding six months from now we could have the tools to gradually release a lock down and try and get into a  tolerable stable situation with new cases being trapped really fast.  If we are lucky the tech will stop the epidemic completely because it can't transmit, if not it might be enough to hang on until there's a vaccine without a horrendous amount of death and ICU admissions.

Post edited at 17:02
 MG 16 Mar 2020

UK cases dropped two days in a row. Luck?

 wintertree 16 Mar 2020
In reply to MG:

> UK cases dropped two days in a row. Luck?

It’d be nice to think something is working.  A few people have pointed out that brits touch each other a lot less socially than the French, Italians and Spanish, and that we have more of our elderly living in separate accommodation so it should be possible to do better here.  It could also be that not closing schools is helping.

Or it could be a change in testing policy which I gather is more focused on hospital admissions now, combined with people who get it being told to stay home and not report it or seek medical attention in the first instance.  Sadly I think at this point the death rate takes over as the more reliable reporter.

Post edited at 20:58
 Dr.S at work 16 Mar 2020
In reply to wintertree:

Yes, its interesting how changing test stratergy alters apparent disease spread and mortality.

With the new stratergy we will identify less disease, and those patients identified will be sicker so likely our reported mortality rate will rise.

 wercat 16 Mar 2020
In reply to wintertree:

surely the German figures show what you get if you do a lot of detection as compared with deaths.  We appear to be a bit of a gulf away ...

<<

At a press conference last Wednesday, Prof. Dr. Lothar H. Wieler, President of the Robert Koch Institute in Berlin said, "From the beginning, we have very systematically called upon our doctors to test people."

He added that the German system can provide "testing to a high degree so that we can easily look into the beginnings of the epidemic.">>

and yet a government secretary of state said this morning that after China and Italy we were testing more than any country in the world.

Perplexed of Cumbria

Post edited at 22:14
 wintertree 16 Mar 2020
In reply to wercat:

>   We appear to be a bit of a gulf away ...

Having advised people with suspected cases to self isolate and only phone 111 if it’s not getting better, accurate infection rate statistics are now a pipe dream.  I’d rather have basically healthy but contagious people out of circulation than accurate figures.

What’s really needed I think is an antibody test so we can start determining who is recovered and hopefully immune.  

Post edited at 22:18
1
 Neil Williams 16 Mar 2020
In reply to wintertree:

Yeah.  I would love to know if I did in fact already have it back in Jan/Feb and would happily pay a few hundred quid for a test (which is the typical going rate) to find out.

 Offwidth 16 Mar 2020
In reply to wintertree:

A scary link posted on the other channel by PaulB indicating the government experts got it wrong. I can't say it's correct but it looks very concerning. 

https://mobile.twitter.com/alexwickham/status/1239655710872518663

I was glad the protection measures have escalated but the lack of clarity on pubs, restaurants, cinemas etc is pretty scummy in terms of their ability to recover losses (compare to Macron's approach:  as stated a pretty much guaranteed cover). The CSA finally admitted the 4 weeks the UK behind Italy was wrong (people here had a real go at Stichtplate but most gave the CSA, the main government expert spokesman on this, a nearly free ride).... still he says 3 weeks.... the actual deaths data still indicates maybe just over 2 weeks (and the Italian ITU sytem was in a better state to cope). I'd add the point wercat made on testing... if anything the UK seems short of tests, given the efforts some GPs recently made to get tested with no success; the idea this is better than all other countries than China and Italy is ludicrous. The schools and university question is puzzling, when non essential travel is advised against (for instance what travel risk attaches to a climber/walker with someone they live with going to a quiet crag or hill to climb or walk,  or on their own to walk or boulder... albeit, sure, we should cut our risk of ending up in A&E). People on ZHCs look stuffed, maybe a good fraction of the self employed as well: the recent BBC series on Universal Credit shows a system struggling to function... imagine numbers of applications doubling and many staff being off sick and no new jobs. What's being done for food banks?

In the meantime the west allows the markets to continue to get ravaged, despite governments pumping in billions of our money: the parasites making money out of this seem to need no quarantine. Pretty much the same parasites who crashed the world markets in 2008

Post edited at 23:00
3
 Robert Durran 16 Mar 2020
In reply to Offwidth:

>  The CSA finally admitted the 4 weeks the UK behind Italy was wrong (people here had a real go at Stichtplate but most gave the CSA a nearly free ride).... still he says 3 weeks.... 

This is completely irrelevant to what people had  a go at Stichtplate for. The point that he failed to grasp is that the lag with Italy is irrelevant to the trajectory of the exponential phase.

