Covid plotting #57 continued

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 wintertree 22 Dec 2021

The interesting times continue.

A backstep from some interpretation on #57.

  • I had suggested on #57 that I was concerned at how quickly PCR positivity was rising, suggesting some more infections were not being detected as cases.  Unless I'm going senile, the reported positivity numbers for Dec 12th dropped a few % at some point.
    • Perhaps test numbers being updated after positive cases numbers come in?  Again, positivity is rising in the leading edge of the testing data for England, but I'm more minded to see that as provisional for now...   Stepping back from the leading edge, positivity is still rising, but at a less alarming rate
  • The demographic heat map numbers (rates per 100,000) turn out to be for a 7-day period which makes some of them marginally less bonkers than the per-day (but over a 7-day rolling average) figures I'd misunderstood them to be.  Doh, idiot moment!   Mind you, ages 25-29 in Wandsworth have now hit 6393.5 per 100k per 7 days which is still bonkers.

Some updated plots

Plot 18 - Regional Rate Constants

  • The rate constant for cases in London is collapsing right down away from the precipice of 4-day doubling times.  The other regions have seen smaller falls or levelling off showing.

Plot D1.c - Demographic Rate Constants

  • As is all the rage this week, I've expanded the range of the colourbars to encompass the very high rate constants.
  • The regions beyond London are moderating their rate constants before the demographic distribution becomes so incredibly tilted towards young adults as has happened in London - this is visible in the concentration of colour on the leading edge of the left side plot for London but not elsewhere.
    • So - massively different demographics are locked in for now between London and elsewhere - so caution applies about directly translating a top level (non-demographic) case-to-hospitalisation aliases from London to the regions beyond.

The big question over all these plots is why growth is running out of steam.  End of schools, WFH push, lots of press coverage, lots of anecdote on cancellations, footfall, London underground usage etc.  Seems like people are taking this very seriously in the run up to Christmas. 

  • The next couple of ONS updates on their random sampling survey are going to be really useful to understanding how much omicron has actually spread (vs detected cases; with the expectation more omicron may be symptom-free) which, along with the progress of vaccination, will give us a clue what we think is going to happen after the holiday period.

London - Rate Constant Plot

  • I'm wondering if we're going to see cases go in to decay in London over the next few days; this rate constant is plummeting down in a way rarely seen; the sheer level of immunity induced by the bonkers spread in younger adults (where cases are concentrated) and the ongoing vaccination could tip this over.
    • The rest of England has seen nothing like as much omicron spread; vaccination alone is unlikely to force R<1 other than with pretty strict control measures
    • About 30% of all English cases are in London right now, so if it does go in to rapid decay that's going to dominate the top level cases for a while.

I'd hope the improvements to the cases doubling times will continue up to Christmas or there-abouts; then we get some bonkers sampling artefacts from a festive-weekend (weekends are always a low) followed by a double bank-holiday.  That week is probably going to be a near write-off for understanding until it's well passed.  Then we find out if there's an explosion of household transmission mostly from younger adults to older family members...

Feels like we're on the brink of finding out which of two ways this is all going to go...

https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_57-...

Post edited at 17:10

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 elsewhere 22 Dec 2021
In reply to wintertree:

D1.c London - vertical axis, are ages mislabelled?

OP wintertree 22 Dec 2021
In reply to wintertree:

I've done a new plot 22 for London.  This shows the occupancy in hospitals on the x-axis and in intensive care on the y-axis, with time indicated by the colour of the data markers.  The yellow line is a smoothed trendline.

It's really interesting.  

  • The rate occupancy is increasing has shot up -the data points are spaced further apart in the x-axis more recently.   A lot of people going to hospital
  • Intensive care occupancy was rising in proportion to hospital occupancy - the late November (blue coloured) data markers were moving up as well as right.  That's stopped, and perhaps even reversed....

There are three different interpretations to this I can see:

  1. Lag hasn't played out in terms of the rapidly accelerating rate of omicron admissions going to intensive care, and this doesn't really cut it as intensive care occupancy stopped rising at the rate it previously was.
  2. Delta cases and hospitalisations in the more vulnerable were running out of steam, and stopped contributing to this plot just as omicron hospitalisations took over; if omicron is no worse for the vulnerable then we get more mild hospitalisations in those who mostly weren't even catching delta, and for different reasons an absence of delta hospitalisations of the vulnerable.
  3. Mild omicron infections directly are preventing/displacing severe delta infections

Thoughts on these:

  1. Hard to tell from the public data we have access to, resolved with more time.
  2. I think we were nearly there with Delta - immunity had been rising in successive age cohorts as seen by them crashing down on D1.c and it was due to break I think; 3rd doses were also ongoing and it's possible early precautionary behaviour over Omicron put another nail in delta's coffin.
    • Another hint of this is in my "passband violation" plot - this shows the deviation from the local moving average of the cases rate constant and the central England temperature - both with day-to-day noise smoothed out as well.  When one goes up, the other goes down and vice-versa.  

      There are some small violations of this relationship, which are coloured in red (rate constant too +ve) and blue (rate constant to -ve).  Around the end of November, the rate constant became really -ve despite the weather being cold.  Was this the end of Delta?

      A counter-view might be that Storm Arwen broke so much stuff people didn't go out and/or testing was impacted; but this big violation persists in just the data for London which wasn't much impacted by the storm.
  3. Doesn't seem likely for various reasons.  I say "directly" as omicron indirectly accelerates the demise of delta by driving more precautionary measures, mandated restrictions and faster 3rd dose rates. 

If the cause of this interesting development on plot 22 is lag, that's bad news.  if the cause is either of 2 or 3, I think it's really good news.  Time will tell!  I expect we'll see some proper heavyweight analysis of proper data coming out of the advisory machinery very soon.

Stepping back, it's important to remember that the early cases - now landing in hospitals - in London were mostly in young adults.  That's now changing in the cases data and we'll see how that change plays out in this plot.  I expect with more intensive care admissions...  But here I'm mainly interested in understanding why they've currently stopped rising.

Post edited at 17:14

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OP wintertree 22 Dec 2021
In reply to elsewhere:

> D1.c London - vertical axis, are ages mislabelled?

Good spot, thanks.  Fixed.

 minimike 22 Dec 2021
In reply to wintertree:

Quite a jump in London hospitalisations on the dashboard today.. right where the lag would have it for the leading edge of the omicron cases spike. In a couple of days we should be able to get some CHR estimates, remembering this is essentially the 20-35 yuppie (in the strictest sense) cohort.

OP wintertree 22 Dec 2021
In reply to minimike:

Cross-over of relevant posts there.

> Quite a jump in London hospitalisations on the dashboard today.. right where the lag would have it for the leading edge of the omicron cases spike. I

Yup.  Bizarre how admissions data is less recent than occupancy data.  Mine is not to reason why.

> In a couple of days we should be able to get some CHR estimates, remembering this is essentially the 20-35 yuppie (in the strictest sense) cohort.

Can't do my own demographic CHR estimates as the public demographic bins for healthcare are too coarse to be useful, unless I'm missing something...

Certainly anticipating some proper analysis soon...  Probably going to cause some confusion and false optimising in advance of the spike of cases in older adults...

1
 minimike 22 Dec 2021
In reply to wintertree:

Given the extremely narrow demographic of cases in the first part of the omicron wave in London and the lag, I would say you could get an estimate off the raw case and admission numbers..

edit: CHR by age for delta is published (I’ve seen it somewhere I’m sure but would have to dig..)

Post edited at 18:16
In reply to Šljiva:

Needs a few more than just the usual ones

OP wintertree 22 Dec 2021
In reply to Šljiva:

From the article:

Cohen said that the study's findings could likely be generalised to other countries in sub-Saharan Africa that also have very high levels of previous infection.

"What is unclear is whether the picture will be similar in countries where there are high levels of vaccination but very low levels of previous infection," she said during a media briefing by a group of NICD scientists.

Oof.

OP wintertree 22 Dec 2021
In reply to Longsufferingropeholder:

> Needs a few more than just the usual ones

The BBC doing a poor job of getting the caveats up front; the Reuters one was much better.  https://www.bbc.co.uk/news/health-59758784

The critical thing for me is that the outcomes of those going to hospital are apparently no different between variants; but a smaller fraction of cases are going to hospital - as we’d expect when there’s a bunch of extra cases in people who are so immune they couldn’t catch delta if they tried.  I’ve broken my drum banging it on this one.   The real good news in there appears to be that omicron is not measurably worse than delta for those susceptible to hospitalisation.  

