UKH

The last two week’s threads have seen a lot more disagreement between various posters who normally have similar views, and I think that reflects the scale of uncertainty in the current situation and data.

The exponential rate constant for cases has dropped across all English regions (plot 18) and Scotland (plot 6s), with the doubling time for English PCR cases having extended from a brief peak of 8 days to around 16 days (PCR plot).  Reasonable arguments can be made in the context of this and other data to reach very different interpretations:

• Quite Optimistic - we’re starting to reach herd immunity thresholds (for the current level of restrictions) and the growth rates are moderating
  • Main reason to be skeptical - the effect is happening at the same time across English regions and Scotland, but the progress towards herd immunity thresholds (if they’re reliable against spread of the new variant…) is not so synchronised - although Scotland is probably leading the way there and has - for now - perhaps crossed over to decay in case numbers.  But that could be the football (see below).
• Somewhat Pessimistic - a bunch of factors are acting to depress the rate constant, and are transitory, so we'll see it go back up....
  • HE: The end-of-term outbreaks in university ages (Plot D1.c, 20-25) are subsiding, masking some of the more general rise
  • Football: A big super-reading outbreak/spike relating to a recent Euro 2021 football match is subsiding in Scotland, and that outbreak is masking the underlying behaviour
  • Weather: I’m basically convinced that short term changes in the temperature convert to short term changes in the exponential rate constant, and right now the weather would be expected to be depressing the rate constant.
  • Lots of people are isolating due to contact tracing - perhaps enough to prevent uninfected, isolating people from getting infected in unrelated exposures.

To me, the main reason to be cautions from the data remains the trend in ITU occupancy followed by the trend in hospital occupancy.

The phrase “breaking the link between cases and admissions” keeps coming up in messaging about the vaccine, but that’s a mathematically fallacy.

•  What the vaccines do is reduce the conversion ratio from infection to admissions etc, but that ratio still isn’t zero, and if cases double, admissions double etc. 
• The ratio has been generally continuing to drop from ongoing vaccination and the now stalled demographic shift, which is reducing but not eliminating the coupling.   

So, if cases go up, so do hospital admissions and ITU admissions, and in a fast enough rising exponential phase, occupancy can go up faster than admissions (interplay of rising admissions and mean occupancy time).

English hospital admissions are happening at about 1/4th the conversion rate of the last wave, and ITU occupancy is about 1/5th the level it was for comparable cases last time and is doubling every ~16 days.  We have about 3.5 doublings to go until it reaches the unsustainable level of the last wave, and that point is probably reached in real terms sooner as the staff aren’t getting much recovery time after the last difficult year.   

The worse case scenario would be that the masking effects I list above might fade just as restrictions are dropped and the weather swings round to a crap phase around July 19th; by that point we could be ~3 doubling times (in occupancy) away from ITU limits; a big rise in the exponential rate constant for cases could leave very little time to respond (by the time it’s identified, analysed, presented to cabinet and acted upon) before we’re looking at really bad news for healthcare, again.

But at this point, I can make a reasonable case for either optimism (some spitballing of numbers on the last continuation thread) or pessimism.  The growth in case numbers (still rising in absolute terms for England even as the rate constant drops) seems to me enough not to put at risk any plans for an “exit wave” that might be behind the current approach.  There’s lots of good reasons to want the remaining restrictions gone as soon as possible, and IMO dropping them progressively - some every week or two - gives us the best change of genuinely doing that irreversibly; as time goes on the data should become clearer, the conclusions more bounded, so I’ll be happy if we see the announcement on July 12th act cautiously but progressively to stack the cards in our favour.

That's a lot of words to say "I don't really know where we are right now".

The other big issue right now IMO is the dramatic slowdown in the rate of first doses (vaccine plots).  Total failure to reach agreement on the last thread about if this is down to supply or demand issues.  Lots of public data over the vaccines that’s not granular enough to be decisive, and lots of anecdotes each way.   The answer to this casts one of two very different lights on the current situation IMO, and I’ve not seen cabinet pressed on this issue clearly enough.

Links to previous threads and continuation:

• https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_33-...
• https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_33_...

A look at the age-breakdown of English data that drove the demographic shift over recent months, helping to reduce the conversion rations from cases to healthcare consequences.

Squint at the lower right of D1.c and you can see cases decreasing in university aged adults (20-25 mostly, and some in 15-20).  This is reflected in a very mild reversal of the demograigc shift (Plots P1.e and C) with the relative number of infections rising in the age band 35-50 compared to two weeks ago.  This doesn't mean infections are spreading more in that range, rather that they are spreading less in a younger band.   Three main factors I can see that could drive this:

• End of university terms 
• Ongoing vaccination of the younger adults in particular
• Infection granted immunity in younger adults rising after the last month

So, it looks like no more demographic shift, so the only factor likely to further reduce healthcare ratios now is ongoing second doses to adults over around 30 years go age.

•  Given the increase of consequences with age, that says to me that where we are in terms of protecting healthcare through vaccination is perhaps about as good as it's going to get until variant tuned vaccines land, or a booster round starts for the most vulnerable.  
• There are a lot of people who are going to experience long terms effects from their infections, and they will be better protected by controlling case rates for a bit longer to give second doses time to roll out.  In terms of ethics/morals, this is where the question of "supply or demand limited?" over first doses becomes critical.

The Lissajous plots.

Not much to add to the interpretation from last week.

For now, at least, cases are decreasing in Scotland so those traces are starting to close the loop.

The one case where the conversion ratio from cases to outcome seems to be really breaking is deaths - for England and the English regions I've shown the rate of these continues to stagnate or fall despite rising cases.  The one caveat is that this is the "within 28 days of a positive test" metric.  Given the rising ITU occupancies, it's possible that the recovery of people who would previous have died is becoming more drawn out, so checking the same metric for the 60 day period and the death certificate based metric is important, but it's going to be a while yet before there's enough data (bigger window and longer reporting lag respectively) to make that analysis worthwhile.

Deaths in Scotland continue to rise as the lag from infection and cases plays out.  That's stand-out different to England and it would be interesting to hear what the longitudinal data says is different between the two, it also raises the stakes for Scotland if their cases turn back to rising.

The Four Nations plots.

• Welsh case rates might be stagnating, although the last low raw data point has the look of reporting lag
• Scotland has gone in to decay.  Will it stay there?  
  • If it does that starts to demolish my pessimistic case from my first post, and suggests England could see decay in another 1-2 weeks.
  • If it doesn't, my optimistic case starts to fail. 
• Most of the decay in rate constants is in the provisional window of the analysis - in it all nations look to be heading for decay, but it's labelled "provisional" for a reason.  Some hope to hold on to for next week... ?

Not much more to say on Scotland above earlier posts.  

• The hospital admissions plot shows that - in exponential terms - it's not long before the peak of the last wave is exceeded.  
• With cases stagnating perhaps it won't happen before the lag plays out.  By the time the stagnation of cases translates through to admissions, the occupancy is going to be close to the peak - with the sustainable limit probably less than half a doubling time beyond that. 
• There's a worrying sign in the admissions plot of the curve getting steeper; as it's a log-y plot that means the rate constant is going up (shorter halving time); this can also be seen on plot 9 (black curve).  
  • Hopefully that's just the third peak in the blue curve for cases translating through the lag.  It's interesting that the 1st and 3rd recent peaks are translating to admissions but not the 2nd.  
  • Perhaps the 1st was importations of the new strain into vulnerable sub-populations (causing hospital admissions), the 2nd was university related (very few admissions) and the 3rd is related to the football spike (vulnerable to admissions).  I feel I'm over-reaching a lot on interpretation here, and Scotland doesn't manage to publish data with the MSOA or demographic granularity England does, so I can't test any of this against the data.

The plots for England look a lot like a simple continuation from a week ago.  The rate constant for cases is starting to drop.  We'll just have to wait and see if that's sustained or not.  Deaths have stopped rising; the demographic shift in cases working its way through the healthcare pipeline?  When you compare the cases and deaths plots, it shows just how much difference the vaccine is making both directly and indirectly.

Lastly, the vaccine plots.

The first plot is more useful perhaps for matching up first and second doses.  We can see the notional gap between first and second doses is now down below ten weeks, showing progress is being made with the plan to reduce the gap to slow transmission of the new variant.

The second dose rate has been falling as the number coming due falls, but that number coming due now starts to rise, and I suppose the second dose mix is switching from AZ/Oxford heavy to Pfizer/BioNTech heavy.

The split axis plot makes it clearer that the first dose rate has crashed recently; looping back to the critical question of "why" I raised in my first post.  A definitive answer to this would be good.  It's not unexpected that vaccination slows down as we reach saturation and we're left with the people who find it harder to engage or who don't want to engage and it's tempting to assume that's all there is to it, but it feels wrong to be following the path we are apparently on if supply issues are involved, so it would be nice to know the absolute position. 

Thanks again for these.

What return rate are you assuming when you infer  the delay between doses?

100%.  One of two reasons it’s labelled “notional” - the other one being that it assumes everyone is going for their first and second doses in the same sequence - I think sequence violations drop out of the maths but haven’t thought it through.

I also think people coming back in a different order (assuming that's what sequence violation means; on first read I thought you meant people going for their second dose before their first!) should be meh. Don't think return rate can be ignored though. That would cause a constant, false gradient on the interval, wouldn't it?

Looking as usual at late Scottish numbers on https://www.travellingtabby.com/scotland-coronavirus-tracker/.

Pfizer first jab (5457) not much more than Pfizer second jabs (4722). Looks like 2nd jabs for under 40s are due and this explains drop in first jabs.

Moderna is now significant (2802 first jabs but only 46 second jabs).

First jab uptake % for age 18-29 still looks pretty linear. No sign of saturation which previously happened whey they ran out of people to send appointment letters to. Will have to wait and see.

News today is 2nd jab delay to be reduced from 8 to 4 weeks. Hopefully this signals government confidence it's achievable.

Particularly enjoying your verbal analysis this week - thanks as always.

Re relationship of deaths and cases - given the low absolute number of deaths in Scotland, or any English region, do you not feel that your plots are pretty vulnerable? Comparing each of the three regional plots show the deaths metric is very ‘bouncy’.

As cases rise, and we still test everyone going in to hospital, there's going to be an increasing number of people who die with it, not of it, messing up the stats too. The 'within 28 days of a positive test' can't be a great indicator for much longer.

I thought the point of this when the graph was created was not so much to try to predict what the real mean duration between doses was (what's the value in that anyway?), but rather to keep a weekly monitor on whether the rate of second doses was high enough to ensure everyone could get their second dose in under 12 weeks. At the time second doses started to become due in big numbers, there was quite a bit of uncertainty about that. In that context, a return rate of 100% made sense as a conservative assumption. 