2
 Offwidth 16 Mar 2020
In reply to Robert Durran:

It was maybe for you but not for all. In any case, he is a spooked front line NHS worker worried about panic...  the CSA is the lead UK scientist on the government pandemic response seemingly failing to understand exponential growth (I really hope he has better data we haven't seen yet). Another point the CSA made was if we don't act now numbers might double every 5 days ....when the deaths are currently doubling in less than 3! I forgot to add above Boris gave vague reassurance to small businesses but said nothing worthwhile about casualised workers.

Post edited at 23:15
 wintertree 16 Mar 2020
In reply to Offwidth:

> Another point the CSA made was if we don't act now numbers might double every 5 days ....when the deaths are currently doubling in less than 3!

It was when I read that that I decided to stop reading the news for the rest of the day and to do something productive instead.  Although I did wonder if he’s looking at a different set of estimates generalised from the reported data...

1
OP Stichtplate 16 Mar 2020
In reply to Robert Durran:

> This is completely irrelevant to what people had  a go at Stichtplate for.

It wasn't "people" having a go at me, it was you, with a remarkable lack of grace for somebody entrusted with teaching children.

>The point that he failed to grasp is that the lag with Italy is irrelevant to the trajectory of the exponential phase.

And the point that you continue to be unable to grasp is that the mathematical model is not God. If the trajectory of the exponential phase was set in stone why do you think epidemiological strategists, health system planners and clinicians would even bother turning up to work? We'd all just throw up our hands and say "well that's done and dusted Mr Durran, the secondary school maths teacher says we're all on an unalterable trajectory and whatever happens, we're Italy innit, may as well put our feet up".

Christ, I bet the kids you teach have thought up some choice nicknames for you.

5
OP Stichtplate 16 Mar 2020
In reply to Offwidth:

> It was maybe for you but not for all. In any case, he is a spooked front line NHS worker worried about panic...  

And I'm equally spooked about panic as I am the actual corona, rightly so as it turns out. Miraculously, I had the full weekend off and on Saturday met up with four course mates from university, all now working as registered paramedics. Much of the talk was centred on covid 19, the huge impact it was having on EDs and the almost daily changes we were seeing to our procedures and protocols, but only one of us had attended an actual suspected case. Fast forward to today and my 12 hour shift saw 5 out of 6 cases labeled as possible covid 19, only one of which was a solid possible. You would not believe the difficulties presented by ensuring effective infection control in such a situation.

Fear isn't just clearing shelves, it's having a massive impact on the NHS.

 Dr.S at work 17 Mar 2020
In reply to wercat:

oddly hard to find data about the number of tests Germany has done....

 Dave Garnett 17 Mar 2020
In reply to wintertree:

> the clinical trial of the MAB Theralizumab being an example of immune related therapy crossing over into "messing with forces we don't understand". 

Actually, at least possibility of the problem with this could have been predicted from the sequence differences between the human and monkey binding site but even that might not have mattered if the protocol had been followed properly for a first in human trial.

You’re completely right though, this kind of thing is a minefield and a totally different challenge to making a vaccine.

 Robert Durran 17 Mar 2020
In reply to Offwidth:

Sorry to take so long to reply, but I really wanted to think carefully about this since you raise some interesting points.

> "You really want me to dig that hole deeper for you."

There really is no hole...…..

> Firstly the entire vertical axes are based on dubious data: case detection accuracy varies from country to country.

That is a very good point and I admit one that I had overlooked (note that Stichtplate never mentioned it either). However, by a happy and neat property of exponentials, it, perhaps unintuitively, makes no difference to the conclusion that the exponential phases of the various countries are on similar trajectories. This can be shown formally algebraically but is slightly technical, so the following argument with a simple example will suffice: suppose that only half the cases are being detected and that the doubling time of the exponential is one week. Then the number of detected cases lags the actual number of cases by exactly one week - in other words the graph of the number of detected cases is simply the graph of the actual number of cases moved one week to the right (the graph of the actual number of cases is the hidden "iceberg" we have already hit which Stichtplate thought was as mythical as the Loch Ness Monster!) but, since all the various countries' graphs are being shifted horizontally until they are on top of each other for comparison of their trajectories in the exponential phase anyway, the only thing which might be mis-estimated is the lag between different countries - I wonder whether this might have something to do with the difficulty you mentioned in your recent post that people seem to be having deciding how far behind Italy we are; it may simply be a function of the number of unknown undetected cases.

> "The graphs have been shifted so the bit where the 'earlyish' clear exponential rises overlap and, as such, on a log scale, the differences in gradients are hard to spot (plus, Italy, as shown, had a change in gradient, above that point). The time shift to make the graphs overlap is 'the days behind Italy'. "

Yes, but if I understand correctly what you are saying, the fact that they overlap so closely that they are hard to distinguish surely simply confirms that they are on very similar trajectories. And yes, it does appear that if the exponential doubling time for other countries continues, they are on a worse trajectory than Italy which is worrying (maybe this is evidence of Italy's lockdown measures kicking in).