Which way of looking at it depends on the context; the actual CHR being lower is a critical piece of context when it comes to interpreting high case rates as not the disaster they would have been with delta, for example.  Not that anyone would credibly bang on about case rates bereft of all critical context, so that’s okay.

Post edited at 20:03
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 Misha 22 Dec 2021
In reply to wintertree:

> I had suggested on #57 that I was concerned at how quickly PCR positivity was rising, suggesting some more infections were not being detected as cases.  

I may be missing something but isn’t this just a reflection of increased prevalence? That could in turn mean more infections not being picked up in terms of absolute numbers - perhaps that is what you meant. However the % of actual infections picked up could be the same. People not testing in the run up to Xmas or due to limited testing capacity in hotspot areas could be more of an issue…

1
 Misha 22 Dec 2021
In reply to wintertree:

False optimism? But the real point, which the article does make, is these relatively small drops in severity are more than offset by the higher spread. Still, better to see good news rather than bad.

https://www.bbc.co.uk/news/health-59758784

Edit - you beat me to it. 

Post edited at 21:53
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OP wintertree 22 Dec 2021
In reply to Misha:

> I may be missing something but isn’t this just a reflection of increased prevalence?

Think about the liming cases.  Imagine a "sane" system for funnelling people in to PCR tests:

  • A very low positivity (P) would likely indicate most infections (I) were being caught as cases (C) with overly wide gating in to tests (C/I ~ 100%),
  • A very high positivity would suggest the system was saturated and infections were being missed (C/I << 1)

So, you could draw a graph of P (X-axis) and I:C (y-xis) and you'd know the limiting cases were (P=0%, I:C=1) and (P=100%, I:C<<1).  Clearly the relationship has to scale as a continuous curve between these points, so we know that increasing positivity means a decreasing fraction of infections caught as cases.

Now, it's really guggy for our our testing, because...

  • There are other infections causing symptoms that gate people in to PCR testing, and their spread is affected by Covid control measures 
  • There are lots of people going for PCR tests without any symptoms for various reasons, representing something of a random sampling component

But the general model of positivity vs detection fraction still holds some sway.  The curve can't be discontinuous between the limiting cases.

(This is a very mathematical way of thinking about something that's way more complex, and that has more constraints than I've considered, but I think it still has use.  Others may disagree...!)

Much less of an issue than I thought, because the rapidly rising positivity (up 2% a day) disappeared retrospectively.  Likely provisionality issues in the dashboard?

> False optimism? 

You're westernising in your optimism/pessimism scales!

What I mean is that trumpeting that omicron is less harmful is very selective in terms of how you choose to look at it (consequences per infection vs consequences per exposure), and it's not shaping up that omicron is going to measurably reduce hospitalisations in any meaningful way - far from it, they're looking pretty exponential in London right now and other regions are set to follow.

> But the real point, which the article does make, is these relatively small drops in severity are more than offset by the higher spread.

The point to me is they are not drops in severity when looked at through the lens of exposure to the virus, rather than case numbers.  

  • People who could not catch delta upon expoosure are catching omicron and are most are not going to hospital.  For them exposure to omicron is more severe than exposer to delta.  There is more sickness induced in the population per X exposures to omicron than per X exposures to delta.
  • People who would catch delta on exposure and go to hospital are likely catching omicron on exposure and going to hospital.

The reason the drops in severity are offset by the higher spread is that it's mostly the same people (group A) going to hospital under exposure to either strain, but the ability of omicron to spread mostly harmlessly through a bunch of other people delta couldn't infect (group B) means that the people in group A are going to hospital much faster.  Of course, we can't have a negative number of people from group B going to hospital, and it's unlikely to be zero, so chances are omicron represents more people net total going to hospital, as well as an acceleration of the process that was happening with delta.

So, in terms of hospitalisations per case, yes, omicron is less severe now than delta was in the past, but it's more severe than comparable exposure to delta would be now.  Only, people wouldn't be getting comparable exposure to delta now because the population was becoming so immune it's R was heading for less than 1.

Maybe I should just let this one go...

> Still, better to see good news rather than bad.

I don't see it as good news so much as confirming the default interpretation from the antibody neutralisation assays and the T-cell epitope analyses.  Although I suppose of late "We're not completely f**ked, again" is actually good news.

In reply to wintertree:

I'm sorry to say that i think the 'omicron is less severe' is just political bollocks to let them 'get Christmas done'. That is all the government seem to care about. This is borne out by 'shutdown on boxing day' stuff; they know we need to shut down, but they're terrified of cancelling Christmas again.

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 Misha 23 Dec 2021
In reply to wintertree:

As you say, there’s a lot more to positivity rates / missed cases, not least behavioural factors pre Xmas (some less likely to test, some more likely, who knows!). That said, there must be a lot of missed cases out there right now given official cases have more or less stalled - perhaps due to lots of asymptomatic cases, which goes to your second point.

Yes, less severe in terms of % cases but not individual outcomes is a good way of seeing it. I don’t like the whole less severe terminology. For a start, it’s not the virus itself which is less severe for the most part (I think one of the stats was those unvaccinated have a 10% lower risk of hospitalisation - that’s close to being statistically insignificant I suspect!). It’s the fact that people have a lot more immunity now. 

3
 Misha 23 Dec 2021
In reply to captain paranoia:

My understanding is they want a parliamentary vote and I saw somewhere it’s a 2 day notice for a recall. I imagine the earliest for a vote would be 27th so any new rules from the 28th. Strictly they might not need a vote (I think the regs just need retrospective approval as has been done on some previous occasions) but politically they feel they need to. It might be later of course, partly due to dithering and partly because the post Xmas data backlog won’t be cleared till 4pm on the 27th at the earliest presumably and would then need to be assessed (notice on the dashboard saying no updates on the 25th and 26th!).

1
In reply to Misha:

> My understanding is they want a parliamentary vote and I saw somewhere it’s a 2 day notice for a recall

How convenient... Funny how they're suddenly so keen on parliamentary democracy, having prorogued it not so long ago...

I'm pretty sure the existing legislation gives them executive powers.

1
In reply to captain paranoia:

> I'm sorry to say that i think the 'omicron is less severe' is just political bollocks to let them 'get Christmas done'. That is all the government seem to care about.

If they had any sense they'd put a restriction on movement from London until after Christmas so that people going to visit relatives doesn't create a super-spreader event.  But they've done the opposite, they've reduced the self isolation period to make it easier for Christmas related travel to happen even when people are quite likely still loaded up with Omicron.  It's like they are trying to get everybody in the country infected as fast as possible.

https://twitter.com/DonOBrien1/status/1473611653723955202/photo/1

Post edited at 02:56
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 David Alcock 23 Dec 2021
In reply to wintertree:

I know it's late guys. I keep testing neg - two per day as of Monday. Supposed to head south tomorrow. Getting a bit of a scratchy throat. It's a hard call, since my family don't give a damn this year. My mum, 73, still works in the hospital. Lung physio. But she's adamant.

Should I stay or should I go? I know the answer, but she has reached the point of don't care.

Thanks Wt and all of you for all your enlightening and sometimes baffling efforts.

I just feel up against the wall, ethically.

But Merry Xmas everyone. Dx

 summo 23 Dec 2021
In reply to captain paranoia:

> I'm sorry to say that i think the 'omicron is less severe' is just political bollocks to let them 'get Christmas done'. That is all the government seem to care about. This is borne out by 'shutdown on boxing day' stuff; they know we need to shut down, but they're terrified of cancelling Christmas again.

Indeed, even anti lockdown sweden applied new restrictions today, mainly because they just don't know, cases have increased, but not much else. If we wait two weeks it could be too late and in reality it's only 2 or 3 more weeks and they'll be a wealth of new omicron data.

 summo 23 Dec 2021
In reply to tom_in_edinburgh:

> If they had any sense they'd put a restriction on movement from London until after Christmas so that people going to visit relatives doesn't create a super-spreader event.  

I presume sturgeon did the same with Glasgow when those first omicron person to person transmission cases appeared a few weeks ago? 

1
In reply to summo:

> I presume sturgeon did the same with Glasgow when those first omicron person to person transmission cases appeared a few weeks ago? 

Only in the addled brain of a unionist would 10 to 20 cases in a normal week require anything like the same response as tens of thousands of cases just before Christmas.

The Tory policy of facilitating large numbers of potentially infected people who would normally be isolating to travel all over the country is going to cause an explosion of cases.