Thanks as ever.

I can't get my head around the behaviour of the hospitalisation rate and death rate (although I can see more easily why the latter could be noise) in England. Eg the admissions in the North West reducing for a week in the second half of June before rising again. Seems very weird.

I don't really agree that Scotland is likely to be closer to a current herd immunity than England. Although it has been worse hit over the last month, there would have been less pre existing immunity because it got hit far less badly by alpha in December / January. This is borne out by the ONS antibody study that suggested levels in Scotland were ~5% lower than England and ~7% lower than Wales in mid June. Quick fag packet calc - there have been roughly 60000 cases in Scotland since mid June. If we assume we picked up 50% of cases then that's 120000 infections and if we assume all of them are in adults rather than children then that's still only a further 2-3% of the adult population. So, I don't see that Scotland can have caught up with elsewhere in terms of population immunity (unless effective immunity from earlier waves has already substantially worn off elsewhere despite the presence of measurable antibodies, which would put us all in a worse place.)

This would challenge the possibility that the current turnover in Scottish cases is due to herd immunity levels being reached. However I guess there is more possibility that we are seeing the impact of immunity being built up specifically in the sub-populations most likely to get infected at this time, that having changed a bit since the last wave. 

Good to see from your graph that cases in the the North West appears to be tapering over as well, this wasn't as clear from eyeballing the raw data.

Forgot to mention, obviously you'll be aware but the North East is now leading the way in infection rates and still apparently rising faster than the North West. Hopefully things will start to tip over there soon.

More foolishness from PHE, creating some real anger.

https://www.theguardian.com/world/2021/jul/10/public-health-england-accused....

As well as the 'what the hell is going on with young adult vaccination' question, an equally important question is who exactly is catching and spreading it:  at ONS reported antibody levels this must involve second infections/infections in the vaccinated. Knowing the early prevalence of second infections of Delta might better predict how high this wave will go and improve advice to those with antibodies. Too much government messaging implies people are safe if double jabbed...most probably will be, but those they infect might not

Looks like today the guardian would like you to be angry about PHE calling 74% "highly effective". I'm not getting angry about that. Try harder, the guardian.

And yes, the proportion of cases in vaccinated people will increase, and no that alone is not a sign the vaccines aren't working. Think about the extreme case where everyone is vaccinated. Then 100% of cases would be breakthroughs.

“Professor Sir Ian Diamond, the UK’s National Statistician has told Sky News that about nine in ten people in England and Wales have antibodies against coronavirus, up from two in ten in January. 

The group with the lowest at around about 60%, is those age of 15 to 24, he said. 

The vaccination program remained “incredibly important” but added:

Certainly we’re making an enormous amount of progress and absolutely admirable amount of progress. 

Diamond said the link between infections and being admitted to hospital, having serious disease and even dying has been “severely weakened”:

We have a younger cohort of people being hospitalised at the moment and while hospitalisations are going up, they are now a long way from some of the levels we have seen before.

And so I’m very hopeful that we have really made a strong break, but at the same time, I would have to say at the moment all the evidence allows me to say severely weakened.” 

Why the attitude? This is a criticism from organisations who lobby on the behalf of the immuno-compromised. The guardian is just reporting their concerns. Some public health staff I know well think this was a PHE mistake.

Back on last week's argument. Indie SAGE presented stats on Friday 9th on first dose ethnicity variation for the 18+ group: 81% for white down to 50% for black. So I was right that uptake was much higher overall than anecdote and didn't contradict ONS intention surveys in such a huge way. The local population numbers used in the denominator were known to be the least accurate of age groups due to student mobility etc giving a lot of double counting.. The ethnicity variation is still a massive concern.  Local Health experts are blaming government mixed messages (feel free to shoot the press messenger again).

https://www.theguardian.com/world/2021/jul/08/vaccine-uptake-coronavirus-en...

Study suggests vaccine efficacy in immuno compromised people may be higher than previously thought, but with small numbers of people and recommends further research.

PHE report that vaccines have high efficacy in immuno compromised people.

Body representing immuno compromised people demands that PHE retract their statement because it might give the wrong message.

Guardian reports the above (seems reasonable to me but the headline is a bit sensationalist).

People on the internet like different newspapers.

The end.

Just been doing some assuming and multiplying on this. Be interested in what others come up with because it takes a lot of guesstimates, but ab initio, given ONS and other available stats, what would you reckon the number of daily deaths within 28 days of a positive test would be in the case where nobody died of covid*?

* - to be clear, this is absolutely not what I think is currently the case. This is a huge exercise in whatiffery, but I think it's one we need to give some thought to.

To me it read like "Angry woman writes strongly worded letter". You're right though. Will stop polluting the thread now. 

Because of all the inflammatory language they've used. 

I mean, it's the guardian, so there's always someone to blame, but I'm not sure on this one. They don't say what those mixed messages were. The only message I've seen is "get the jab" (apart from "we're letting it rip" of course, which adds weight if anything to the former). It's clear that is not working universally, so we obviously need to try something else. Pointing and moaning probably isn't the best plan.

I don't give a stuff what media people like. If the Telegraph produced an important science story where the science wasn't distorted but the headlines were slightly lurid I'd happily link them (if they were not paywalled.). I though we were prioritising the important science behind the politics here. I know a few immuno-compromised people who have been getting increasingly anxious recently and already believe PHE were not really looking out for them as they should. In particular mask use makes a massive difference to their freedom.

Some more anecdote. We went to SHAFF yesterday (very pleased it went ahead.....I really miss events and seeing friends in the real world). The train up was very busy, effectively forcing strangers to sit next to each other, but with 100% mask use and well ventilated with all windows open and with 3 staff on a two carriage train. The lateish train back was slightly less busy but had a few drunk groups, one group not wearing masks at all. It was air conditioned ...is it just me or are open windows more reasurring? We only saw one member of staff on that train. Unsurprisingly no one challenged the unmasked group. The cinema screening we went to was very empty looking due to number restrictions, a move to a bigger screen due to technical issues and households sitting together.

Five.

edit: at current infection rates

Vaccine plots, IMO the split axis plot is much clearer as the vertical spread gives an immediate feel of the total number of vaccinations.

Can we have the notional gap on that one as well please.

It seems like we're going through a period of high risk uncertainty. The only thing that seems certain is that this is still not being well handled by the government.

Keep up the good work and try and get a paper out about the temp v rate factor "anti" correlation. You deserve some kudos beyond the UKC support.

So how inflammatory in comparison with those Guardian words was serious minded people here saying the 18+ group was a huge concern last week, completely contradicting ONS intention surveys, when it turns out the actual national vaccination first jab rates must have been well into into the 70% range (and that with the lag to be reported in the Indie Sage slide from Friday)?

It was predicted in the Guardian and their scientific political wing known as Indie SAGE the real concern is likely to end up being in some ethnic groups and in deprived areas. We must not forget how their entryists have infiltrated northern public health departments to the point they now run them. It's lucky the government has done such fabulous work on areas like dealing with ethnic variations in vaccine hesitancy and misinformation in deprived areas, devolving local public health response and ensuring the poorest who catch covid are well funded to be able to isolate, everyone understands the importance of mask use indoors and good ventilation, all backed by world class track and trace (this paragraph is all sarcasm in case someone missed it).

The story wasn't about the science though, it was about the messaging afterwards.

The science story as I understand it is a positive one. From the people in the study (which I haven't read myself but according to the Guardian's summary), the differences in vaccine efficacy between immuno compromised and other people was within the confidence intervals. That is surely a very positive development.  The problem was that PHE gave an over simplistic message afterwards and the woman in charge of a blood cancer charity wants the messaging to be cautious and caused a fuss.

Go tell the charity that and see how they respond. Public Health should be properly focussed on the most vulnerable. The criticism about an incautious position was fair in my view and will likely be changed. Everyone agrees the science is mostly positive, the small bit of the science being criticised might not be.

PHE and Public Health departments have been in a real mess since the Lansley 'reforms'.

It's here: https://www.gov.uk/government/news/covid-19-vaccines-highly-effective-in-mo...

Direct link: https://khub.net/documents/135939561/430986542/RCGP+VE+riskgroups+paper.pdf...

Interesting the guardian chose not to link it....

Anyway, my takeaway is that there's not a huge reduction of effectiveness after 2 doses relative to the general population (i.e. highly effective) in immunocompromised people. N=a couple hundred. Can't have been easy to find data on that many tbf. Could do with more work but it covered a lot of different priority groups so hard to ask for more. 

"There were 9 cases after 2 doses among immunosuppressed individuals, the majority of whom were over 70 years of age. Cases under 70 years had autoimmune conditions (Crohn’s disease; type 1 diabetes and multiple sclerosis; psoriatic arthritis) and were on immune modulating therapy."

I read that article as having a relatively straightforward message for what is admittedly a technical/statistical issue:

- government says everything is fine because the headline number is 74%
- charity says hang on that has a huge uncertainty on it, how about we stay cautious and try and get a more definitive answer

- government repeats “but the number is 74%” in a Nigel Tufnel voice

Yet another anonymous consultant. Two questions are obvious: why do they feel they need to remain anonymous and why do so many people have fingers in their ears and not listening to really obvious unnecessary risks?

https://www.theguardian.com/society/2021/jul/09/im-an-ae-doctor-covid-patie...

The main issue is I see is that that particular executive agency of government should understand the "the number is" is not an answer, and that the CI is an integral part of the answer, and they shouldn't need bringing up on this stuff.  

It's not been the first time someone in possession of a suspicious mind might suspect some senior appointments just don't have the specific backgrounds needed to understand important details.

Next we'll be having people, who really shouldn't need it explaining to them, misunderstanding the importance of ventilation...

I’m not 100% clear on exactly what you mean by "vulnerable" but they’re low numbers which always means a lot of statistical noise - I normally qualify that and didn't this time round.  The “bumpy” effects still look significant and real to me.  There’re similar bumps in the admissions data that Si dH notes, and similar two-bumps behaviour in bot London and the North West.  Hold on to that thought...

In reply to Si dH:

I haven’t strung together a detailed model, but my sense is that this relates to the way outbreaks continue to drive the cases at a much higher daily rate t(where  past waves had long since moved to an all-encompassing "global" mechanic.) This makes sense if vaccination is not homogenous and isotropic and there are separate, more vulnerable sub-populations; vulnerability to either just transmission or to that and hospitalisation can introduce wobbles in the relationship between cases and admissions.  For example the low vaccine uptake sub-communities where importation events were focused would have a higher hospitalisation rate than average, then the cases move to university age cohorts and the hospitalisation rate drops, then it goes global and the rate rises again.  It is notable that we’ve not seen this kind of bumpy behaviour before, and it’s likely I think that the bumpy admissions is a path on the pipeline to the bumpy behaviour in deaths.