> "I stand by my statement that what you say is not an easy thing to justify for me, who broadly believes it,  let alone a class of kids.

Why? All you have to be convinced of is that the rapid exponential phase is what affects the outcome of the epidemic and that the superposition of the different countries' graphs demonstrates that their trajectories up to this time are very similar. It really doesn't seem difficult! I had hoped to try it out on a class of 13 year olds this week, but I've been told that topical coronavirus maths is inappropriate (which is fair enough) but in a way it's a shame because it's very unusual to have so many pupils interested in and talking about a topic so rich in interesting and accessible mathematics! 

> "If you as the expert, in front of class, tell the kids this... yes they will believe you. Most of the kids in my mid 70s geography class believed oil would run out by 2000."

I don't think the analogy is appropriate. It might have been true that using up known oil reserves at the same rate would use them all up by 2000, but if teachers told you they would run out they should have added that this was only if insufficient new reserves were found. We were very clear in pointing out to Stichtplate that the graphs showed that we would most likely continue to follow Italy's trajectory only if we did not do something different in our measures to control the virus.

It may be that you were referring to something else which I as "an expert" expected Stichtplate to believe without justification. I really don't think there was anything. However, if he had made your objection about detection rates I discussed above, I might have required him to accept the fact that it made no difference if the algebra or my "hand wavy" argument was too technical for him (I've no idea if it would have been). Of course I am faced with this sort of issue on a regular basis as a maths teacher and I always try to be completely honest when I am requiring pupils to take my word for it as a trusted "expert". I had a perfect example only last week when I got a class to plot the graphs of several quadratic functions. Of course they realised that they were all "U shaped" with a line of symmetry. While it was simple enough to explain why the basic y=x^2 is symmetrical, they had to take my word for it that all quadratic graphs are in fact symmetrical, but I promised that I would justify it once they had the necessary mathematical tools. Unfortunately I know of no "hand wavy" argument for this (unlike with the property of exponentials); it does seem really unintuitive to me that you can add the symmetrical y=x^2 to the asymmetrical y=6x and get something symmetrical! But that's the wonder of maths...…. I did point out this surprising fact to the class. If anyone knows of a way to make it seem intuitive I'd love to see it.

Sorry if I've rambled on a bit (with a wall session out, I've had the time this evening...…. ), but my interest in this does come largely from the perspective of a maths teacher and it's a good exercise for me to put my thoughts down anyway!

>

Post edited at 00:51
3
OP Stichtplate 17 Mar 2020
In reply to Offwidth:

> Some other news of impacts on the NHS:

We got the email on Friday. Hard to see what else they can do though as the PPE involved is normally stuff that gets dragged out once in a blue moon. I got through 5 full sets today. At the moment It just isn't possible to replace the higher grade PPE at the rates we were using it and the majority of cases we're now attending in  PPE aren't genuine covid cases. 

Perhaps some of the posters on here will begin to appreciate why I've been so keen to urge that we damp down the fear levels. One of the impacts is it's resulting in lots of worried people ringing for help unnecessarily, we respond in full PPE, we begin running out of full PPE, we start having to respond in downgraded PPE. It doesn't take a genius to work out what happens next.

 Robert Durran 17 Mar 2020
In reply to Stichtplate:

>  We'd all just throw up our hands and say "well that's done and dusted Mr Durran, the secondary school maths teacher says we're all on an unalterable trajectory and whatever happens, we're Italy innit, may as well put our feet up"

Oh dear. I've lost count of the number of times you have now been told that we are not on an unalterable trajectory - the whole point is that it seems likely that we shall remain on a similar trajectory to Italy UNLESS we do something to alter it. 

> Christ, I bet the kids you teach have thought up some choice nicknames for you.

Funnily enough I was nicknamed Jesus for a while.  Not because of any Christ like characteristics, but because I had been called The Monk for my balding head but then they gave me a series of promotions.

Post edited at 01:01
1
 Robert Durran 17 Mar 2020
In reply to Stichtplate:

> Perhaps some of the posters on here will begin to appreciate why I've been so keen to urge that we damp down the fear levels. 

I fully see your point, but there is a real problem - what makes some people panic will barely make others bother washing their hands regularly, and if not enough people wash their hands and do other stuff to reduce transmission, the epidemic will be even worse. I really do sympathise with your position caught up with it, but it just seems an almost impossible balance to strike

1
OP Stichtplate 17 Mar 2020
In reply to Robert Durran:

> Oh dear. I've lost count of the number of times you have now been told that we are not on an unalterable trajectory -

Weird. I seem to recall endlessly repeating that we aren't Italy only to be shouted down. Perhaps you could supply a few quotes where you've stated "that we are not on an unalterable trajectory". Not a difficult task since you've lost count of the number of times you've told me so.