11
 bridgstarr 23 Dec 2021
In reply to tom_in_edinburgh:

> Only in the addled brain of a unionist would 10 to 20 cases in a normal week require anything like the same response as tens of thousands of cases just before Christmas.

Of course it's a question of what you're trying to achieve, but if you can't see a reason why one might wish to lockdown with 10 cases rather than 100000, then you're not trying very hard

2
 summo 23 Dec 2021
In reply to tom_in_edinburgh:

> Only in the addled brain of a unionist would 10 to 20 cases in a normal week require anything like the same response as tens of thousands of cases just before Christmas.

How many cases in Scotland now? Is it beyond Glasgow? Maybe sturgeon was just waiting for Londons lead? Weren't all the cases linked to one event, so not so hard to contain?  Maybe she isn't strong enough to lock down her constituency? 

Edit. You know the answer already, weak indecisive leadership. 

Post edited at 07:39
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In reply to David Alcock:

I had a scratchy throat last week. It turned into a sniffle. 1 week of paranoia, 4 LFTs and a PCR later I was reminded that it is still possible to get a cold. It's just a lot more stress and admin than it used to be.

Latest stat I saw (Zoe study I think) was that 1 in 4 'colds' is covid. That might have changed with the higher prevalence now.

Do you feel lucky?

In reply to summo:

The answer is you are trolling.

Usual summo sh*te of a series of questions and then a few bullsh*t assertions.

It's pretty obvious which leader is attempting to do a proper job and having it made more difficult by being in the power of the complete arseholes in London.

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 chris_r 23 Dec 2021
In reply to David Alcock:

> I know it's late guys. I keep testing neg - two per day as of Monday. Supposed to head south tomorrow. Getting a bit of a scratchy throat. 

The NHS/Gov official list of symptoms that should trigger a PCR are:

  • a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
  • a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
  • a loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal

A scratchy throat isn't listed. You've tested negative on LFT on consecutive days. Go see your family.

I don't doubt that the 3 "main symptoms" need some refinement for Omicron; but normal winter colds haven't disappeared. 

1
In reply to bridgstarr:

> Of course it's a question of what you're trying to achieve, but if you can't see a reason why one might wish to lockdown with 10 cases rather than 100000, then you're not trying very hard

Ten cases can potentially be dealt with by contact tracing, not locking down whole cities. 

After seeing the cases in London explode there's zero doubt about what will happen if there is a large amount of Christmas related travel out of London and especially if they allow travel by people who are infected.   It's going to explode everywhere and when the Tories finally decide they've got enough data for a post Christmas semi-lockdown every other region will already be f*cked.

9
 summo 23 Dec 2021
In reply to tom_in_edinburgh:

I'll grant you it's easy for anyone to look good relatively speaking as a leader when Boris is the comparison. 

OP wintertree 23 Dec 2021
In reply to tom_in_edinburgh:

> Only in the addled brain of a unionist would 10 to 20 cases in a normal week require anything like the same response as tens of thousands of cases just before Christmas

Away with the “unionist” crap.  You’ve told us many times before - correctly IMO - of the benefit of decisive, early action to stall for time along the growth curve to understand the situation and specifically in this case to advance 3rd doses.  You’ve told us - correctly - now control measures earlier on achieve the same delay to exponential growth but with less demand on healthcare and more scope for contact tracing.

But you’re going to throw all that away when it comes to criticism of Scotland being no better than England and now you’ll argue the opposite till you’re equally blue in the face.  The Steps concert was perhaps the super spreader event that kicked Scotland so far along the growth curve vs Wales and the English regions outside London. 

I don’t have a strong view on Scottish independence and I’m not a Tory.  I also don’t think Scotland has been meaningfully more precautionary at the critical times.  They have to be more precautionary now because their immunological situation is worse than that in England.

Post edited at 08:24
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OP wintertree 23 Dec 2021
In reply to tom_in_edinburgh:

> After seeing the cases in London 

I haven’t posted if because I didn’t want to trigger you in to vomiting all over another thread (as another poster so eloquently put it a few week back) but Scotland has seen cases explode as well compared to most of England.

>  there's zero doubt about what will happen if there is a large amount of Christmas related travel out of London

Are you advocating to lock West Lothian down then?  Where I live I’m more worried about returnees from Edinburgh than London.

> and especially if they allow travel by people who are infected.

So, a total travel ban on the Scottish cities then to prevent asymptomatic infected travellers, including those who would test -ve on PCR from a fresh infection then become infectious after travelling?

2
OP wintertree 23 Dec 2021
In reply to captain paranoia:

> I'm sorry to say that i think the 'omicron is less severe' is just political bollocks to let them 'get Christmas done'. 

It’s very pervasive in the international media, so not a local ploy but I’ve no doubt it’s convenient.

Really it’s a case of “the people are more robust to covid, and omicron is the first thing to test/prove this”.  Which I think is a really optimistic message.

OP wintertree 23 Dec 2021
In reply to David Alcock:

Merry Christmas indeed!  

We have Jr’s grandparent coming over; I’m going to keep the stove going to draw copious fresh air in to the main room, and we’ll run portable HEPA in the dining area.  3 doses all around, LFTs and a grandparent who has made up their mind.  At the rate they age, their risk factor goes up appreciably each year, perhaps faster than medical factors are going to pull it down for covid and just up up up for most stuff.  There’s not much point stalling for time, to be blunt, so we let them decide.

One benefit of having a very small surviving family the low probability of having any vaccine refusers in the mix…

 mountainbagger 23 Dec 2021
In reply to David Alcock:

> I know it's late guys. I keep testing neg - two per day as of Monday. Supposed to head south tomorrow. Getting a bit of a scratchy throat. It's a hard call, since my family don't give a damn this year. My mum, 73, still works in the hospital. Lung physio. But she's adamant.

> Should I stay or should I go? I know the answer, but she has reached the point of don't care.

> I just feel up against the wall, ethically.

Hi David, we have two 75 yr olds who each live alone coming to ours for Xmas day. They're very conscientious when it comes to following guidance, but they're also very fed up of not seeing family (or many other people). We are testing each day and, short of getting a positive result or the government actually locking us down in an unprecedented way (not even allowing bubbles!), they will both be here.

I live down south and rates are a bit crazy here, but we're balancing that situation against emotional needs of family members. You're doing the right thing by testing up to the event. Sounds like the rest of your family is comfortable with that (assuming you've told them about the scratchy throat?).

Incidentally, my brother is the same as you (minus the scratchy throat) and is agonising about coming. However, he is scarred from a particularly bad Covid infection from March 2020, from which he has still not fully recovered, so he is naturally more nervous than others...he knows how bad it can be. He hasn't made a final decision yet.

Good luck and I hope you have a good Christmas whatever you decide to do.

OP wintertree 23 Dec 2021
In reply to thread:

There’s an almost instant and very characteristic voting pattern going on on all posts on the current Scotland sub-thread.

I know I’ve said this before but it’s all so awkward when it goes wrong, so just remember - Pro Tip: Don’t forget to sign in to the right account before posting.

 girlymonkey 23 Dec 2021
In reply to Longsufferingropeholder:

> Latest stat I saw (Zoe study I think) was that 1 in 4 'colds' is covid. That might have changed with the higher prevalence now.

Just watched the latest Zoe update and it's now 1 in 2!

 summo 23 Dec 2021
In reply to wintertree:

> Really it’s a case of “the people are more robust to covid, and omicron is the first thing to test/prove this”.  Which I think is a really optimistic message.

Their opinions on no.10's last Christmas might influence their actions this year more than logic. Robust in the fact they'll ignore anything boris says from now on. 

 girlymonkey 23 Dec 2021
In reply to chris_r:

These symptoms have been out of date for a very very long time. Vaccination and Delta changed them significantly. 

Tim Spector, who runs the biggest Covid study in the UK (maybe in the world? Don't know about that), has been saying for at least a year now that those are not top symptoms. They don't even make it into the top 5. 

I would suggest watching some of his videos on YouTube, and if you have cold like symptoms then you should get a PCR. This week's update suggests that 1 in 2 with a "cold" have Covid. 

 Šljiva 23 Dec 2021
In reply to wintertree:

More caveats / glimmers of hope: 

https://www.reuters.com/business/healthcare-pharmaceuticals/scotland-report...   (offset by number of cases?) 

https://www.reuters.com/business/healthcare-pharmaceuticals/hospital-stay-r...  (offset by number of cases?) 

https://www.reuters.com/business/healthcare-pharmaceuticals/astrazeneca-sho... (no 3x AZ here) 

Passing thought - remember when 100k cases a day seemed acceptable in the summer exit wave? 