Only the longitudinal data knows, and we don't get that except as presented in snapshots in submissions to SAGE.

In reply to Longsufferingropeholder

If someone can point me to an actuarial dataset giving probability of dying within each year of age that could be combined with the demographic case rates and population estimates to give an estimate to within a factor of 2x or so (allowing for seasonality in normal deaths).   It would be quite useful to put such a bound on the plots now that we hope to be approaching a point this "died with covid dominates the measure" topic becomes almost tangible. 

My much rougher estimate comes out much less than the numbers seen here.  The 28/60 days analysis I want to put together properly would also give insight here.

Changing topics….

In reply to Si DH:

Yu may well be right.- we’ll find out at the next ONS survey.  That’s the result a lot of people are going to be waiting for I think.  The devil is in the detail of where infections are landing and the current ratio of infections : cases.

I had to take my peril sensitive sunglasses off to read that sentence.  The growth is slacking off here.  We had a massive university outbreak, so hopefully normality returns.  

In reply to Michael Hood:

Agreed, this one is working better now, I’ll shift the curve over to that plot.  Lots of discussion up-thread on that notion delay; yes as Si dH notes it was more about seeing what the gap was and that it survived the high-demand week in 2nd doses - it did, just.  The issue of people not going for second doses would salt the analysis; I can’t believe that’s many people however???

I’m walking away from a world based around kudos and papers, too much about it was driven by the wrong kind of kudos tied up with the wrong kind of rewards (in my rather jaded opinion) and it’s nice to be done with it all (Me? The 13th Duke of Wybourne, leaving academia, with my H-index?  What were they thinking?)  What I was thinking about doing was putting a Python/Jupyter notebook up on GitHub with the analysis in it and getting the RAMP mailing list’s UKC mole to circulate it there.  

In reply to elsehwere:

Interesting.  Diversity in the supply chain seems like a good thing here.

 In reply to Longsufferingropeholder

I reckon it's probably currently in the high single digits and, obviously, rising. Definitely means we'd seldom expect to see a zero by that metric.

If you want population mortality, rather than a specific sub-set.....

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriage...

Somewhere, if you particularly need them, they do produce single year versions rather than the 3 years combined. More up to date but more volatile.

Possibly not granular enough: https://ourworldindata.org/grapher/death-rate-by-age-group-in-england-and-w... ?

Out of date but more succinct: http://www.bandolier.org.uk/booth/Risk/dyingage.html

Annoying site: https://www.statista.com/statistics/1125118/death-rate-united-kingdom-uk-by...

You need to account for cause of death I think. Someone who’s hit by a bus with asymptomatic covid is unlikely to have tested positive, but someone who dies in hospital with asymptomatic covid will definitely have been.

Re ‘vulnerable’ I mean that when numbers are so low other factors than the broad relationship between infection and death could have a big impact. If you applied a robust statistics approach, how many data points would you have to lose to change the slope significantly?
 

As you say, you are usually careful to caveat and ‘vulnerable’ is probably a poor choice of term.

Yeah, didn't want to show my working until a few others had chimed in, but yes and no. To put a low bound on it, if you just say about half of all deaths happen in hospital (it's typically 40-odd %, with another 20% in residential care from what I can find), it's easy to convince yourself there should be some number per day that you might expect to have recorded a positive test in the last month, and that log of that number is about 1. Obviously the demographics where infection is concentrated won't *currently* be the same as those most likely to die in hospital of other things, and loads of other factors, so it won't be right, but it won't be none and five to ten sounds like a non-crazy estimate.

That’s roughly my view. I don’t really have the time for a proper analysis (but I’ll happily provide constructive criticism!) 😂 

Although also consider the demographics most likely to die are also least likely to be exposed to children and students.. also the most likely to be vaccinated.. etc.

Yep, that was a consideration; cases currently concentrated in the not so likely to die tomorrow ages, but also don't forget the sadly very non-zero chance of catching it in hospital. It's all confusing but I'm sticking to log of it ~1

But hedging your bets my not telling us the base!

I didn't say ln.....

I do mean high single figures in this case, but i find a good way to convey a bat shit uncertainty on a complete wild arse guess to an engineering audience is to say "log (10) of it is probably 2 or 3". Usually makes the point.

On around the 20th Oct last year we were in a similar boat.. 3 weeks previously there were approx 10k cases per day which at that time led to 200 or so deaths. There was no obvious difference between the 28 day and death cert metrics..

this implies to me the order of the non covid deaths in the 28 day metric is no higher than around 1/1000 cases (3 weeks earlier)

on that basis at most 1/3 of current deaths can be attributed to this effect. 

Of course some people (particularly in ICUs) die of covid more than 28 days after their positive test too.. they don’t retest patients on ventilators!

However, more pertinent at this juncture is whether the posting frequency on this thread will be higher or lower after 8pm tonight.. poll via the like(lower)/dislike(higher) buttons.

NOTE THE PARITY!!

Mathematics and music are so similar at times.. 

I’m certainly in the dunces corner for both, although when I work at my maths it at least improves…

Thanks for the links; I couldn't figure out how to convert the life expectancy in the link from AJM in to what I need.  I used the "Our world in data" all cause mortality rates which apparently source from the ONS.

I converted these from annual deaths/1000 to a daily probability of dying, and then convolved the demographic daily case numbs for England with a step function of width 28 days and a height of the daily probability of dying to estimate the demographic deaths for causes unrelated to Covid amongst people who have received a positive test.  I then sum these over all ages and plot it.  Caveats:

• The mortality rates are 2015 data
• I don't consider the higher mortality for "<1 year old" in the death rate data, just using 1-4 years instead.  
• The death rate data is given as a single value for 80+ years, but presumably gets higher with age.
• I'm assuming that the daily probability of dying is invariant of the time of year, so I ignore all seasonality in deaths.

This feels like an analysis VictimOfMathematics would be much better placed to do with all the detailsI, if they happened to be reading...

The results are below - England deaths data above in black and a baseline in red showing what we might expect from people dying "with Covid" not "of Covid".  I wish I'd thought to put this together a year ago to demolish the noise from some of the denialisms.

The bottom sub-plot shows the ratio between the two; perhaps 10% of people now dying within 28 days of a Covid test might be expected to have died anyway in a world without Covid.  I think that more than anything, this graph shows the progress of the vaccine in a compelling way.

I think the numbers are lower than the estimates on the thread because non-Covid mortality risk skyrockets with age, and direct and indirect effects of the vaccine have concentrated cases in to the young.  

May be a little late now, but did you download the .xlsx that had qx and Mx values in it? Those are probability and force of mortality respectively.....

For what it's worth, a perios expectation of life for age X ought to be something along the lines of eol(X) = qx*0.5 + (1-qx)*eol(X+1) (i.e. the weighted average of dying half way through the year and surviving and then having the expectation of life for the year above). Something along those lines would unpick an expectation of life series back to the constituent mortality rates.

Interesting! So the order or magnitude is about right.. 

Nice.

Edit: also presumably doesn't account for the bias in testing towards people admitted to hospital?

Good analysis.

If you were using it to persuade covid deniers they were wrong then it'd be worth having a linear plotted version too. Apart from the fact most people don't really get log plots well, it'd emphasise the magnitude differences a bit better.

I want to be able to validate this using the difference between deaths within 28 days of a covid test and deaths with covid on the death certificate, but from a quick sample of the numbers, the relationship appears completely different. It doesn't really need it anyway, your analysis suggests the effect of unrelated deaths with covid on the big picture is very small.

Is the data available to do something similar with hospitalisations? I'm not sure whether total UK, national or regional hospitalisation admissions data as a function of age exists anywhere. If it does you could do a similar analysis with hospitalisations which might be more powerful, given how much debate there will no doubt be over covid hospitalisation figures in the next couple of months.

I just went through this a bit more thoroughly, not a lot, but a bit, using numbers from here https://www.finder.com/uk/find-out-your-odds-of-dying  

and multiplying the central number for each age band in cases data by the cases, then carelessly scaling to a daily number. Got about the same answer. But, (this but pertains to Si dH's reply just now, and it's nothing you haven't said in different words already) no surprise to anyone, the main contribution comes from the older ages still, despite relatively few cases. So points made above stand; as (if?) cases homogenise across ages and increase in number, this could, and in an ideal world would, become a non-negligible thing.

As you say Scotland is falling pretty fast now from a peak of about 3,500 infections/day to 3,000.  The main factor was probably the football but with some end of school term stuff mixed in.  It looks like Sturgeon called it right by not imposing extra restrictions.

If we assume Scotland hitting records for infections was due to the football and the infection peak was actually a week or so after they got kicked out then England is heading for a huge peak a week or so from now.  The football effect is going to be much larger because you guys got to the final and the scenes from yesterday in England were way past anything in Scotland during the England game.

If you then remove restrictions as the Tories are planning to do on 19 July close to the peak of what is coming from the Euros anyway I don't see how you can avoid putting it into overdrive.

Just had a go at quantifying this. If I redistribute cases across the age groups in proportion to population, the bottom line number (i.e. daily expected deaths with not of) goes up by a factor ~4 or 5.

Thanks - I'll look at swapping the data source for the ONS one.  Better that way.

In reply to Longsufferingropeholder:

Correct.  It took a while to think this one through.  My best take is that some fraction of infections are not normally detected as cases (estimate 50%).  For the fraction of people who fall in to that category, and who go in to hospital as part of their non-Covid death (estimate 50%), they are gong to get a Covid test and are more likely to have their Covid detected.  Having thought through the permutation, I think at most this could raise by red line by 50% (in linear space) which still leaves it a factor 5x from the current deaths.  The neglected seasonality moves the red line the other way at this time of year.

I don't think this is a correct approach (unless I misunderstand you)?  The detection as a case is an actual gating mechanism for this measure, along with death, and it's longitudinal.  So, the demographic distribution of population does not affect this estimate at all, rather the demographic distribution of cases does.  The question is "of the people who have been assigned Covid status through a positive test, how many do we expect to die within 28 days of their test from normal all-mortality statistics?"

Or do you mean that if we end up with a uniform demographic distribution of cases (as one might expect once its endemic?), then we would see no significance in deaths above "deaths with Covid"?  That's boggled me a bit, as it seems if we give more people Covid to even the distribution, more people die of it, but as they're added at a higher age, more of them would die anyway.  I haven't squared that circle in words yet.