OP Stichtplate 17 Mar 2020
In reply to Robert Durran:

> If accurate, that is absolutely terrifying.

It's accurate. 

OP Stichtplate 17 Mar 2020
In reply to Robert Durran:

> I fully see your point, but there is a real problem - what makes some people panic will barely make others bother washing their hands regularly, and if not enough people wash their hands and do other stuff to reduce transmission, the epidemic will be even worse. I really do sympathise with your position caught up with it, but it just seems an almost impossible balance to strike

That seems similar to arguing that shouting 'fire!' in a theatre is justifiable as some people will dawdle if you calmly ask them to make their way to the exits.

 Robert Durran 17 Mar 2020
In reply to Stichtplate:

> Weird. I seem to recall endlessly repeating that we aren't Italy only to be shouted down. Perhaps you could supply a few quotes where you've stated "that we are not on an unalterable trajectory". Not a difficult task since you've lost count of the number of times you've told me so.

Wintertree, Sunday 19.45:

I’m curious - have you read the article Robert Durran linked to?  Nobody has said we are in tramlines - it’s in all our power to change growth rates.

Me, other thread Saturday 19.45:

It has been pointed out to you that most European countries including ourselves are following closely the same trajectory as Italy. The reason we keep talking about Italy is that it is a couple of weeks ahead of us and so gives us the best picture of what to expect if we don't tackle the epidemic differently.

Post edited at 01:46
2
 Robert Durran 17 Mar 2020
In reply to Stichtplate:

> That seems similar to arguing that shouting 'fire!' in a theatre is justifiable as some people will dawdle if you calmly ask them to make their way to the exits.

Except that in this case the dawdlers are running amok with flame throwers.

2
In reply to Offwidth:

> In the meantime the west allows the markets to continue to get ravaged, despite governments pumping in billions of our money: the parasites making money out of this seem to need no quarantine. Pretty much the same parasites who crashed the world markets in 2008

Pretty amazing that nobody blinks an eye at £500Bn of 'market interventions' using printed money to buy stocks and bonds or letting banks borrow at 0% from the Bank of England when they are charging 20% on credit cards to their customers but it is all shock horror if somebody suggests protecting people and companies rather than banks and investors.

Even in the US Mitt Romney, a Republican, is suggesting giving everyone $1,000 and doing it again next month but Boris and the Tories are dicking about with little tweaks and 'maybe you can pay your tax a bit late if you ask nicely'.

The government science advisers are now saying they don't see how to lift this lockdown safely until there is a vaccine and that could be 12 to 18 months.   That takes a whole different level of intervention.  They need to put everything on hold - no tax, no rent/mortgage, no interest payments for anybody and a universal basic income to everyone sufficient to have a reasonable standard of living in lockdown.  Which isn't much since you can't go out anyway, just food, utilities and a little Netflix etc.  Take all the fear of poverty off the table immediately and let people who are locked down focus on getting healthy so they can resist if they get infected and maybe doing some distance learning or voluntary work.

Post edited at 02:12
1
OP Stichtplate 17 Mar 2020
In reply to Robert Durran:

> Wintertree, Sunday 19.45:

> I’m curious - have you read the article Robert Durran linked to?  Nobody has said we are in tramlines - it’s in all our power to change growth rates.

> Me, other thread Saturday 19.45:

> It has been pointed out to you that most European countries including ourselves are following closely the same trajectory as Italy. The reason we keep talking about Italy is that it is a couple of weeks ahead of us and so gives us the best picture of what to expect if we don't tackle the epidemic differently.

My main contention has been that we aren’t Italy. We are tackling the epidemic differently. Our pre hospital acute care system has a far wider scope of practice, with more highly trained staff, we have a unified health system, our entire strategic plan is different, our demographics, cultural norms around social contact, geography and climate are different, the epidemiological clusters are hugely different.

but you know all this because I’ve written it all before. Apparently all these factors don’t make us different enough. According to you I’m “dim, daft, stupid, thick and pig headed’ for even raising these differences. An incredible amount of vitriol from one poster on a thread in which everyone else has managed to remain courteous even while disagreeing.

1
OP Stichtplate 17 Mar 2020
In reply to Robert Durran:

> Except that in this case the dawdlers are running amok with flame throwers.

From my perspective those who are panicking also have flamethrowers, and they’re currently torching all the supplies of protective gear that are supposed to be there to keep me, my colleagues and our patients safe.

still, what do I know. You’re sure you know better.