OP wintertree 23 Dec 2021
In reply to Šljiva:

> (offset by number of cases)

In effect; it seems to me that the variables policy seeks to control are hospital and intensive care occupancy; the additional people getting omicron who wouldn’t have got delta can more or less be ignored in that calculation (other than the impact of high isolation orders if it happens way too fast).

> Passing thought - remember when 100k cases a day seemed acceptable in the summer exit wave? 

Indeed; want to take a punt on the peak this time around?

OP wintertree 23 Dec 2021
In reply to Longsufferingropeholder:

At this point I think JBM should get a job as a cabinet/data/science liaison.  

Every time I read a post and thought “Yes, but….”, the next post caveats it.

Looked at another way, to continue the exit wave we were progressing through, we’d need circa 300k to 500k omicron cases a day.  

The critical issue seems to be how close we were to the end of that wave; I think really very close.  If so, this could all be over by mid January.  That seems very optimistic compared to the models however…!

OP wintertree 23 Dec 2021
In reply to chris_r:

Big elephant in the room how criteria for PCR testing haven’t updated despite variants and vaccination.  Would love to know what that’s all about…

> but normal winter colds haven't disappeared. 

Which is really interesting when we look at how social distancing etc more or less cancelled flu last winter but not winter colds.  Some textbooks might be getting rewritten over their R0 numbers…?

 jonny taylor 23 Dec 2021
In reply to Longsufferingropeholder:

I feel conflicted with Paul Mainwood's summary:

> Imperial: faced with these challenges we corrected for the major confounders using up a Poisson regression model with a neo-Bayesian fitting process as described in working paper 59e (to come) and … Edinburgh: we looked at who got sick.

Raises a smile, but... if you *don't* look at it all through a Bayesian lens, there are so many tempting but incorrect conclusions you're liable to draw...

Post edited at 10:00
 minimike 23 Dec 2021
In reply to jonny taylor:

Peril sensitive sunglasses with Bayesian lenses?

 neilh 23 Dec 2021
In reply to tom_in_edinburgh:

The same position will be happening in every major city- Paris, Berlin etc. Biden is saying the same in the USA.

Its hardly unique.

In reply to wintertree:

Mid Jan peak is definitely one of the scenarios in the models. All the developments so far actually pushing me towards thinking it's one of the more likely.

Something has changed in the last few days. None of the explanations offered yet fully stacks up. http://sonorouschocolate.com/covid19/index.php?title=CasesByAge

Testing hasn't stopped. Socialising, sure, there's less but enough less?? Not with R=scary. Susceptible pool shrinking? No way it's that alone. Boosters kicking in and having an effect? That would line up nicely in London, given when all the walk in places threw their doors open to all ages.

Big shrug. Hard to say what that means for the bigger picture.

In reply to jonny taylor:

Too true. The Imperial paper really is hard going though, which is why that national embarrassment we call 'the press' have gone exclusively for the Edinburgh paper that had like 15 cases to go off but writes the answer in a way someone with the reading age of a journo (about 6, it seems) could grasp. 

OP wintertree 23 Dec 2021
In reply to Longsufferingropeholder:

> Testing hasn't stopped. Socialising, sure, there's less but enough less?? Not with R=scary. Susceptible pool shrinking? No way it's that alone. Boosters kicking in and having an effect? 

I call it the “Lou Bega and Mambo No. 5” effect.  A lot of different things are coming together at once.

There’s also the “lightning fork” effect; imagine a network of people most susceptible to transmission, spread through the population like an origin-free Lichtenberg figure.  This is a network of people with the most social contact at work and elsewhere; the fastest doubling times; infection flashes through this network then collapses, and what’s left is the slower spread in the people around it.  Those people may have briefly been forced to a higher doubling time themselves based on proximity to the lighting.  (Yakawa-like coupling???) which accelerated the remaining, slower growth population along their exponential curve a bit.  It also primes everyone else locally to the issue with more people talking about it and knowing people isolating etc.

We’ve never seen aggressive doubling times sustained, copious evidence that many outbreaks at UTLA level have segue from low cases short doubling time to high cases low doubling time.  Omicron appears to have slammed all of London through that at once?  With the mambo kicking in we may even see actual reducing case numbers (hard to tell with a 4-day weekend coming up….) for a while.

Then rumour has if some people might be self testing but not reporting LFT positives - to allow them to make their own judgements over Christmas rather than being stuck in a box.  

Post edited at 10:19
In reply to wintertree:

Network effects are typically accounted for in most of the models. We've never seen such a sharp end to those; usually they're more of a highway network to get quickly to multiple seedings than an end in themselves. Sure the rapid rise should slow but not like this.

And testing numbers don't seem to be dropping, so unless people are taking the trouble dishonestly and in big numbers to report their +ve as a -ve I don't buy the testing thing either.

Edit: and you can look only at PCRs...

Post edited at 10:21
 Misha 23 Dec 2021
In reply to David Alcock:

Get a PCR, though bit close to Xmas now. Anyway, it’s just a day. There are at least 4 days of holidays for most people (unless they are in the NHS…). You’d think you’d get a result by Mon / Tue. Or just visit for NY. People are too fixated on Xmas…

OP wintertree 23 Dec 2021
In reply to Longsufferingropeholder:

> Network effects are typically accounted for in most of the models.

Sure; but they never actually pan out to match reality.  Network effects, demographics, details.  That’s a *lot* of free parameters.  More than there are days of days.

> We've never seen such a sharp end to those; usually they're more of a highway network to get quickly to multiple seedings than an end in themselves. Sure the rapid rise should slow but not like this.

But… the doubling times are much shorter with omicron landing in a time of low precaution and evading immunity-against-infection, and so the time axis is compressed compared to the less transmissive alpha outbreaks pre vaccination. Compressed a lot.  Because the exponential part has been doubling more than twice as fast as previous network flashes.

The self-moderating effect is stronger in the past at UTLA level, London seems more synchronised as a whole this time.

London started to have its rate constants pitch over a day before the regions - squint at the time-series D1.c plots above; I think perhaps we had the end of the rapid doubling phase start just before the precautionary and policy measures kicked in nation-wide, along with school closures.

Edit: Oh, I didn’t post those time-series updates.  I’ll do that when my laptop is out.  IIRC, London started to decay a day sooner than the regions. So if that way a London-specific effect (network effects) almost immediately multiplied by a national effect (precaution and policy), it would make sense.

> And testing numbers don't seem to be dropping, so unless people are taking the trouble dishonestly and in big numbers to report their +ve as a -ve I don't buy the testing thing either.

LFT positivity is low however, so omitting positives wouldn’t affect test numbers much.

There’s enough different things all happening at once that I don’t think there’s a great mystery behind it.

Post edited at 10:34
 Misha 23 Dec 2021
In reply to chris_r:

> A scratchy throat isn't listed. You've tested negative on LFT on consecutive days. Go see your family.

> I don't doubt that the 3 "main symptoms" need some refinement for Omicron; but normal winter colds haven't disappeared. 

Indeed but why would you want to pass a cold to a 73 year old parent or indeed anyone else?

4
 Misha 23 Dec 2021
In reply to summo:

> Their opinions on no.10's last Christmas might influence their actions this year more than logic. Robust in the fact they'll ignore anything boris says from now on. 

In which case we should all go into lockdown immediately 🤣

 chris_r 23 Dec 2021
In reply to Misha:

> Indeed but why would you want to pass a cold to a 73 year old parent or indeed anyone else?

Because in some parts of the UK, life expectancy is for men is below 74. At some point there won't be a next Christmas to wait for.

I completely recognise that it's finely balanced and every family has to make their own decision.

 Si dH 23 Dec 2021
In reply to Longsufferingropeholder:

> Mid Jan peak is definitely one of the scenarios in the models. All the developments so far actually pushing me towards thinking it's one of the more likely.

> Something has changed in the last few days. None of the explanations offered yet fully stacks up. http://sonorouschocolate.com/covid19/index.php?title=CasesByAge

> Testing hasn't stopped. Socialising, sure, there's less but enough less?? Not with R=scary. Susceptible pool shrinking? No way it's that alone. Boosters kicking in and having an effect? That would line up nicely in London, given when all the walk in places threw their doors open to all ages.