In reply to everyone discussing this subject:

As long as the red curve is falling, it seems to me we can't be at the "only people with Covid" point yet, regardless of the (in)accuracy of calibration of the projection.  As long as it's falling, it disproves that hypothesis (unless a Covid test makes people less likely to die in the next month, actually perhaps not an unreasonable assumption given the concomitant isolation order...).

In reply to Si dH:

A very good point; the denialism battle ground has to move in with such a successful reduction in deaths.   The only consistently available Covid hospitalisation demographic data I've found is in the dashboard, and uses a very different and much coarser set of age bins (18-64 in one bin IIRC) which are borderline useless for any details given the strong demographic dependance going on here.   One minor bit of fall out from all this should be looking at geographic and demographic reporting boundaries and doing what can reasonably be done to homogenise them across all the different components of the state, the disjointedness - particularly around the NHS - is an unnecessary barrier to timely analysis in a criss.  I'm not aware of a data source for demographic admissions in a typical non-Covid year; again VictimOfMathematics might if they're reading...

Fate protects fools, children, ships named Enterprise and countries that extemporise their Covid response in times of highly uncertain data.

When it works out okay, it's important to recognise that luck can swing both ways, and not to grant it as proof that those advocating for much more incaution were right.

That's true, but I think that unlike Johnson, Sturgeon is naturally cautious but she has less power than Johnson and is faced with a hostile unionist controlled press.  Politically the option to lockdown cities when the death numbers were in low single digits and the media were clamouring for her to follow England and open up further wasn't there.    There were also some clear temporary one-off factors pushing the numbers up.  The compromise was to maintain existing restrictions and ride it out while keeping a close eye on the numbers.

I don't think Sturgeon is incauotious.  The policy is to move to level 0 at the beginning of August, which is not no restrictions at all, and isn't that big a jump from where we are now.   Nothing like the July 19th thing and the delay means they'll have some idea of the immediate consequences of July 19 before they do it.

If you are particularly interested in seasonality - I haven't found it broken down by age yet (and I would expect it to be most pronounced at the highest ages) but I have seen graphs of the variation of standardised mortality rate (actual mortality rates applied to a fixed reference population) over a calendar year. As you'd expect, in a year without a bad flu season it's a rough sine wave with a peak in about February and a trough around August.

The best I have found is in the link below, which has SMR by broad age bucket and might help unpick some of the age shape to the seasonality...

https://www.actuaries.org.uk/system/files/field/document/Mortality-monitor-...

Yes (see below)

I didn't go that far.

All I did was take the same total number of cases but instead of using their current distribution with age, I pretended that distribution was the same as the underlying demographics. So that I could see what would happen in the hypothetical (and extremely unlikely) case where everyone had the same likelihood of being a recorded case regardless of age. It makes a huge difference. I'm still keen to point out that I'm not suggesting this is a large fraction of the "deaths within 28 days..." total, but it puts a lower limit on it, and makes it potentially misleading in the longer term depending on the prevailing circumstances. Especially when looking at changes in CFRs inferred from it.

Fully agree with this.

Having a webpage with nice simple graphs and words in laymans terms to debunk this whole 'with covid' thing would be incredibly useful hint hint......

Yes, vaccine passports for high risk venues could be quite the lever here...   

[...]

Agreed; my point was more that Indie SAGE could at least apply pressures to get definitive answers on what the source of the problem is, rather than giving the impression it's solvable in a timescale of a month or two, and that we should be doing that.

• Give our security services a mandate to unpick the web of misinformation and lies fuelling a range of conspiracy-style views - including but not limited to Covid skepticism and anti-vax,
• Set the CPS thinking about appropriate criminal charges if, for example, it's found that cross-site browser tracing and detailed analytics are being used to target people with mental health problems.
  • Another poster hit the nail on the head when they mentioned PREVENT training in the context of radicalisation for other purposes. 

 A person more cynical than I might note that a number of people identified as involved with Covid skepticism are also identified as being involved in the Brexit campaigning, and would further note the pertinent bounds of the "Russia Report."  

I could send something in the direction of https://www.covidfaq.co for their review and inclusion.

If only we had an academic unit devoted to evidence based medicine at an esteemed university with a 925 year history, the professor at the head of the group could use their (presumably) formidable skills and resources to perform analysis such as this, and could disseminate them through their group and university branded blog, in order to further public health during this crisis.

His students probably have done it, but it’s just stuck on the tea room wall..

Covidfaq already has an answer to the with/of question, suggesting that in the first wave, 93% of deaths with covid mentioned on the death certificate were ‘of’ implying 7% were ‘with’.

That’s after accounting for the 28 days effect as it’s all based on certificates and retrospective.. quite a bit higher than we are estimating I think.. 

That’s averaged over the whole first wave where we had a mean daily death rate of say 300. Which gives an average of 21/day died ‘with’ even in the cert stats. Given the mean case rate was about 30k, that implies in a couple of weeks we should see around 20/day (plus the few from the 28 day effect).. which could represent 50% in the effective vaccine scenario?

pull my noddy logic apart please

I think you're spot on, and we're violently agreeing with each other here.

I don't think I said the number out loud, but fwiw the scenario I was on about just above, where the case rate is ~30k a day but not concentrated in any age group, leads me to an estimate of ~30 daily "deaths within 28 days..." 'with' covid.

The current bias in cases towards younger ages (or rather the relatively lower case numbers in older ages) is all that's keeping it down at ~5-10.

👍agree. Extremely peaceably..

That's a slightly different question however as nuanced human judgement comes in to the death certificates and their downstream measure, where-as there have been specific claims that the "within 28 days of a positive test" measure is falsely attributing a significant number of non-covid deaths to the virus, a claim that has come up on here contentiously a few times as well as in other places.

Press conference has started; the messaging has changed quite a bit towards caution, but it looks like the majority of restrictions are being dropped.  As much as I'd have been more comfortable with a more progressive dropping of restrictions and mandatory vaccine passports for nightclub style venues, I'm keeping my somewhat optimistic hat on for now, unless the data starts to knock it off in about 10 days time.

As ever, I keep my eye on your hat. Continued thanks for all your hard work, and to those on here who discuss these thorny issues so courteously.

Yes I agree it’s different. I guess I’m not that interested in debunking idiots.. I think it’s rather futile at this point, but you may still be less cynical.

im more interested in understanding the reality and as the case load grows but (hopefully) the death toll doesn’t as much, I would like to understand what’s really going on.. a preview of retrospective ‘excess deaths’ if you like. 

I think we agree there are two components to that.. firstly the 28 day metric capturing a few (n=2 maybe currently) which are not registered with covid on the death certificate, and a larger number (n=20?) where it IS mentioned but did not fundamentally cause death.

https://www.france24.com/en/europe/20210712-follow-live-france-s-macron-add...

"Soon after the president's address, France's online health portal Doctolib.fr crashed because of too many people trying to book vaccination appointments."

Although I must admit having a "wait, what?" moment when I got to the PCR test part.

Ah, gotcha - I better understand where you're coming from now, I think we were at cross purposes in motivation.

I agree - all the different approaches discussed (including I think the 28 vs 60 days one) are different and useful measures that help to measure when deaths from Covid become part of the background noise of life (and death).  These feel to me like important measures as they'll be an early indication both of reaching an "endemic" status and of any future departure from it.  It may be that the all-cause mortality is going to rise a bit once we get there, but who knows with the stuff going on around flu.

In reply to Longsufferingropeholder:

That's a big move from France.  I assume born of desperation when looking at their modelling over the new variant and their uptake rates.  

Do the French have a colloquialism for "The law of unintended consequences"?

Yeah, it's red button time there. Looks like they want freedom day too, and he's willing to reach for the A3-5. 

I'm sure someone familiar will be along shortly to explain why their way is better than ours.

Well it seems the Netherlands is an interesting picture of what ‘freedom’ might look like (and how long it might last..)

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

This is the modelling that I assume underpins the decision to go ahead as planned, suggesting that hospitalisations will peak at similar levels to the second wave, with all scenarios having R peaking at 2.5 after "freedom day".  The "pessimistic" scenario gives another 115,800 deaths by mid next year.  However basically little difference in the scenarios if "freedom day" delayed for another month.

I think it possibly depends on the Venn diagram of people who like clubbing*, people who won't get the vaccine, and people who already had or are likely to get covid.... Their one might not quite look the same. We can hope.

* What else is actually, substantially changing? Haven't we kind of done most of it already??

Its worrying that he has to threaten Health care workers to get them to vacccinate. What does that say to the General public.

Looking on our world in data their current cass growth is similar to ours at the start of wave three - but with a much lower base of vaccination.....

Um.......

https://www.bbc.co.uk/news/uk-57492264

its a fair cop!

3.8 million vulnerable people, so a bit of human interest to counter-point the data porn.

https://www.theguardian.com/world/2021/jul/12/frightened-readers-risk-ill-c....

Boris was really serious today... we must behave responsibly with masks. He's just a lying liar or he would keep it compulsory. I guess we should all be grateful that as PM he is serious at last..... can't we not eat brioche?

Plus some breaking news from Holland, that takes me back to my post punk club days... " When you're in a Rutte you gotta get out of it, out of it, out of it..."

https://www.bbc.co.uk/news/world-europe-57811538

The thing they didn't model which they should have modelled is not having a freedom day at all.   The government is using the study as a smokescreen, rather than addressing whether 'freedom day' makes sense at all they want to turn the debate into whether it is better to do it in July or August or September.

There is a slower path which would have very low levels of virus in the community and hardly anybody getting ill.  It would involve keeping mask rules for shops and public transport as long as needed and maybe strengthening mask rules to mandate more than a bit of cloth,  an expectation that people who can work from home should work from home, jags for younger age groups, booster jags and mixing different vaccine technologies to increase immunity, border controls and gradually upgrading ventilation and air conditioning systems.

I think this is a bad move by Macron. It's going to scare the hell out of the vaccine hesitant, irritate and penalise health care workers (some likely to quit if they worked through the entire pandemic without a vaccine only to be fined) and charge the public for public health related testing? Triple whammy.

The charging for tests is to discourage the other option, which is to get your pass by testing negative every few days. I get it, but does seem completely perverse when you look at the big picture.

Can we please not quote the Guardian for Covid articles anymore.

They’ve always been a bit biased towards the anti-government line, but in the past month it’s become hysterical as they bellow and rage against unlocking.

The science is often wrong, the opinion pieces are cherry picked and there is plenty of emotive articles (like the one you’ve linked) dressed up as news.

Rant over.

I know it was quite explicitly written in the article. But like you are think it is entirely missing the big picture.

I mean..... Case rates won't look as bad I guess....

Supporting the current GBNI government is a bit of a struggle given their record.

It is no worse quoting the Guardian than any of The Party's own propaganda sheets (more or less the rest of the media). Truth can be inconvenient sometimes  -  I fear for their future 

Thanks for the link.