Post edited at 07:40
1
 wintertree 17 Mar 2020
In reply to Stichtplate:

Today there is a sudden dramatic change in gov tactics.  They say “the science has changed” or “the evidence has changed”.  In reality what I think has changed is that the public fear level is now enough for the required measure to be broadly accepted.  

The cynic in new wonders how accidental this was.  Then again I also wonder if it took this much proximity to 250k-500k dead for senior government people to actually start believing what the scientists have been saying.

https://www.bbc.co.uk/news/health-51915302

As I’ve said before, the problem to me isn’t panic it’s panic about the wrong things.  If everyone washed their sodding hands instead of stocking up in loo roll....  I also think it’s inevitable you’ll see elevated numbers of suspected cases - this is every top ten item in the BBC and headlining all radio and print news - and with good reason.  I wish every article told people to wash their hands as it’s first sentence to capitalise on that.  

OP Stichtplate 17 Mar 2020
In reply to wintertree:

> ....  I also think it’s inevitable you’ll see elevated numbers of suspected cases - this is every top ten item in the BBC and headlining all radio and print news - and with good reason. 

I think you're misunderstanding me. Of course we'd expect to see an increase in suspected cases, we're in the middle of a pandemic. What's not appropriate is the number of people wanting an ambulance because they have a temperature or a slight cough.

 Offwidth 17 Mar 2020
In reply to Robert Durran:

The fact two people with good maths brains are still arguing proves my point about it being complex. On the first point, cases reported may have no simple relationship to real infections, with the relative proportion changing with time. Infections have run faster in hot spots and in the early countries, due to government action at critical levels, cases started to come under control in the worst affected areas, at the same time as new later outbreaks in the same country were growing at a faster rate (Wuhan , Korea and the likely scenario in Italy right now)  On the second point, take out the inaccurate case data and try plotting simulated data for different countries against the real death rates in China, Italy and Korea, where in the simulations the time it takes for the number of deaths to double varies between 3 and 6 days (typical early rates); all on the same 'scale' as those plots. The outlook after a month in terms of deaths will be very different at the extremes of that simulated range but those overlapping straight lines on a small part of a log graph won't indicate that very clearly. On the third point, you don't think the analogy is appropriate but talk to an expert in educational psychology. Kids brains are being poisoned with dangerously hateful religious dogma, in parts of the world, let alone building-in problems from variable teaching of maths. My geography teachers ignorantly misrepresented the discovery rate of new oil reserves, not being experts on the geology of this. On the final point, those of us in STEM get used to trusting fellow experts (despite scepticism remaining important) and it's a real shock when they let us down. Our country's CSA, who should be as well informed as anyone,  is, in a life and death scenario, still seemingly getting this sort of stuff wrong. Imagine what if feels like in terms of understanding for the average UK citizen where maths is something they last did at school.

So, I appreciate you rambling but a bit more humility might be appropriate, and kindness towards Stichtplate, and a redirection of concerns on data interpretation to where they have most import.

Post edited at 08:34
 Offwidth 17 Mar 2020
In reply to wintertree:

The Imperial paper that has stoked the fire under the previous stated government policy.

https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fel...

Deadeye 17 Mar 2020
In reply to Stichtplate:

https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fel...

Apologies if posted earlier; not had time to read the full thread.

 freeflyer 17 Mar 2020
In reply to Robert Durran:

Thanks for your posts. They remind me a lot of the time at school (a long time ago) when the maths teacher was off sick and the head of department was parachuted in for a lesson. He abandoned any thought of curriculum and spent the lesson in a whirlwind hand-wavy tour of the wonder of maths!

It's inspired me to this day - never under-estimate the power of the wonder of maths!

 wintertree 17 Mar 2020
In reply to Stichtplate:

> What's not appropriate is the number of people wanting an ambulance because they have a temperature or a slight cough.

No; I understand you but I don’t think it’s down to panic - the level of lockdown we’re being softened up for needs massive public awareness and that awareness drives overreaction inevitably.  My eyes where opened during a comet 15 years ago (swift Tuttle?) when our observatory was blighted m with people calling desperate to know what it meant for their love life or farming practices etc.

I don’t know how to fix that . Well education education education but I don’t know how to fix *that*

 Robert Durran 17 Mar 2020
In reply to Stichtplate:

> Still, what do I know. You’re sure you know better.

No I don't know better. As I said, it must be an almost impossible balance to strike and I'm not one of the people having to make the call on something like this.

 MG 17 Mar 2020
In reply to Offwidth:

The throw-away sentence in the discussion about ICU need is a bit worrying.  I'd have expected this to have been explored earlier  If not for Covid,  as part of a general sensitivity study for these sorts of models.