> Big shrug. Hard to say what that means for the bigger picture.

I think it's probably a few bits of the above causing the rate constant in London to drop as per WTs analysis and I'm inclined, without any evidence, to a view that this will have peaked by mid January. However I think the graph in your link is misleading. For some reason, which I think has been magnified this week, cases on Thursday and Friday are usually lower than the first half of the week. You then of course have the weekend low. Together these manifest as a flattening in your link. However, if you look at the preliminary data for the Monday just gone, it's already clear it's going to be well above last Monday and probably the highest day yet.

Don't want to get too into the hospitalisation rate discussion but generally I see it as very good news, even with the caveats. I think it'd be better if when trying to calculate an overall hospitalisation rate to inform healthcare planning (as opposed to trying to inform individuals about their personal risk) paper authors would headline the peak healthcare load that their IFR would lead to, rather than headlining the IFR. This would prevent some of the subsequent misinterpretations.

Post edited at 10:38
 summo 23 Dec 2021
In reply to Misha:

> In which case we should all go into lockdown immediately 🤣

Indeed, the message in sweden is just don't travel if you have any symptoms, sit it out where ever you are. Icu pressure has increased, it's a split between rs virus, influenza and covid cases. Of the covid it's almost entirely unvaxed or very old / multiple other conditions.(according to this mornings health department announcement)

In reply to wintertree:

I'm holding on to hope that two of those things are i) boosters ramping up protection disproportionately quickly in the spready demographic in London and ii) the little-discussed possibility that omicron has an appreciably shorter generation time. ii is about the only viable explanation I've seen for how things played out in Gauteng, and it's a big ray of hope for things here. Would also fit with the flash in the pan in London, and still not contradict anything you've just highlighted.

 summo 23 Dec 2021
In reply to chris_r:

> Because in some parts of the UK, life expectancy is for men is below 74. At some point there won't be a next Christmas to wait for.

> I completely recognise that it's finely balanced and every family has to make their own decision.

The fine balance is if a person wants to risk being the factor that causes the last Christmas, influenza kills 20-30,000 every winter in the uk, the risk isn't just covid. 

 Si dH 23 Dec 2021
In reply to summo:

> The fine balance is if a person wants to risk being the factor that causes the last Christmas, influenza kills 20-30,000 every winter in the uk, the risk isn't just covid. 

Yes, but to put the opposite view, the influenza prevalence this year is relatively very low, and very few people have ever cancelled Christmas for influenza.

I'm definitely with the above that, post a Government decision that lockdown isn't required to protect healthcare, individuals should make their own decisions about what to do at Christmas and not judge others'.

 Misha 23 Dec 2021
In reply to chris_r:

If they are fixated on Xmas, yes. Other weekends are available. 

3
OP wintertree 23 Dec 2021
In reply to Longsufferingropeholder:

>  I've seen for how things played out in Gauteng, and it's a big ray of hope for things here.

This is one of two things which has me doing my impression of Stan Laurel this week.The other is...

In reply to Si dH:

> For some reason, which I think has been magnified this week, cases on Thursday and Friday are usually lower than the first half of the week. You then of course have the weekend low. Together these manifest as a flattening in your link. 

The raw cases data over the last week is just plain weird.   I'm wondering how much postal delays are factoring in to this - presumably the post is hit as hard as elsewhere by isolation orders and staff absences, and a lot of PCR samples fly through the post.  There was an announcement some months ago that they were moving from the data a specimen entered the lab to the one recorded by the person doing the test, but I never saw a significant change to the weekend sampling low and Monday sampling high, so I wonder if that change didn't pan out?  If so, a combination of the pre-Christmas postal rush and staff absence could be redistributing the day-of-week sampling biasses.  Segueing in to the 4-day weekend around Christmas and then New Year, it's a really bad time to look for understanding in day-to-day and even week-on-week changes in the data...

In reply to Longsufferingropeholder:

See the plots below

  • Recent weeks of rate constant measurements (using a week-on-week ratio) for a few ages chosen to represent peak-growth and the more vulnerable.
  • In London: Ages 25 to 29 in London started to pitch over a day before the other young ages I've shown.  That's the cohort that's had the most bonkers cases/100k.
  • London young aunts rate constants went in to decay a day before rEngland rate constants.  If you squint at plot 18 rate constant for cases in the OP you can see top level cases for most regions pitched over a day later than London as well.
  • I don't think the shark is out of the water yet in rUK older adults rate constants - that is, we're not seeing the "true" omicron doubling time but a compound doubling time of the static-or-decaying level of delta cases and the lower but rising number of omicron cases.

 Offwidth 23 Dec 2021
In reply to Si dH:

Really?..most people I've seen with influenza can barely get out of bed let alone consider having a normal xmas.

1
 Misha 23 Dec 2021
In reply to Si dH:

Equally, very few people would go to a family do with flu symptoms.  The issue at the moment is that so many Covid symptoms are mild cold like symptoms and that’s on top of asymptomatic and presymptomatic cases. So comparing it to flu is, as ever, not really valid (albeit flu can start with mild symptoms; I’m no expert but don’t think asymptomatic and presymptomatic spread is an issue to anywhere like the same extent with flu?).

Then again, if it’s a small family gathering and everyone is boosted and LFTed, the risk seems relatively low. The question then is if someone has a cold, which is probably just a cold, do they want to give it to everyone else and does everyone else want to get it? 

1
OP wintertree 23 Dec 2021
In reply to Misha:

> . So comparing it to flu is, as ever, not really valid

The valid comparison for me is that pre-Covid, many people would dose up on medications so they could go on public transport and to the office with highly transmissible diseases that would kill 10s of thousands of people some winters and regularly bring the NHS to the brink of exhaustion in the process.

Just watch this recent, short advert...

youtube.com/watch?v=grR35J7CJ6s&

As a society we now have a completely unintegrated view to risk management over what Covid is increasingly becoming and over other pathogens that cause respiratory diseases.  

I agree with Si dH - if intervention in people's lives is not required in order to protect healthcare (and we never even considered interventions when flu would degrade service levels for all) then the government should make that clear, and make it clear that people have to make their own decisions.  A critical part of this is making sure that people have access to the best quality of evidence on the risks - prevalence, severity, individual risk, appropriate control measures etc.  

I've been mulling over the possibility of integrating a bespoke, individual risk score in to the NHS App - this could access surveillance data on prevalence of various diseases - perhaps down to a regional level, fed through a model for the individual's risk based on their medical history.   This could give them a traffic light system for risk vs type of venue, something like a personalised (and so greatly simplified) version of this sort of tool that some employers use to evaluate risk as part of their Covid measures: 

https://alama.org.uk/covid-19-medical-risk-assessment/

This app could tie in to a more widespread surveillance system that re-purposes some of the PCR capacity in the post-Covid era; perhaps running a version of the ONS random sapling survey but for multiple diseases, and increasing the capacity of DataMart.

Part of expecting people to make their own decisions is enabling them to make those decisions in an informed way, and frankly reading the media coverage is never going to enable that.  An App could integrate the best scientific and medical evidence.

Might need to get a solicitor or two to look at the disclaimers...

Edit: Don't know why I didn't think of this before.  The other thing we should have started doing 12 months ago is giving pubs and restaurants "Air Hygiene Scores" based on their ventilation systems.  Big, prominent posters at the entrance like food hygiene scores.  Give individuals access to information to manage their own risk.  Could tie in with the app, with a traffic light colour given for each score based on the person's medical history and current prevalence measurements.

There's work for a whole new industry in assessing Air Hygiene Scores.  Is this where I make my first ever political donation?  These scores would also reflect VOCs and particulate matter concentrations...

Post edited at 11:23
2
 jkarran 23 Dec 2021
In reply to wintertree:

> But here I'm mainly interested in understanding why they've currently stopped rising.

Could it just be ICU approaching saturation?

Jk

2
 elsewhere 23 Dec 2021
In reply to jkarran:

> Could it just be ICU approaching saturation?

ICU admissions would saturate below full capacity if limited by staff absences.

"A total of 3,874 workers were absent from the capital’s hospitals on Sunday December 19 – up 2,334, or 151 per cent, on the 1,540 who were sick or self-isolating on the same day a week earlier."

https://www.standard.co.uk/news/uk/nhs-staff-absences-150-covid-b973520.htm...

I'm not hearing* that ICUs are full or that they are limited by staff absence so I'm guessing not enough patients (a very good thing!).

*surely government/NHS news management couldn't hide if ICUs were full or not being used because not enough staff? 