I'd argued on a different thread last week that there was clearly no need to accelerate the current case rates if the authorities wanted to try and achieve an "exit wave" this summer.   The current data is quite clear on that IMO.

Looking at Figure 4 in the modelling you linked, they model a range of scenarios and about half risk healthcare overload (the dashed lines on the admissions plots) within their own CIs.  I'd be very interested to see that plot for a more gradual relaxation of restrictions.  It's hard to imagine it would be anything other than reduced hospitalisations and deaths, and fewer curves risking healthcare overload given the continued march of second doses (currently picking up in pace as more become due).  So, it feels to me like once again we're rushing where there's no clear need to rush in the science, and where there's great risk if we get it wrong.  This would be the least worst time we've done so - by a large margin.  I think this and the modelling explains the big shift from triumphant to cautions messaging.  The Byline Times have weighed in on the background to the decision:

https://bylinetimes.com/2021/07/08/governments-mass-infection-plan-pushed-b...

The authors of the modelling themselves continue to note the large uncertainties in the models and the importance of the actual data going forwards:

• Given the large uncertainty regarding the possible magnitude of the future wave, continuous careful monitoring of the epidemic trajectory will be critical as will further evidence on vaccine effectiveness against the Delta variant.

Whilst they model a range of scenarios, one optimistic assumption is core to all of them, and they recognise this:

• Preventing the further importation and spread of variants of concerns (VOC) with moderate to high immune escape properties will be critical as these could lead to future waves orders of magnitude larger than the ones experienced so far.

This is where my biggest beef - by far - with the change is.  Allowing double vaccinated people to return from amber list countries without quarantine builds an efficient lightning rod to maximise the chances of importing an escape variant short of deliberately trying to find and return one.

Yeah, I'm not sure that's a Hydra the government can afford to start hacking at given several of the heads are likely tangled up with them and their sponsors.

You just know they'd put Shapps in charge of the fact finding review.

Conservative voters will love that, finding themselves subject to counter-terror laws!

Quite.

jk

Respectfully no. Of the UK newspapers it's as good as any and better than most with a match to the scientific mainstream and it's not pay-walled. Much of the media has been actively anti-scientific especially the Telegraph, Mail and Express.

The politics of this are important as very few in mainstream science are happy with all the current government approach. The BBC is occasionally good but too stuck on trying to present two sides of a one sided argument (as it still does on masks) with too much inane vox pox. Ministers on the BBC today were allowed to push the insane idea that we can take personal responsibility on masks, when we clearly can't, as it's the mask wearer that protects others and everyone that can, needs to do it: one person who selfishly choses not to wear a mask in an indoor public space can remove that safety. Given there is a significant minority of unscientific support to end mask use indoors (backed by heavy lobbying as per the byline times link wintertree included.... Prof Dingwall has no expertise in virology or epidemiology and clear links to the Barrington group), in practice an aggressive minority will make most public indoor spaces no-go zones for the vulnerable (the point of the Guardian article).

Individual companies will now be expected to make mask rules and enforce them, in the face of aggressive anti mask viewpoints. Those working in public spaces are put at risk both from the virus and in the practicalities of dealing with angry mask refuseniks. Masses of police time will be wasted on this dangerous idiocy.

The Guardian has a wide range of opinion articles, from fairly far over on the left wing to very centrist (I prefer the latter). On covid they have done a better job than any other major papers of presenting balanced criticism of the Govt's approach from a starting point of wanting to protect public health. Their perspective in most covid articles is generally (not 100%) well aligned with that of informed people reading this thread and in other parts of the internet (eg more intelligent parts of the twittersphere), if often a bit behind. The bbc have generally avoided criticism of any kind, while all the other major papers have veered to various extents in the direction of idiotic anti-lockdown propaganda with no scientific basis. Whatever your normal political leaning, my view is that if you think the guardian is just spouting propaganda on this, then you are blind to the truth and I put you in the covid denier bucket to be ignored and pitied.

If you want some confirmation bias.... I opened that bucket last week when they told me I was risking far more deaths by urging caution when the modelling showed we had to have the exit wave now to avert winter disaster. They neglected to mention the modelling they were basing this on was (a) out of date and (b) heavily caveated in terms of uncertainty (as the new variant was then brand-new when its originating data was taken).  The poster explained that they knew the more current unpublished models would show the timing of the exit wave had to be now (despite current data suggesting otherwise...), as otherwise the government policy would not be to release all measures now.  They they asked if I would return to apologise when the next update to the published modelling showed that there was no risk to healthcare of an exit wave now.

It turns out the models, when published, show that we could have a more gradual relaxation of restrictions (allowing time to evaluate changes and adjust as necessary) and that healthcare overload is on the cards for about half of the scenarios - including the more central ones.

I've certainly had less than generous things to say about Indie SAGE recently, and some of their members often contribute to the articles in the Guardian.  I don't think the other poster's allegation that "the science is often wrong" is supported, far from it, but it's not always presented in a neutral light.  The problem is, the Guardian are up against people who have no compulsion in writing heavily emotional, logically flawed and scientifically rubbish pieces for the Telegraph and the Spectator in particular, and smattered across the red tops.   This is not simply my subjective opinion either, the press regulator has upheld complaints against Toby Young for his column in the Telegraph [1], and we have a group of experts who have carefully documented signifiant misrepresentations from a whole set of journalists [2] on the opposing side to the Guardian. If the other poster genuinely believes the guardian are presenting "wrong science" they are free to send a dossier to the press regulator.   One might not an utter lack of specifics in their allegations though, just a sham attempt to appeal to balance.

[1] https://www.independent.co.uk/news/media/toby-young-immunity-complaint-dail...

[2] https://www.covidfaq.co

You're points on Indie SAGE last week are one of the few areas we disagree. In particular I think the discussion last week on demand in the 18 to 25 age group being down to really major problems with hesitancy have turned out to be plain wrong and Indie SAGE is the only mainstream public space I've seen that evidenced this. Their slide showed over 80% of the white 18 to 25 population group nationally were vaccinated early last week. This means we really need to move to second jabs faster and work on better ways, preferably locally public health managed, of getting the smaller numbers not yet jabbed through the system. Several very intelligent people here really didn't think through the likelihood of the ONS intention survey for the 18 to 25 age group being that badly wrong. The hesitancy in some ethnic groups (black especially) and in deprived areas does remain a real issue.

I'd add that knowing Dingwall is on NERVTAG and JCVI is worrying to me and does indicate some success of Barrington lobby efforts.... maybe there was something on this specific point in Tom's nationalism.

I'm not denying some messaging from the Guardian or Indie SAGE could be better at times but in a crisis (as we are right now, with this Boris dice game) perfection is the enemy of good: being picky on detail is good but moving this to wider concerns undermines the message that there are really major problems with the government approach. Most on this thread see the high risk but most of the public don't. I've said before that progressives need to work together to defeat the dangers of populism and this is one small part of that.

If we agreed on everything on these threads, people would start accusing us of being an echo chamber!  

Under 60% of people aged 18-34 have had a first dose, and under 55% in the group 18-25.  If their data is correct, that suggests very low uptake in the young adult, non-white subset of the population.  

I agree, but it doesn't look like "small numbers" to me

I see it more that they are making themselves to easy for the other side to dismiss, rather than avoiding a perfect/good situation.  

Yes.

It is indeed clear that one or other of those two numbers must be wrong. If it's the number on the Indie SAGE slide I'll apologise and criticise them but it seems unlikely given their record. Where does the 60% number come from? If its an average of local uptakes it may be massively depressed by double-counting local populations in that age group due to students.

I simply can't believe ONS intention data is so wrong. If anything anti-vax sentiment seems anecdotally to be reducing (from evidence and from practical incentives like near future ability to travel).

This might also explain why Indie SAGE recommended looking to adolescent first jabs and how this could happen quite soon.

Where we do agree is the situation needs investigation.

The slide is about 8 minutes in. June 30th ethnicity data showing the highest being  81% for white down to 50% for black.

youtube.com/watch?v=9bOX_lYJe3A&

Yes, I don't think they can be squared off within the population mix.

The demographic heat map down here:

https://coronavirus.data.gov.uk/details/vaccinations?areaType=nation&ar...

I'm not sure it has to be "wrong", and I'm not sure it has to be anti-vax sentiment driving this.

I have all sorts of good intentions and if the ONS came along and, for example, asked me if I was going to fix the pointing on the garden wall or to get my chipped tooth seen to by the dentist, I'd truthfully say yes, but they're not exactly at the top of my priority list.

It's certainly happening elsewhere in the world; some of the pushback against this seems disproportionate and unevidenced, bordering on the deceitful (see the Byline Times article up thread), but there are also proportionate and reasonable arguments against it, both over lack of direct benefits and over the much more urgent demand for vaccine elsewhere in the world.

JCVI are I think expect to update their guidance at some point soon.

Indeed.  First dose rates have taken another step drop over the last week.  I'm hoping the most recent low from Sunday is a football related effect. I think several members of Indie SAGE are ideally placed to run a clear, well evidenced article in the Guardian putting this front and centre of the debate.  

There we go.... population data is from NIMS for that 60% which is notoriously inaccurate at times especially in student age groups (as per the More or Less explanation of Cambridge low vaccination rates). The ONS data from 2019 survey will probably over estimate jabbed percentages but only by a couple of percent at most (I apologise as I should have said both numbers could be -and most probably are strictly speaking- wrong).

Why is it OK to jab an 18 year old but not a 17 year old? I see the sensible dividing line at 16 year olds. I see 16 year olds as being OK with decision making under parental permission. Some people would say that is a bad idea because they are immature but I see no noticeable increase in serious decision making (eg voting) above 16...even with hormone influences.

I get the argument that the demographic data is sketchy at a local level, especially in younger adults where they're most mobile, but that evens out at the national level - which is the data I linked to.

(noting that the mass exodus from Britain of young, foreign workers during the pandemic was a lot smaller than initial estimates, it seems...)

The 2019 ONS mid-year population estimates gives the adult population of the UK as ~52m, and the dashboard gives the cumulative number of first doses as ~46m, so there's about 6m people who haven't had a first dose.  The demographics at a national level suggest this is heavily skewed towards younger ages.  This doesn't seem controversial to me, so perhaps I'm missing something?

I think there's plenty of room for reasonable differences of opinion, and it really is over to JCVI on this one.

Edit:  I just saw your edit up thread:

My alarm bells went off over Dingwall in February when he wrote a piece in one of the red tops arguing against "powerful" scientists pushing for Zero Covid - IMO dishonestly arguing against what by that time had long been a non-existent position.  