Regardless, Fig 3A suggests we are stuck with lots of deaths, really.

 neilh 17 Mar 2020
In reply to Deadeye:

You want to listen to the Radio. They had Imperial on this morning on R4 Today. In summary Imperial and London school of tropical medicine ( and others) have been working for 2 months 24/7 on this reporting to Government.,. I suspect al the so called  modellers on here ( Mr Durran ) would not even be able to light a touch paper to the stuff they are doing.

They are part of SAGE who in turn report to Cobra.

Well worth listening to for the scepticcs ont the segment between about 8.05 and 8.20.

 neilh 17 Mar 2020
In reply to MG:

Go onto iplayer and listen to the professor from Imperial being interviewed is the answer on R4 Today.Your question is answered.

 freeflyer 17 Mar 2020
In reply to Stichtplate:

I have heard the same from a number of personal contacts. It's a massive problem, somewhat similar to panic buying in the shops. However I've also heard that there is big change afoot as health professionals adapt to the new situation, so I've every confidence that triage will improve. Let's hope there's some help from public announcements and more guidance on the telly aimed at the panickers; not everyone reads gov.uk.

If you have time and energy, please keep posting about how it's going for you - even if it's all bad!

 wercat 17 Mar 2020
In reply to Dr.S at work:

from the start I suspected the much larger number of cases compared to deaths indicated a testing regime.   The slowness of the deathtoll might be perhaps because the Germans seem to be very conformist and socially minded when it comes to the general good as well as being similar in temperament to us with not so much public touching and kissing, a bit of social reserve.

My wife said something about a Koch Institute for stats

I've got a Spirometry next week - wondering if I should cancel it

Post edited at 09:27
 wercat 17 Mar 2020
In reply to tom_in_edinburgh:

I thought about how the govt could help 3 groups initially, business, families and councils

They should give councils what they would take in business rates and council tax and let the rest of us off.  this is particularly progressive as a start because of the increased burden, proportionately, on struggling families.  Businesses would get some relief and councils would not have to worry about keeping services going when no one can pay rates and local tax

 Offwidth 17 Mar 2020
In reply to freeflyer:

Lets hope so as it's a mess for health workers at present... another link on this:

https://www.theguardian.com/world/2020/mar/16/everyone-is-scared-to-speak-u...

In reply to Offwidth:

This is a good paper, they are starting to say sensible things.

They need to tweak the scenarios to model technical assistance at the point the lock down is lifted.  LIke I've been banging on about - if they get the number of cases right down with suppression to the point where contact tracing and elimination becomes feasible and have tech systems in place to facilitate it could be winnable.

The other positive not currently included in the model is ongoing improvements with time in hygience and treatment which will also lower R0 and mortality.

If government gets its finger out with a simple, massive and generous economic support package and we stick it out for a year or 18 months we could get through this with tens rather than hundreds of thousands of deaths and an economy that can be restarted.

 freeflyer 17 Mar 2020
In reply to thread:

Ok, another topic.

I believe the French are wrong in a total shutdown, and the UK will do better with its current strategy.

For me, the (possibly unattainable) solution seems to be to have all the low-risk segments of the population under 60/70 get the virus as soon as possible, consistent with not overloading the health service, and then find the best solution for the older segment in due course, which would hopefully be some kind of vaccine, however unlikely that currently appears in the timescale required, or else have them exposed to the virus in whatever way gives them the best possible chances.

 Offwidth 17 Mar 2020
In reply to freeflyer:

People believe all sorts of things. What is your evidence? 

 RomTheBear 17 Mar 2020
In reply to freeflyer:

> Ok, another topic.

> I believe the French are wrong in a total shutdown, and the UK will do better with its current strategy.

> For me, the (possibly unattainable) solution seems to be to have all the low-risk segments of the population under 60/70 get the virus as soon as possible.

The problem is that these segments of the population can get seriously sick too, and many of them end up in ICU. They are very likely to survive  with the proper care, but it takes so little for ICU capacity to be overwhelmed, most people would simply not get it. This is the experience of many contries around the world who have been there and done that.

The big big issue is if we get to the winter, and people are fed up with the restrictions and give up, at this point you get a very, very deadly rebound.

I’m afraid basically the only way to not end up with many many deaths is to maintain these restrictions for the long haul, or until we have either a vaccine or a good treatment.

How sustainable that is I don’t know. I actually think that we will find all sorts of ways to go on about our lives without physical contact.

What is going to feel counter intuitive is that the actions we take will always look disproportionate. This is because of the exponential lagged nature of epidemic.

1
 Offwidth 17 Mar 2020
In reply to Robert Durran:

This World in Data overlay plot illustrates my point about gradients really well.

https://ourworldindata.org/grapher/covid-confirmed-cases-since-100th-case

Much of the variation will be down to inaccurate confirmed case numbers.

 freeflyer 17 Mar 2020
In reply to Offwidth:

Frankly I don't think there is any usable evidence available that I know of; also I'm much less qualified to comment numerically than other posters.