Post edited at 12:06
 Si dH 23 Dec 2021
In reply to jkarran:

> Could it just be ICU approaching saturation?

> Jk

No, it's nowhere near.

Post edited at 12:06

 Michael Hood 23 Dec 2021
In reply to summo:

> The fine balance is if a person wants to risk being the factor that causes the last Christmas, influenza kills 20-30,000 every winter in the uk, the risk isn't just covid. 

Have you got a reliable source for that?

A bad flu winter ok, but EVERY winter?

 summo 23 Dec 2021
In reply to Michael Hood:

> Have you got a reliable source for that?

> A bad flu winter ok, but EVERY winter?

https://www.google.com/amp/s/www.bbc.co.uk/news/health-54463511.amp

There is a graph a little way down. I probably underestimated. 

In reply to neilh:

> The same position will be happening in every major city- Paris, Berlin etc. Biden is saying the same in the USA.

My daughter lives in Berlin. They don't have anything like the Omicron infection rate.

5
 Si dH 23 Dec 2021
In reply to tom_in_edinburgh:

According to owid, test positivity in Germany is running at 20%. I think you can be confident there are even more cases being missed there than here.

In reply to wintertree:

> I don’t have a strong view on Scottish independence and I’m not a Tory.  I also don’t think Scotland has been meaningfully more precautionary at the critical times.  They have to be more precautionary now because their immunological situation is worse than that in England.

Scotland is being more precautionary now because it isn't run by a total w*nker.

Scotland has done more jags than England.  Fewer people have caught Covid in Scotland and fewer people have died of Covid in Scotland than in England.

The Tories policy is ridiculous.  There's absolutely no reason to turn this into a gamble when you could slow it down for a couple of weeks, get more jags done and then act on the basis of strong data.  Maybe it will be mild enough that letting it spread is OK but you should know that for absolutely certain before going that way.

7
 Misha 23 Dec 2021
In reply to wintertree:

Sure, people going to work when ill is an issue. Even less socially acceptable now. However flu has low R, partly I suspect because pre and asymptomatic spread is far less of an issue and even symptomatic spread is lower than with Covid because on average flu symptoms are worse so people actually stay at home. 

Whereas Covid spreads much more readily and whilst mild for most, can be severe for some. Hence I don’t think it’s a good comparison. We can get say 20k flu deaths in a winter but it’s not 100k and whilst bad for the NHS it never overwhelms it. So I get what you’re saying but I just think it’s not actually a good comparison.

It could be that post Omicron and post boosters there will be so much immunity that Covid won’t be such a threat any more. We shall see. 

1
OP wintertree 23 Dec 2021
In reply to tom_in_edinburgh:

> blah blah blah w*kner blah blah Tories blah blah England blah blah blah

Whatever

> The Tories policy is ridiculous

The governments for both London and Scotland were both perfectly happy to let cases rise to a high level before applying different levels of restrictions.  Neither acted sufficiently hard up front to delay the spread of omicron until more data was in.  Both practically welcomed it with open arms, or big steps if you like.  If - against all scientific expectation - the resultant wave had turned out to have the same lethality as delta, both Scotland and London would have been up poo creek by now.  They’ve either both been thoroughly reckless, or listened to the scientists, or fallen somewhere in the middle.

Now the horse has bolted, we’re seeing more significant divergence of policy.  

2
In reply to wintertree:

> Whatever

> The governments for both London and Scotland were both perfectly happy to let cases rise to a high level before applying different levels of restrictions.  

Scotland has significantly lower infection rates than England right now and the new restrictions are only going to widen the difference.

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/con...

"In the latest week (ending 16 December 2021), the estimated percentage of the community population that had COVID-19 was:  

2.21% in England (1 in 45 people)

1.79% in Wales (1 in 55 people)

2.06% in Northern Ireland (1 in 50 people)

1.45% in Scotland (1 in 70 people)"

8
OP wintertree 23 Dec 2021
In reply to tom_in_edinburgh:

I’m not talking about prevalence as well you know.

I’m suggesting that both governments were happy to bolt the stable door after omicron rose to prominence.  If - against expectation but as you have been arguing we should assume - it was directly bad news, both sides of the border would be more screwed, and no doubt you’d be tastelessly pointing out how much more screwed England was.

Thankfully we’re not in the situation but don’t let that stop you.

3
OP wintertree 23 Dec 2021
In reply to Si dH:

> According to owid, test positivity in Germany is running at 20%. I think you can be confident there are even more cases being missed there than here.

Even accounting for lags and recent Omicron spikes, they have a higher deaths/100k than us, by a factor of about 2, despite their cases being lower.

It always surprises me to see Germany less invested in testing, but then they have so much more headroom in their healthcare system than us, so they can afford to do less measurement and let the deaths continue.

I suspect they're in a bit of a bind now with omicron though; if their plan really was to let delta burn has fast as possible through winter, they're really going to struggle to control that burn with omicron.

Hopefully the Pfizer anti-viral (big UK order just placed, expectation of MHRA approval imminently?) is going to give them something of a Deus-Ex way out of their bind.

OP wintertree 23 Dec 2021
In reply to thread:

There's a big Monday spike (it mops up missing weekend cases) developing in the provisional data - my plots don't use that.  It makes last week's raw cases data look quite atypical indeed.

Some updated plots to hi-light interesting changes.

Some time series of the London demographic cess show tat the doubling time is continuing to slack off for young adults, but that this change is not translating through to older adults - this being the age where susceptibly to hospitalisation is a bigger worry.  What's interesting is that the young doubling time is backing off below the old doubling time; might not expect this if we were seeing a universal response to control measures; some serious immunogenic water under the bridge perhaps?  Perhaps also ages less likely to suddenly have their transmissive networks fragmented by the end of Christmas party season and the closure of workplaces?

The most recent time slice for London is definitely getting filed under "Not Great News" - doubling times holding between 4 and 5 days for adults in their 60s and 70s.   

The time series for rEngland (all except London) shows the doubling times backing off a bit but not a lot and looking to stabilise; this sort of fits with my idea that the relevant London times started backing of in response to immunogenicity of the recent tidal wave of young adult infections and that this was compounded by the increased precaution and policy measures; so it's heading for lower doubling times than rEngland which hasn't had the same immunogenicity - so it started falling sooner and will take longer to fall to its new level.  Or I could be over-interpreting well beyond threadbare to the point of the Emperor's New Clothes... (!)

Squinting at plot 18:

  • The rate constants for many regions are levelling off; and London's continues to decrease; as the giant young people spike in London collapses, if the growth in older people continues, that top level decay won't hold for much longer.
  • Hospitalisations in the North West are firming up as definitely looking to be in continued rise.  A look at the raw data [1] supports this.  I've given the region its own colour on the line plots to help trace it through.  It has the second highest growth - in terms of peak and sustained level of rate constants - after London, so this makes sense.
  • Deaths for London are the only ones to consistently remain in growth; whilst most regions have decay, and squint and you can the the North West having the closest position to growth after London. 

So, having omicron take over from delta is definitely driving a growth in cases that is also driving a growth in hospitalisation and death rates; a peak in to the future for the other regions.

Hospitalisations for both London and the North West continue to double slower than their respective cases.  This is good, but it's largely the result of transitioning from one case hospitalisation ratio to another and from the (now reversing) demographic shift to younger people; as these transitions play through the lag, the doubling times become decoupled.  Eventually we'd expect them to come to similar values on an appropriate lag, although the endlessly shifting demographics rarely mean that actually happens.  As shifting sands go, these aren't good ones.

In other news...

I won't be posting the next thread on Saturday this week for obvious reasons involving periods of gluttony and sloth punctuated by nice walks.  I'll probably do the next thread on Friday (an actual Friday Night thread!) as there's no point waiting until Sunday as there won't be data reporting over the weekend according to the dashboard.  In general I expect cases data to be pretty messed up over the next week by it all, so maybe it's not going to be that meaningful for a while.  Hospitalisations are the one to watch and they're presumably going to rise somewhat with the demographic shifts going on. 

[1] https://coronavirus.data.gov.uk/details/healthcare?areaType=nhsRegion&a...


In reply to wintertree:

Re your London ponderings.

I’m down in London at the moment and I’ve never seen the pubs so dead. I walked past a whetherspoons near Clapham junction and there must have been 5-6 people in there.

Either everyone is self isolating or behaviour has dramatically changed.