It is good to have people with a range of opinions on JCVI in particular, but Dingwall appears to be walking a very tight line indeed.  The part I'm less happy with is having a JCVI member write opinion pieces for newspapers to lobby for a particular policy over Covid that has a direct relevance to JCVI decisions, IMO he should recuse himself from the committee on conflict of interest grounds.

The difference due to the two different population measures is actually significant.  If you want to see the approximate current difference compare the current ONS based percentage with the current average of the local areas. It doesn't average out, as a lot of young people get counted twice on NIMS: at home and at university. Knowing the likely errors on ONS population from 2019 those Indie SAGE numbers are by far the closest to being correct (and what I'd expect from the ONS intentions survey). The national average vaccination level for 18 -25 was almost certainly in the mid 70s percentage for June 30th.

More or Less dealt with the NIMS based problems: the highest local vaccination rates at the time were below the National ONS based average value! Cambridge was a particularly egregious example provided (hardly a hotbed of anti-vax sentiment but with a lot of  students per capita).

Indie SAGE were likely right to say we should be looking to vaccinate older adolescents soon, with the proviso that JCVI allow it. Given it will be demand led and with parental permission it could be done pretty fast for a 16 &17 age group, with 2nd jabs closer to 3 weeks than 12.

I apologise for my edit style. I find it harder to spot errors as I get older and my eyesight declines, plus my tablet does some weird corrections at times and doesn't pick up all spelling mistakes and sometimes the post crashes unexpectedly (low battery or whatever) or because I accidentally hit the wrong button. Therefore my posting style on big posts is to get something nearly right out there, before I lose it, and re-edit as quicky as I can. 

I think his ethical position is so far from the norm he should be removed from both committees. His comments on the vaccination of children issue is enough on it's own (he is not an expert on this to be speaking in a personal capacity).

https://inews.co.uk/news/children-covid-vaccine-claim-better-getting-natura...

Please stop thinking face coverings are the difference between no-go and safe. They make it safer. It's definitely still not safe for vulnerable people to hang out in busy indoor spaces. They still are and always should be thought of as incredibly dangerous places for vulnerable people and should be avoided at most costs. To think otherwise is dangerous idiocy.

I disagree.  Vulnerability varies and indoor venues vary. A big volume with good ventilation and legally compliant mask use will be safe enough for many. Going into poorly ventilated areas with poor social distancing and low mask use is very high risk for the vulnerable.

Fig5: https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnici...

80% of White 18-24yo is 3.44M, that's 65% of all 18-24yo (5.27M) in the UK.

Given 55% isn't even that close to 65% it looks like there's something wrong somewhere. Could be the difference between the 18-24 and 18-25 bins or UK vs England but I doubt that accounts for all of it.

jk

Wigan’s under 30’s jab rate was 60% last week.

Took my son for his vaccine yesterday. Had a total nightmare: he feinted and cracked his head on a wall. Staff assumed he had had a reaction, adrenaline came out, ambulance, said ‘your throat is swelling’. Well scary. Ambulance crew were great and after all the checks said ‘you’d just feinted, no reaction’. Phew. Bad thoughts were entering my head although my gut instinct was ‘you look kinda OK to me and the staff are over reacting.’  Cant blame them in a way. Anyway, the real reason I’m telling this story is I got chatting to the jabber and they said that because they are only doing Pfizer for young adults, often from small local hubs, they don’t have the waiting room space (for the 15 minute) so they are jabbing far fewer.  This could contribute to the low uptake. 
 

Edit: to add his feinting was most likely due to low blood pressure and stress - he’s had previous in similar type settings (removing a cast from broken arm) nearly feinting. 

I am younger with ok eyesight but do just the same, for similar reasons. Getting a long post right first time on my tablet is a very infrequent event!

Re: vaccination uptake. The indie sage slides reference the following source for their data:

https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-vacci...

I have attached an image of the most relevant content from the recent (8th July) monthly spreadsheet update. There are lots of breakdowns in there.

Unfortunately Offwidth I think you have have misinterpreted 18+ from indie sage to mean 18-24 or something. It actually means all adults. The figure of 80% for white people over 18 can be seen to be the mean accounting for the three figures I have highlighted. (This data all looks quite bad, but it is all calculated using NIMS.) There is still a long way to go.

I know you disagree. 

Yes. Of the mitigations you list, the thing that you should be worrying about is the ventilation, and distancing, but mostly the ventilation. The thing you keep shouting about isn't the ventilation.

This is a very esoteric stat to quote. Can't see why you'd pick it out unless you had some agenda to push. Also as others have said can't verify it. The number I'm seeing in the places I'm looking is what many other posters have reported already.

And agree that it looks like the intentions people reported to the ONS haven't yet been carried through. That one's clear, but it there's still hope.

I didn’t intend a dig!  I spot my mistakes much better in a live post than the edit window or preview one…

I quite agree and our glorious government has been very clear on this that it’s nothing to do with them anymore. However, the recommendation is that if you are in a confined and poorly ventilated indoor space, in close contact with other people, wearing a face covering is the responsible thing to do.

But of course, if you are a teacher working in a confined and poorly ventilated classroom, in close contact with lots of children, wearing a face covering is now …er…. an irresponsible thing to do. WTF!

I don't understand how they are getting away with this hypocrisy; if it's irresponsible not to wear masks in those situations (u-turn from Javid, who only a week ago said he wouldn't wear a mask, even if asked), why is it not irresponsible to lift the mandatory requirement to wear a mask in those situations? It just seems to be pandering to the nonsensical 'libertarian' swivel-eyed f*ckwit Tory right wing.

When I googled this, the only place I found it reported was on an NZ news site. Reporting a similar comment from Labour's Shadow Health Secretary. Not seen the BBC or any other UK news outlet reporting that question. Maybe my google-fu was weak that day...

I thought I had read somewhere that the logic behind the change in mask rules in schools was that it effects education because young kids development depends on learning and using visual cues, facial expressions etc.

I'm not sure this applies to high schools and I don't know how valid a concern it is so I'm not using it to defend the policy; I just remember reading it somewhere.

Presumably it's also pretty hard to get good compliance and good mask hygiene out of kids, especially high school kids.

I find the current general debate about mandatory masks a bit surprising, since in the only place it matters that I would like to go to (the wall) basically no-one wears them any more anyway The situation there can't get worse and I have never seen any enforcement. In hospitality no-one is wearing them when sat down so it all feels a bit pointless. So it sort of feels like the mask bird has flown, except in shops where risk is relatively low anyway. I guess I'm in the minority here. I don't use public transport at the moment.

Cheers. I admit I was wrong about the 81% percentage applying to 18-25. It's clearly 18-50 for Indie Sage, and NIMS based (18+ was a rather unfortunate label for both data sets). I remain 'to be convinced' that NIMS national numbers for the denominator are correct (ie are removing all the double counting). ONS vaccination percentages are modelled, not actual, but they are higher and the big difference is the 2019 population estimate denominator rather than the local NIMS denominators (and that led to the statistical oddities discussed in More or Less: where the highest local vaccination level was below the ONS average).

I do agree with wintertree again now that Indie SAGE can't justify adolescent vaccination yet on their own numbers. Plus I apologise for causing confusion by not looking a bit deeper into the data sets. 

The 18-25 stat bin was wrong but the idea you think it was irresponsible agenda pushing says more about you. Local NIMS denominator based vaccination rates can be unreliably low as discussed on More or Less and ONS average rates a tad too high.

Mask compulsion is something we can do right now in an infection peak approaching record levels. Fixed ventilation systems take time to change. TfL, Wales and Scotland agree masks should remain compulsory.

500% weekly case increase reported in Netherlands reopening but hospitalisations still under control.

https://apnews.com/article/europe-health-government-and-politics-coronaviru...

My point was about the irrationality of the statement about irresponsibility of not wearing masks vs the removal of mandatory masks in certain circumstances.

The stances taken today by TfL, Manchester Metrolink and Wales seem more rational.

Think yourself lucky that you don't have to use public transport or confined shared spaces.

I wasn't arguing with you - my comment was more about the heated debate between Offwidth and LSRH.

I actually agree with your view, I'm just surprised by the level of feeling on rule vs expectation because IME, where it really matters the rule either already effectively doesn't exist (hospitality) or is routinely ignored by almost everyone and unenforced (climbing walls.)

People choose to go to hospitality and climbing walls. They can't always choose to go to work or use public transport for work or essentials. I also think clear messaging based on data and clear trade-offs is important and that is only scientifically consistent with indoor mask compulsion.

A mid-week update to the English PCR rate constants plots.  

The exponential growth rate is starting to stagnate - it's still positive so this means the average cases/day value is still rising (counting for day-of-week sampling effects etc), but there's not much to it.

It seems in accordance with the weather theory to me; we saw a similarly slow period in the rate constant about a month ago when temperatures were high.

There's a humdinger of a weekend coming - if it is the weather, perhaps it'll push things in to decay temporality. I'm planning a visit to some of the lesser know waterfalls in Teesdale that are good for plunging if not swimming, and that should avoid the crowds.

Or we could be reaching herd immunity thresholds.    Feels unlikely but the data's not there to proclaim either way.

Nightclubs opening in 5 days should settle that question one way or the other once the data percolates though....  Confounded (in the top level stats, not the demographic ones) however by schools breaking up - those that aren't already disrupted by the vast number of isolation orders going out at the moment.

Thanks.

There are still quite big regional differences though. In some regions it's still growing a lot faster than in others. Rates are already falling in some major cities but rising fast in others.

(Edit - so what I meant to say was, perhaps it's a combination of weather and other effects?)

I don't think we can tell from what happens after 19th whether we have reached, or how close we are to, herd immunity levels now. The herd immunity threshold is dependent on people's behaviours and whether there are any restrictions. Once nightclubs open, you need a greater proportion of young people to be immune to see a herd immunity effect. So, even if Scotland and some bits of England are currently seeing dropping rates because they have reached herd immunity, that does not mean the effect will necessarily be sustained come 19th July.

Interesting new paper here demonstrating the multiplicative effect of masks + ventilation in a small-ish lecture theatre in an American uni. Of note (to me at least) is the conclusion that ventilation alone is not enough - especially given my assumption that the standard of mechanical ventilation is higher in a US uni than in UK in general - and the way in which they assess the contribution of relatively poor quality masks.

Caveat: this isn't my field and I'm not qualified to assess the paper generally.

On the other hand, commendo/disclaimer: I taught for this Uni for several years and know they look after their staff and students - a rare thing nowadays.

https://www.tandfonline.com/doi/full/10.1080/23744731.2021.1944665

EIn reply to Si dH:

For sure; the weather I think acts as a modulator on top of all the regional and demographic effects.   Plot 18 was showing a lowering rate constant in all regions today (I didn’t post it, laptop is put down for the night now…) but I think much lower than regional level and it’ll be hard to disentangle it from all the other effects.