As Rom points out, the key issue is to avoid overburdening the health system, but at the same time, suggesting that everyone avoids getting the virus seems akin to digging a large hole in the sand, and then putting your head in it, *unless* it is part of a longer term plan to immunise the population. Infection in a controlled manner is one route to that goal.

 Offwidth 17 Mar 2020
In reply to freeflyer:

The infection rate is already so fast that parts of the UK health service will likely be overwhelmed.  Even if you support herd immunity we still need to slow the spread ASAP. That is all evidenced based from China, Korea, Italy etc despite what you claim.

 neilh 17 Mar 2020
In reply to freeflyer:

By slowing things down in society and the economy you are going to get less non-coronavirus medical incidents ( road crashes, sports injuries etc etc). So it could possibly be a multi pronged approach.

 StuPoo2 17 Mar 2020
In reply to Stichtplate:

https://www.jpmorgan.com/directdoc/COVID19_compilation_AMV.pdf

Charts updated and all sources inc.

Cheers.

 Robert Durran 17 Mar 2020
In reply to neilh:

> I suspect al the so called  modellers on here ( Mr Durran ) would not even be able to light a touch paper to the stuff they are doing.

Of course not! I was just having fun fiddling around with some differential equations for my own amusement. I'm like the fat bloke kicking a ball around in the park having been inspired by watching the world cup on the telly.

 freeflyer 17 Mar 2020
In reply to Offwidth:

Yes, I totally agree with a lockdown, don't get me wrong - my post above was misleading on that point.

The current UK advice may reflect our earlier position on the curve rather than the nature of the solution. However we are not advocating schools closed and are not enforcing the lockdown in the same legal way as the French, which leads me to think that there may be still some herd immunity element to the UK plan. Of course it's also possible, even more likely, that it's a practical solution to reduce child care problems and keep parents in work, especially health professionals.

Regarding your valid point about evidence, it would be ideal if we had mass testing capability; it's not clear to me why this is possible in Asia and not in the west.

Perhaps now is not the right time to be discussing exit strategies in the public debate, but it should surely inform approaches to longer term planning.

 neilh 17 Mar 2020
In reply to Robert Durran:

not sure that stichtplate took it as fun.

My daughter is doing a Master in Maths at  Warwick, she has als been intrigued by linking it with medicine.Oppotunities that she had never really thought about will be opening before her eyes.

 Robert Durran 17 Mar 2020
In reply to Stichtplate:

> My main contention has been that we aren’t Italy. We are tackling the epidemic differently. Our pre hospital acute care system has a far wider scope of practice, with more highly trained staff, we have a unified health system, our entire strategic plan is different, our demographics, cultural norms around social contact, geography and climate are different, the epidemiological clusters are hugely different.

> but you know all this because I’ve written it all before.

Yes, and I've come back to you about it before. I agree, there are a lot of these differences with Italy. My point is that DESPITE all their differences, many European countries, as shown by the graphs (which I still don't know whether you have looked at), are following remarkably similar trajectories to Italy; it seems that either these differences are not very important to the course of the epidemic, or we need to succeed in marshalling some of them to our advantage pretty damned soon if we are not to follow Italy's trajectory in the longer term.

> Apparently all these factors don’t make us different enough.

I'm not sure whether you think that yourself or think it is what I think! Different enough for what anyway?

> According to you I’m “dim, daft, stupid, thick and pig headed’ for even raising these differences. 

I have not once criticised you for raising these differences. I have simply called into question their possible significance to the trajectories (as I have in this post).

And for what it is worth I did not say you were dim. I called your Loch Ness Monster analogy for undetected cases daft (which it is). I'm virtually certain I have not called you thick, though if you can reference me doing so in exasperation I shall apologise.  I have said you were either stupid or pig headed. I think I can now stop hedging my bets and settle for pig headed given the way you have repeated some stuff over and over again despite myself and wintertree repeatedly explaining very clearly why it is nonsense.

Post edited at 14:23
1
 wercat 17 Mar 2020
In reply to freeflyer:

> Regarding your valid point about evidence, it would be ideal if we had mass testing capability; it's not clear to me why this is possible in Asia and not in the west.

we in the UK must have a lot of evidence as we are testing more people than anyone else apart from Italy and China!

 freeflyer 17 Mar 2020
In reply to wercat:

There's not enough information out there about official testing plans, which could be for various reasons. Testing is one area where you can apply some serious techniques.

From the Sun of all places:

On March 12, Prof Whitty originally said it was "no longer necessary for us to identify every case".

He has since defended the UK's new plans after the World Health Organization's advice is to keep testing.