 Michael Hood 23 Dec 2021
In reply to summo:

> There is a graph a little way down. I probably underestimated. 

They combine flu and pneumonia because flu often causes pneumonia but don't give any indication how much this occurs - so your "underestimate" could be ok, or it could be a big overestimate (if "independent" pneumonia has significant numbers). We may never know and it's probably irrelevant with respect to the point you were making about Covid not being the only "nasty" out there.

 Si dH 23 Dec 2021
In reply to VSisjustascramble:

> Re your London ponderings.

> I’m down in London at the moment and I’ve never seen the pubs so dead. I walked past a whetherspoons near Clapham junction and there must have been 5-6 people in there.

> Either everyone is self isolating or behaviour has dramatically changed.

That's interesting. It happened a bit here (Merseyside) in September 2020 when we had a rise (which seemed big at the time albeit later dwarfed) and were put in local (but mild) restrictions when almost everywhere else was still doing ok. People stopped going to cafes etc, there were also lots of people wearing masks outside. I think maybe if people's own area/city is constantly in the news for having high covid rates, even if they normally prefer to ignore the whole thing, then they start to avoid going out and being cautious. When the message is national but not enforced, then not so much.

 Misha 23 Dec 2021
In reply to wintertree:

At a guess - date constants in the older age group might burn less bright but therefore a bit longer? Those age groups don’t go to nightclubs…

 Šljiva 23 Dec 2021
In reply to VSisjustascramble:

Been like that for a couple of weeks now, lots of cancellations.   (Although tends to be quiet in a normal year over the actual holidays as everyone leaves town).  

Post edited at 21:01
 oureed 24 Dec 2021
In reply to everyone:

🤣🤣🤣

5
 David Alcock 24 Dec 2021
In reply to Misha:

> Indeed but why would you want to pass a cold to a 73 year old parent or indeed anyone else?

Since I've just seen the thread again, I thought I'd give an update and some context. 

Scratchy throat had vanished by dawn. I did two lfts an hour apart, and phoned family. So I did drive down. 

73 year old woman, my mother, has worked the pulmonary wards at the RD&E since the very beginning. It was hard to say no.

I was just gutted I got negatives. It would have been a good excuse. But on the other hand I accept her point of view - it could feasibly be a last chance, so it was her call.

The fact we hate each other, and Christmas as a whole... well that's another story.

Thank you all for your input - I did read everything pre-noon.

And Merry Christmas! 

 Maggot 24 Dec 2021
In reply to tom_in_edinburgh:

> Scotland is being more precautionary now because it isn't run by a total w*nker.

Maybe so, but she seems to be trying to be as useless as our asshole. Edit, when I said trying, I meant IS.

Goons like you would drink her diahorria from a cheap bar plastic cup if she asked you.

Tell me, do you get a warm feeling inside when you're getting conned by a politician for years in end? 😂😂😂😂😂😂😂

7
In reply to Maggot:

> Maybe so, but she seems to be trying to be as useless as our asshole. Edit, when I said trying, I meant IS.

Her policies have resulted in a significantly lower rate of death, hospitalisation and infection than England.  England is about 2,000 deaths / million, Scotland at 1,500.   The reduced rate of infection will translate into reduced rates of long covid and other post disease health problems. 

Reducing the public's chances of death and disease is what politicians are supposed to do.   The Tories think their job is to skim money off the top for themselves and appease right wing wankers who donate to their party.

> Goons like you would drink her diahorria from a cheap bar plastic cup if she asked you.

Maggot.  Name checks out.

> Tell me, do you get a warm feeling inside when you're getting conned by a politician for years in end? 😂😂😂😂😂😂😂

I'm not being conned by a politician. About 80% of the time Sturgeon does what I would have done in the same circumstances and of the other 20% I can usually understand why she went the way she did.

9
 summo 24 Dec 2021
In reply to tom_in_edinburgh:

> Her policies have resulted in a significantly lower rate of death, hospitalisation and infection than England.  England is about 2,000 deaths / million, Scotland at 1,500.   The reduced rate of infection will translate into reduced rates of long covid and other post disease health problems. 

After 10 years of snp majority how's Scotland normal mortality rate? 

2
 Offwidth 24 Dec 2021
In reply to summo:

In terms of regional and national change of life expectancy.. the same as nearly everywhere in the UK. Scotland are not noticably worse and the SNP started their time in government from the the lowest baseline in the UK. The big change is the recent shift to the poorest going into decline on average longevity (especially in England) whilst the rich still live a bit longer every year. This is almost certainly related to underfunded health and social care.

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/hea...

https://www.theguardian.com/commentisfree/picture/2021/dec/23/steve-bell-on...

Post edited at 08:55
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 elsewhere 24 Dec 2021
OP wintertree 24 Dec 2021
In reply to Offwidth:

Unless I’m missing sometime, table 1 shows it to be worse in Scotland than anywhere else?  Quite a bit worse than some of England, although there’s a clear north/south divide.

Certainly going to affect the demographic-wide IFR of covid between regions.

Big picture though is almost everywhere is getting worse; not something to be proud of - especially set against a background of cancer survival times rising by about 2 months every year, meaning an even larger rise in mortality from elsewhere than the top level numbers suggest.

OP wintertree 24 Dec 2021
In reply to elsewhere:

> "Is Omicron a New Wave or a Parallel Pandemic?"

Not a surprise if infection by delta doesn’t provide protection against infection from omicron.  If a key from lock A doesn’t fit lock B, the key from lock B isn’t going to open lock A… Antibody evasion is clearly a part of omicron’s spread.

I think the main things sending delta in to decay are probably the responses to omicron - a third vaccine dose which is terminal pro omicron spread in the short term, and increased precautionary measures and policy measures setting R<1 for delta.

The cross-immunity they really matters is immunity against severe disease, and we know that exists between variants given that the “extra” people catching omicron - those so immune they couldn’t even catch delta - are having more mild illness.  We also know this immunity persists for much longer than antibody fade.  Which is one of the reasons it’s really important people qualify which vaccine efficacy they’re referring to (catching it vs severe disease)…

 elsewhere 24 Dec 2021
In reply to wintertree:

Is there data that Delta is in decay? I've heard comments within last week saying possibly fairly constant absolute numbers. However as behaviour changes over last few days, and in the other direction over the next few days who knows...

Post edited at 10:26
OP wintertree 24 Dec 2021
In reply to elsewhere:

> Is there data that Delta is in decay?

Sort off, in a wooly way

  • One can perhaps loosely infer this from the hospitalisations falling in most English regions despite the rising cases 
  • One can perhaps loosely infer this from the cessation of rising ITU admissions in London.  
  • There's also the big splurge of blue in my weather passband plot (up-thread [1]) which shows the rate constant for cases (mostly Delta at the time) was way more negative than we'd expect from the usual weather trend.  Delta was heading rapidly for decay...
  • Figure 2 in the omicron daily overview [2] is pretty compelling, give-or-take the limits of SGTF data.  Caveats apply about this data.
    • Plots below: I've measured the height of the bars in Figure 2 to recreate some time-series data and plot it along with week-on-week measures of the rate constants / doubling times.  In this data, the proxy (S-gene positive) for delta has been in decay pretty consistently.  Interestingly the rate constants for both variant-proxies are showing a similar falling trend...  What's good for the goose is good for the gander, perhaps.  
    • I'm bamboozled how they're still reporting 2-to-3 day doubling times in these documents.

None of this seems surprising as we'd been exhausting the ability to spread delta, through running out of susceptible people ever lowering R set against a background of the seasonality ever raising R enough to compensate, maintaining a high daily level of cases and a top-level illusion of changelessness.

Long term, reducing susceptibility through increasing immunity and worsening seasonality can't keep balancing each other out - we bottom out the weather and immunity continues to increase, and left to itself, delta would have fully exited its pandemic phase.  

We have been a gnats whisker from decay in delta for months with warm spells repeatedly pushing it over in to decay for a week at a time, and the last regions of high growth on the demographic plots were drying up.  With the massive surged in 3rd doses and what is known about the effects of that on delta transmission, and increased precautionary measures, it would take a miracle for delta to remain in growth at this point...

> However as behaviour changes over last few days, and in the other direction over the next few days who knows

To misquote Cmdr Samuel Shore, anything can happen in the next half-month.

 [1] https://www.ukhillwalking.com/forums/off_belay/covid_plotting_57_continued-742...

[2] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/...


In reply to summo:

> After 10 years of snp majority how's Scotland normal mortality rate? 