I’ve wondered a few times if the number of people now isolating is enough to impact the rate constant; even if most are uninflected it effectively puts them into control measures tougher than our lockdowns.  

I agree, but my thinking was that if we’re not near the current “bad weather” threshold for herd immunity now but are approaching the “good weather” one, we’re going to be really quite far from the “everyone is pissed and shouting in each other’s faces in a poorly ventilated nightclub” one.   As the Netherlands just saw (sorry minimike & Offwidth, I keep meaning to reply to your posts on that… )

Edit: dot dot dot closing bracket really messes up some auto emoji inserter in the UKC code.  I added a space.

Thanks for this, it looks very thorough - one for the “morning” reading pile however.

I could well believe it for a lecture theatre.  Ventilation outlets are far from the people and there’s only so much that’s tolerable before it interferes with the sound quality, and they pack the students in like sardines.  Thinking a bit about airflow and diffusion, its not a great set up to clear aerosols unless you have air extractors at floor level in a grid with the seats to give a downwards airflow.

I always dreaded the lectures in December and January, standing in front of several hundred people coughing and sneezing endlessly as the results of mixing viruses from all over the country and world together in sub standard accommodation (400% covid cases rise in a week.  In each of two separate waves!) and dive bars/clubs.  I’ve noticed as I get older that the winter colds I develop from that get worse each year.  

Nice to know that there is hope out there.  

Jersey are going for gold. 1567 Cases per 100k on their 14 day rate, just under 10% of their population are contacts of cases.  No self-isolation for contacts, but testing instead (not sure of the exact regime). They have delayed opening nightclubs, advised use of masks and told people to work from home where possible though.

https://www.gov.je/Health/Coronavirus/Pages/CoronavirusCases.aspx

Their vaccination rates for 18-29yr old show about 55% have had their first doses and 10% their second. They're a virtually white community, although a lot of the young are Madeiran or eastern European migrants.

Update - looks like Jersey's struggling with testing (they're doing about 4,000 tests per day, and there's been stories on social media of huge queues for testing)

https://jerseyeveningpost.com/news/2021/07/15/testing-strategy-changes-conf...

Apparently 6-7% of direct contacts test positive, but I don't know if that refers to the first test, or overall.

They struggled with self-isolation rules so they abolished those a week or two ago too.

News locally to us that 10% of Nissan's workforce are self-isolating.

https://www.bbc.co.uk/news/business-57848958

This level of self isolation has to be taking a significant chunk out of transmission by locking down susceptible people.  I've wondered before it there's an oscillatory mechanic - as a lot of people come out of self isolation, the spread goes up and a new wave of faster infections happens, driving a new damping period of self-isolation.  Drive it with a quasi-periodic factor like the weather and if there's an impedance match, resonance city.

Well, that's all going to change soon enough for better or for worse.  

Here in the Northwest case numbers are going through the roof. My eldest’s year group of 300 currently have 85 self isolating.

Freedom day plus the fact that every single U.K. tourist destination is already rammed midweek, in term time and it would seem we’re in for a rocky ride ahead.

Fingers crossed the vaccination rate keeps the lid on the death rates.

Looks like we’re nicely on target to hit 50k cases on or before Monday …. 

That’s without the scarcity of tests affecting numbers. 

I’d be surprised if we don’t  hit 50k cases/day tomorrow and 500 deaths/week by week tomorrow and 1000 deaths/week in 4 weeks time. Schools closing will be more than balanced out by Freedom day easing and the fact that a large % of young adults have little immunity. Hopefully, things like pub closures and holidays getting messed up might persuade people to get vaccinated. 

The latest problem for those pushing Ivermectin as a wonder drug:

https://www.theguardian.com/science/2021/jul/16/huge-study-supporting-iverm...

I'd be very worried if covid deaths doubled in a week twice in a row. Why wouldn't you be surprised? Deaths should increase roughly as cases did a few weeks before that, as the proportion to infections is locked in. A bit over doubled in two weeks.

The main issue for the NHS is that it doesn't become overwhelmed and the next serious pinch point seems to me to be staffing before the self isolation rules change. I think the government are making the mistake that the NHS is as robust as it was last September. The increased staff shortages and mental health crisis from dealing with all that death alongside intense working conditions, and people off sick with long covid means it's not as robust even if there is no longer any need to isolate staff if 'pinged'. I do wonder if things will be so bad that the elastic will break and senior staff will start publicly criticising our PM for his lies about the NHS being able to cope after releasing nearly all legal restrictions.

Back to the Ivermectin link, the Guardian headline is ridiculously understated. The paper appears to be fraudulent in many really scientifically obvious respects, and part plagiarised, and the scientific establishment somehow seem to have missed that completely for months.

Are we still using the 'died within 28 days of a positive test' rule to measure deaths? I would have hoped for a more accurate way of recording this by now if so. This can really skew numbers, of course we expected cases to rise and as such if we still have this fairly lackluster recording method in place you'd expect more people will die with the virus.

The stats of this 'bus theory' were done to death last summer. Pretty much all these deaths are in hospitals or care homes where the covid direct cause or co-morbidity is obvious. The chance of someone covid positive dying of something else is very small (albeit increasing as case numbers go up). In fact the opposite is likely true as more people (still a small number) will likely die at home of covid with no positive test and never get recorded. This proportion of missing covid deaths came from analysis of peak excess deaths.

Like by cause of death from certificates?  That's collated and published on the government dashboard.... It understandably lags the simpler "28 days" measure, and minimal reporting lag is important to understanding the developing situation, so the "28 days" measure retains a critical role in understanding the situation.

There's a discussion of exactly this on the previous thread with some numeric analysis.  Guess what?  It doesn't skew the numbers much.

I would not call it "lackluster" so much as an addition to the conventional, detailed analysis (death certificates) that provides a much faster barometer of change in a crisis situation.  It's the more appropriate measure for some purposes, for others the death certificates are more appropriate.

The time will hopefully come when this measure does change to just reflect people dying with covid, not of covid, but that time is not here yet and I don't think we'll get there in the next few months, sadly.

But for now it remains a powerful and useful tool, and the "bus theory" Offwidth notes remains disproven.

That's handy info, was using ONS previously, this will be a handy addition.

Consider previous statement to read skewed rather than really skewed if you like. It would seem the more prevalent it is, and with vaccines reducing covid mortality generally, you'd increasingly see a larger percentage of deaths within 28 days actually not being covid than pre-vaccine.

Now more than ever we need more accurate and pertinent data as we move into the personal responsibility phase, both over or underestimations will have serious consequences.

If it was a problem the 28 day number would exceed the ONS number. It's really not an issue right now and hopefully never will be (I've still got fingers crossed the case growth stops at around 100,000 a day). I'm frustrated the larger ONS number didn't became the UK headline number in more news reports (from peak excess deaths even it is an underestimate).

Anyway for some welcome good news, a heads up on this celebration of the early scientific vaccine efforts on Radio 4 next week:

https://www.bbc.co.uk/programmes/m000xz33

You’re right, my maths was a week out (or should that be ‘weak’ out ! )

I think it's going to go the other way now; the "demographic shift" towards younger cases from the vaccination is basically done I think, and vaccination is very high and stalled in the older and more vulnerable, so where we are in terms of the distribution of cases away from vulnerable people is where we're going to stay.  With cases and hospitalisation rising, deaths are rising, and so the fraction of people dying "with" rather than "from" covid is, once again, sadly going to pale in to insignificance for the next few months.

I dislike the terminology "personal responsibility phase".  

We have relied on organisation from the government down through councils and employers to individuals all taking collective responsibility and personal responsibility has been a key pillar of our response from the very start when individuals started voting with their feet several weeks before lockdown.  Now we have some abdication of responsibility from higher levels in this diagram, meaning that the personal responsibility shoulders more of the burden.  To anyone whose been paying attention, the outcome of this seems predictable.

My point is you can still be very elderly, have double dose vaccination, but still catch the virus and die with it. This would be counted in the 28 day count, which is what the media sees and reacts to before the more accurate 'mention on death certificate' number comes in. Unless I'm missing some key detail; that seems like a reasonable explanation now that the older cohort are socialising far more than in the shield/lockdown phases. It's why deaths (according to ONS) are still around 50/50 between over 75s and under 75s despite the former being more heavily vaccinated and being a far smaller cohort.

Hence calling it the personal responsibility phase, I don't see how that isn't apt. No argument that higher levels are assuming less responsibility, to some this is a very good thing (especially if you are assured of their ineptitude as I am).

Yes, I think we all understand that.  It's not a difficult concept.

The key detail is that it's not a reasonable explanation when you actually crunch the numbers instead of weaving words together.

If you take the all cause mortality data for a "normal" year and apply it to the demographic case rates for Covid, you predict ~10% of the deaths within 28 days of the positive test that we're actually seeing.   That's without seasonality in the all-cause mortality, with it I expect you'd predict less than 5% of the current rate of deaths. 

So, almost all the deaths are because of Covid, not with Covid.  

This is the closest to only having people "dying with covid" we've been, but it's still a long, long way from that being the dominant mechanism.

Yes but it's been far from a normal year off the back of much stress, separation from family, isolation, lost jobs, grief all sorts. So that seems maybe an overly simplistic method with so many other related factors ignored. 

Doesn't feel like anywhere near the whole picture to me. Do you know of any studies taking a wider view of public health as a whole over the crisis having surfaced yet? Probably a way off yet?

That would require a ~10x increased in all cause mortality to explain what we're seeing in the figures, something absolutely not supported by excess death statistics.

Wider studies - it's going to be years of work to unpick it all.

One that has interested me is that so far( contrary to instinct) suicide rates are broadly the same.

https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00087-9/...

There are still plenty of caveats to date on this subject  

Over 50k by reporting date today, a sure fire sign of what's to come once dates currently in the provisional window resolve their by-specemin-date numbers.

The cases data for Scotland is starting to look compellingly like it really is in to "proper" decay, not just apparent decay from the end of a big outbreak. If you were feeling optimistic, you might even think that the daily hospital admissions were starting to level out, suggesting the peaking of cases corresponds to a peaking of infections (so not a problem with less testing availability or engagement).

That raises an interesting question as to why?

• If (big if) they're running out of susceptible people under current control measures, that's really big news.   
• Or are they between outbreaks?  These seem to be much more important at higher case numbers than in previous waves, presumably due to inhomogeneous vaccination coverage.  

We did some maths on the "with, not of" last week. As wintertree states, it's about a tenth of the number we're seeing. If the cases weren't stacked at the younger end, I reckoned it would be quite a few more, but still very very far from all of what we're seeing now.