On March 16, Prof Whitty did say: "We do intend to continue to scale up testing."

He said tests only show if people are currently sick or not, but not where or not someone had previously had the virus.

Prof Whitty said that test would be "transformational" and that Public Health England was "very rapidly" developing such a test.

 Robert Durran 17 Mar 2020
In reply to Offwidth:

> This World in Data overlay plot illustrates my point about gradients really well.

> Much of the variation will be down to inaccurate confirmed case numbers.

Sorry, I may be being a bit dim, but I'm not clear why it illustrates your point. In fact I'm not really clear what your point is (and I therefore feel unable to respond to it!). What do you mean by "inaccurate confirmed case numbers"? That they have been miscounted? Misreported? That they are not proportional to actual case numbers?

As far as I can see the graph shows that the European countries are roughly following doubling times in the 2 to 3 day bracket (though obviously with some variation between countries and in time for a given country

Post edited at 21:46
1
 RomTheBear 17 Mar 2020
In reply to Robert Durran:

He is best ignored, really.

3
 Robert Durran 18 Mar 2020
In reply to Offwidth:

I am wondering where you actually think either myself or wintertree have criticised something stichtplate posted unjustifiably. I might then be able to see where you think I am going wrong.

2
 Offwidth 18 Mar 2020
In reply to Robert Durran:

It's not unjustifiable it's just odd in the context that the government CSA is seemingly getting it wrong. Plus as an educator if a teaching method isn't working just trying it again and again won't usually help.

I still don't get why you can't see why the relatively small angular difference on overlapping approximtely straight plots on a small part of a log graph (where the range is the fastest exponential growth is twice as fast as the slowest), doesn't clearly indicate the different scales of outcomes in deaths. On that graph a few degrees of difference on the gradient correspond to huge eventual differences in deaths.

 Robert Durran 18 Mar 2020
In reply to Offwidth:

> It's not unjustifiable it's just odd in the context that the government CSA is seemingly getting it wrong. Plus as an educator if a teaching method isn't working just trying it again and again won't usually help.

> I still don't get why you can't see why the relatively small angular difference on overlapping approximtely straight plots on a small part of a log graph (where the range is the fastest exponential growth is twice as fast as the slowest), doesn't clearly indicate the different scales of outcomes in deaths. On that graph a few degrees of difference on the gradient correspond to huge eventual differences in deaths.

Thankyou for clarifying. I'll reply properly later.

 Toerag 18 Mar 2020
In reply to freeflyer:

>

> Regarding your valid point about evidence, it would be ideal if we had mass testing capability; it's not clear to me why this is possible in Asia and not in the west.

I suspect previous experience with SARS and MERS has left a legacy of a decent testing capability.

 Toerag 18 Mar 2020
In reply to freeflyer:

> Ok, another topic.

> I believe the French are wrong in a total shutdown, and the UK will do better with its current strategy.

The French are in lockdown because they're beyond the point of no return and lockdown is the only thing that will save them - their healthcare system is already overwhelmed, or will be iminently with the cases in the wild. We're a week or so behind them on the graphs so theoretically better restrictions earlier will mean there's not the need for lockdown. However, I'd say we haven't done enough and will end up in lockdown anyway - the NHS capacity line on the Imperial graphs is so low compared to the potential lump of cases we're not going to have a choice.

 Toerag 18 Mar 2020
In reply to Stichtplate:

Stricter measures around the world seem to be taking effect. Case increase rates seem to be dropping from 35% to 22%. That's still exponential though, it's just taking 4-5 days to double instead of 3.

http://nrg.cs.ucl.ac.uk/mjh/covid19/

This is definitely going to take a long time to deal with (as per the Imperial report) and any nation that isn't taking strict measures from day one is only going to end up in the same boat as China were and Italy are. Italy are only halfway up their logarithmic curve if China is anything to go by, the worst is yet to come and it's going to be properly bad.

 malk 18 Mar 2020
In reply to Toerag:

> Stricter measures around the world seem to be taking effect. Case increase rates seem to be dropping from 35% to 22%.

35% increase in UK since yesterday

> same boat as China

If you can believe the figures a few thousand deaths seems a good boat to be on..

 wintertree 18 Mar 2020
In reply to Toerag:

> Stricter measures around the world seem to be taking effect. Case increase rates seem to be dropping from 35% to 22%.

Context:  As healthcare starts to buckle and as transmission must be slowed, people who aren’t struggling to stay alive with their symptoms are told to stay home and self isolate, and are not tested.  

 Neil Williams 18 Mar 2020
In reply to malk:

> 35% increase in UK since yesterday

It has an incubation period of about a week.  We won't know the effect of Monday's change of tack until next Monday.


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