The things the SNP government have control of are going well.  They've done an excellent job on the NHS, they've done an excellent job on alcohol and smoking, if the Tories didn't have control of drugs policy they would do an excellent job on drugs.

The structural problems of Scotland's economy caused by centralisation of power in London exercised in the interests of SE England are still there.  It will take independence to sort that out. 

The effects of health problems in childhood or early life will still show though on mortality for a long time.

11
 elsewhere 24 Dec 2021
In reply to wintertree:

Very very detailed response, huge thanks!

OP wintertree 24 Dec 2021
In reply to elsewhere:

Mostly supposition and caveated data tough!

 elsewhere 24 Dec 2021
In reply to wintertree:

> Mostly supposition and caveated data tough!

Far better than the dishonest or ignorant who profess or demand certainty.

Post edited at 11:35
In reply to wintertree:

> If a key from lock A doesn’t fit lock B, the key from lock B isn’t going to open lock A…

The cleaner's key for the door to my building (lock A) won't unlock my flat (lock B) but the key for my flat (lock B) will unlock the door to the building (lock A).  

7
OP wintertree 24 Dec 2021
In reply to tom_in_edinburgh:

> The cleaner's key for the door to my building (lock A) won't unlock my flat (lock B) but the key for my flat (lock B) will unlock the door to the building (lock A).  

That’s nice for you and your cleaner.  

Any analogy has its breaking point, and hierarchical master keys are on the other side of that breaking point for RBD mutations, antibody affinity and symmetry breaking in cross-immunity.

Post edited at 11:37
 Dr.S at work 24 Dec 2021
In reply to tom_in_edinburgh:

witchcraft!

Actually that must be fairly easy to set up - seems very sensible for flats etc

 Maggot 24 Dec 2021
In reply to tom_in_edinburgh:

Oh yeah?

"In 2020 in Scotland, the alcohol-specific death rate was 21.5 per 100,000 population [37].

Provisional data for 2020 in England shows that the alcohol-specific death rate was 12.9 per 100,000 population [38]."

Excerpt from: https://alcoholchange.org.uk/alcohol-facts/fact-sheets/alcohol-statistics

3
In reply to Maggot:

Pretty clear when you look at the graph that the alcohol problem developed during Westminster rule and Labour governments in Scotland and has been substantially reduced since the SNP came to power in 2007.  The SNP acted on smoking in pubs, licensing hours and minimum pricing on alcohol and it has had an effect.

Of course we are still suffering the long term health consequences of decades of Labour allowing it to get that bad.

https://www.heraldscotland.com/news/18895497.the1990s-marked-dangerous-wron...

7
 summo 24 Dec 2021
In reply to tom_in_edinburgh:

> Pretty clear when you look at the graph that the alcohol problem developed during Westminster rule and Labour governments in Scotland and has been substantially reduced since the SNP came to power in 2007.  

That or they are dead / moved on to harder drugs? 

https://www.nrscotland.gov.uk/statistics-and-data/statistics/scotlands-fact...

A chance for you to refresh your knowledge of leading causes of Scottish mortality, not sure you can blame London when health has been devolved for a long time. 

2
OP wintertree 24 Dec 2021
In reply to summo:

The report on drug related deaths suggest they’ve increased 5.5x since devolution.

Comparable data from the ONS suggests about a 2x increase for England in that period.

Looking back over several decades of successive governments ignoring much of what evidence based analysis has had to say about drug policy gives some insight in to how long the science/government split had been worsening before covid landed.

1
 Maggot 24 Dec 2021
In reply to tom_in_edinburgh:

Now Labour are the pariahs!!! English Labour I presume?

Gosh, I feel deprived that we haven't got an SNP here in Manchester.

3
 bridgstarr 24 Dec 2021
In reply to tom_in_edinburgh:

> Pretty clear when you look at the graph that the alcohol problem developed during Westminster rule and Labour governments in Scotland and has been substantially reduced since the SNP came to power in 2007.  The SNP acted on smoking in pubs, licensing hours and minimum pricing on alcohol and it has had an effect.

> Of course we are still suffering the long term health consequences of decades of Labour allowing it to get that bad.

And as we all know, the reason why Scotland's rates increased so much more than England's was because Westminster contrived a policy that they knew would adversely affect the Scottish more than the other nations, and the poor Scottish people would be powerless in the face of it.

Westminster obviously calculated that the increased death rate in their favoured English was worth the cost of killing proportionately more Scottish people. The bastards.

2
In reply to wintertree:

Looks like Germany didn't piss away enough fortunes on t&t https://p.dw.com/p/44nk7

In reply to Maggot:

> Now Labour are the pariahs!!! English Labour I presume?

You were the one who blamed the SNP for alcohol problems in Scotland.  All I did was show the graph how things had changed over time which very clearly shows the problem shot up before devolution and during post devolution Labour administrations and started to fall when the SNP took power.

6
In reply to bridgstarr:

> And as we all know, the reason why Scotland's rates increased so much more than England's was because Westminster contrived a policy that they knew would adversely affect the Scottish more than the other nations, and the poor Scottish people would be powerless in the face of it.

> Westminster obviously calculated that the increased death rate in their favoured English was worth the cost of killing proportionately more Scottish people. The bastards.

I didn't say any of that.

My take is some of the increase in alcohol consumption was down to Thatcher intentionally destroying traditional Scottish industries such as mining and steelmaking and taking most of the economic benefits of the oil south.   Scotland should have been as rich AF over that period, instead there was a lot of poverty.

Alcohol is a specific problem for Scotland.  While we were run by England and parties controlled by England we did whatever was done in England.  The SNP weren't interested in what England was doing, they developed policies to address the situation in Scotland. After independence we will do many more things in a way which is appropriate for Scotland rather than what the Tories think is good for them and their pals in SE England.

Post edited at 15:36
5
 Cobra_Head 24 Dec 2021
In reply to chris_r:

> A scratchy throat isn't listed. You've tested negative on LFT on consecutive days. Go see your family.

That's exactly how mine started out though, quickly followed (4-6 hours) by a cough and headache.

 Cobra_Head 24 Dec 2021
In reply to Longsufferingropeholder:

> Testing hasn't stopped. Socialising, sure, there's less but enough less?? Not with R=scary. Susceptible pool shrinking? No way it's that alone. Boosters kicking in and having an effect? That would line up nicely in London, given when all the walk in places threw their doors open to all ages.

Less people getting tested, than should be, because they don't want to be positive!

If you don't know, you might not have it!

 bridgstarr 24 Dec 2021
In reply to tom_in_edinburgh:

Tbf I was just shit stirring. I think the minimum pricing in Scotland is a good thing.

I hope you have lovely Xmas, and I look forward to some robust anti English sentiment in the new year.

In reply to summo:

> That or they are dead / moved on to harder drugs? 

It's possible that when alcohol got more expensive some people substituted harder drugs.

It's also possible that the long term health impacts of the surge in addiction in the 80s and 90s are showing through as deaths now as that generation gets older.

> A chance for you to refresh your knowledge of leading causes of Scottish mortality, not sure you can blame London when health has been devolved for a long time. 

Increased mortality in 2021 from those diseases has more to do with what people who are now in their 70s and 80s  experienced and chose to do over the course of their life than the state of hospital services in 2021.   Poor housing, alcohol, smoking, poor diet, drug addiction create long term health problems which result in earlier death.

Control of health spending isn't going to fix it.  The Scottish Government would also need control of drugs policy to pursue things like safe consumption rooms, and benefits policies.  If England wants to do austerity and Scotland's spending is calculated based on England's spending then Scotland cannot diverge from England on anything which involves spending significantly more money.  We can't re-prioritise spending to move money from defence to social housing or restructure taxes or regulate our own energy industry.   The solution is independence.

1
In reply to wintertree:

> The report on drug related deaths suggest they’ve increased 5.5x since devolution.

> Comparable data from the ONS suggests about a 2x increase for England in that period.

Scotland doesn't have control of drug laws.

I agree Scotland has a more serious problem with some drugs than England as a whole (whether areas of Scotland have worse drugs problems than geographically/demographically similar areas of England is a different question as is whether some of the headline difference is due to different policies on what is counted as a drugs death).

If we were independent we would have different laws than England to address our drugs issue just like we introduced different laws to England on alcohol.  Many Scandinavian countries with specific problems with alcohol have stricter alcohol laws than Germany. The English Tories refuse to give Scotland the powers to implement evidence based policies on drugs like safe consumption rooms.  

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