Didn't we tear that paper apart back in the gallam1 days??

I'm genuinely excited to see what the new, proper, ongoing study finds. If it works I might have to go out and buy a tasty looking hat.

On masks again: I'm spending a lot of my weekday time at the hospital trust in the below-linked article at the moment, and was informed when I arrived this morning that they'll be taking a much harder line on masking from Monday onwards even than this article suggests. It says they 'may refuse treatment', but what I was told is that they will refuse treatment:

https://www.examinerlive.co.uk/news/health/yorkshire-hospital-warns-may-ref...

It's been noticeable over the last month that the apparently very high number of mask exemptions in the area aren't mirrored in the hospital, or even in the hospital grounds, and I don't expect that to change anyway, even though the nurses did tell me in exasperated tones that they had had patients asking if they could go unmasked next week.

What interests me about this is that Monday's abolition of the legal requirement to wear a mask presumably also abolishes the legal basis for exemption (or as the relevant regs have it, 'reasonable excuse'). Bit of a paradox but it might actually mean Monday brings an improvement in compliance in some limited areas.

The Government seem to be making a right cock-up of their own policies at the moment. For travel purposes we now have green, amber, France and red. I mean wtf. Seen in isolation, stopping people from coming back home from France without quarantining is the right thing to do, but Govt should have seen this coming weeks ago and adjusted their system. Everything they touch at the moment just seems to turn to chaos.

Interesting, thanks. Glad to see the NHS free to make the best decision for their staff and patients.

In reply to Si dH:

The important question - what colour is the alert for France?  

What we need is a consistent reporting system, so we can directly compare what is happening now to what has happened so far. I'd be suspicious of a change in reporting applied now, because I would assume the government was trying to twist the figures to suit their political ends.

Fairly sad that we've got to that level of distrust in the government during a global crisis, but that's what happens when you tell lies again and again.

Amberyred or reddishamber? Quite clear I think!

Reddishambles?

At the moment??

Claret?

Boris’s Blushes?

is that a tautology or an oxymoron? I’m never quite sure

2 for the price of 1..

It’s probably not instantly available anyway. Post mortems  etc all take time. It also needs to fit in with reporting for other causes such as suicides and so on  

28 days is I think the standard now in most of the developed world. If you recall we moved to that to tighten up the numbers after it was shown we were a bit of an outlier. 

My only concern is that the age demographic is changing, and those getting hospitalised and subsequently dying may be younger, and take more than 28 days to die from covid, as they are strong enough to fight longer, and tolerate the invasive treatment. Having 28 day and 90 day figures should allow this factor to be monitored.

We already have 28-day and 60-day figures, at least for England. The latter just don't get reported on in the press or talked about so much, but they're on the dashboard. The total cumulative deaths figure using this measure is 18000 higher than using the 28-day data.

Scroll to the bottom at: https://coronavirus.data.gov.uk/details/deaths?areaType=nation&areaName...

I would also assume that people in hospital for lengthy stays get retested at regular intervals, is that not the case?

At one stage early on the data was measured as 28-days from first positive test (at least according to the dashboard, it may have been erroneous) but they fixed that a long time ago now so it's 28 days from most recent.

generally speaking, for known covid patients, it is not the case. Why retest someone you are treating for a disease if they are still ill? 

For non covid patients they are tested at admission and only again if they are in contact with a case or display covid symptoms. Like everyone else..

Sorry, slip of the brain; I meant 60 day...

So let me get this right, the UK government bans double vaccinated people with a negative PCR test from traveling back/from France without quarantine - many of whom have been unable to visit their families for more than 18months -  but at the same time allows 7000 hauliers a day to cross into the UK without a test, many of whom will be eating in restaurants without a mask.
On top of that 1000s of people in the UK with a Beta variant infection will be free to go mask-less in nightclubs from Monday.

Yep, makes total sense, if your motivation is playing political games. As for protecting the public from Beta variant, it will do absolutely nothing.

It's fairly obvious why we need to stop beta from spreading. If it has significant vaccine escape it could easily put us back in lockdown by the autumn. I think the cumulative number of cases in the UK is still under 1000 and number of active cases is very low.

My you-know-who alarm is going off. Just me?

Maybe true but I don't see how you can justify allowing 7000 hauliers to cross from France every single day, without a test or vaccination status check, and letting them mix in roadside restaurant without mask, and at the same time putting barriers to entry to people who are double-vaccinated and have a negative PCR test.

If they are serious about variants, they should do something about this instead of taking politically driven decision.

the health secretary has the virus……

UK 344 cases per 100k people and just about to explode

France 60 cases per 100k people

And the Tories want people to quarantine when they come back from France where it is 5x safer than England.  This red list thing is pure Brexit politics aimed at persuading morons that the EU is more f*cked up than England.

The beta variant is a red herring, most of those cases are on Reunion Island, a dependency of France in the Indian Ocean.  There are only small amounts of beta in mainland France and there's already small amounts in the UK.

https://www.thelocal.fr/20210717/how-widespread-in-france-is-the-beta-varia...

My amberyred troll alert has been stuck on for the last few threads.  It’s just been joined by the redishamber alert.

That link suggests there is still a lot more beta in mainland France than in the UK. Letting beta in with our current situation here (fast growing, high prevalence, lots of fully vaxxed people) would seem like a really bad idea. Even if it formed only 1% of cases for a while, that could become a big problem as delta eventually fades.

Again, may be true, but if the objectives was really to stop Beta from coming, you still have to explain the logic of letting haulier coming in easily from France by the thousand every day, vaccinated and untested, and not letting easily in people in who are double vaccinated and PCR-negative.

The only explanation is that it is politically convenient. The government get to look like they are begin tough and doing something, but aren't prepared to do anything that could put in stark relief the reliance of the economy on its supply chain with Europe.

Stating the blindingly obvious, we'd be screwed by quarantine disruption to road haulage but not screwed by quarantine on other travelers.

The objective is probably to reduce the number of introductions of a variant and not stop them coming in like NZ.

This may be true, in which case they could just be honest with the public, and say there is no way to stop Beta variant from coming from France without creating severe disruptions to the supply chain, instead of taking symbolic measures that are going to make no difference, at the expense of a minority.

People who drive in, feed the nation, possibly throw a bottle of piss out the window, then drive out again are a) necessary and b) not all that interested in socialising.

People coming back from a doorhandle-tasting trip round Paris are a bit different on both counts.

We really do not need more beta seeding events due to people who won't have it that going on holiday is unnecessary and a terrible idea during a pandemic.

If you think about the big picture you'd realise that it's not a binary choice between keeping the variant out or letting it in.  This doesn't seem like a complicated concept.    

• Infections and cases of the variant are already here.
• It's about the number of cases here, and their exponential growth.  
• The more cases we import, the more cases we have here, and the further along the exponential growth curve we are.  This is bad.
• The fewer cases we import, the less cases we have here, and the further behind on the exponential growth curve we are.  This is good.
• We can't stop. cross channel freight, we can require private and business travellers to quarantine.  

IMO we should require proof of vaccination from all freight drivers and take reasonable measures to slow the import of more cases of any variant through that route.

But I'm not going to conflate that with an attack on a separate, unrelated policy applied to travellers.

1 in 10 cases

Of the only known variant that would really screw us

Looking forward to your rant in a couple weeks about how "The Tories should have shut the border with France"

Just had a look; it's only as implied if they stay <2 days. Any longer and testing is required and subject to robust fines. So... a little misleading there, gasp, from our favourite regular contributor.

A simple look inside a truck stop / roadside restaurant on most major English motorways would prove you wrong pretty quickly.

No, they are different because they are PCR negative and double vaccinated.

This isn't really about people not being able to go on holiday, it's about people who need some freedom to see family and relatives they haven't been able to see for 18 months.

It is true that it's not a good idea to import variants, but having established that there is no stropping it due to our need to preserve supply chains, making the life of a significant minority difficult for marginal or non-existent gain in our effort to stop variants makes sense only if you are trying to score political points.

Anybody know why beta matters? I thought we'd had beta already back in yee olden days when it was called "South African" but it had been subsumed by the growth of Delta.

You can tell French people from a quick look? There's probably a market for that. You should stop doing this and set yourself up a business.

Not against beta they're not. That's the f#&king point.

... and spread a deadly virus as they go, which is how we got here in the first place. You might do well to remember that.

Yes, but when the vaccination programme deals with delta, what's left to run riot?

It's been outcompeted to near extinction by delta in the UK, but not so in France.

Nobody suggested this was a binary choice.  But there is a question of proportion.
If we bring one case of the variant via the travel route - which is tightly controlled with PCR test and vaccination,  for every 100 cases coming from hauliers, cutting the travel route is unlikely to yield anything but marginal gains.

For any such restrictions to be justified the government needs to show that we'd get a non-marginal gain from it. So far it hasn't done so.

Other than some spurious numbers pulled from somewhere the sun doesn't shine, you've made no attempt to show there's no gain to be had.

Is that "tightly controlled" when there's concerns about partial vaccine evasion?  Right now, I think PCR testing capability is falling under exceptional demand for obvious reasons as well.

1) do you have any evidence it is a marginal gain?

2) when 50 people die a day then a marginal gain of 2% might be a life saved per day

3) it's pandemic. maybe they can't show anything because they don't know. an expectation of certainty is dumb.

I was avoiding the news today, but I overhead a joculent conversation on the subject when settling the bill for lunch....  The first thing to pop in to my head?  "The wheels on the bus go round and round, round and round, round and round..."

AFAIK Pfizer vaccine has pretty much same effectiveness against Beta than it has against delta.

If you are worried about the spread of the deadly virus, I'd be far more worried about the lifting of all domestic restrictions for 65 million people, than about a few PCR-tested, double vaccinated travelers.

It is allowed, even recommended, to worry about more than one bad thing at the same time.

I don't expect certainty or tons of evidence, I expect a minimum of consistency, fairness and proportionality in the rules and their impact.

We have many restrictions that we have been using as a multi-prong approach to manage the pandemic. They were needed. But some have a big impact, some have a small impact, some are politically convenient, some are politically inconvenient.

As we are lifting those restrictions, there are many different combinations possible with broadly equivalent impacts, I'd like to see the combination being picked on a criteria other than what's the most politically convenient for the conservative party.

RomTheBear/RomTheBear2/Alyson28/Alyson30/Malaka2/Malaka3333/malice2/LukeEllisWorn/KriszLukash/leahgoodall/leahgoodall2/leahgoodall3/VsMaxMax/VsMaxMax2/mcdiff/Sainigh:

More falsehoods, Rom?

You seem to be conflating the UK (pop 67m) with England (55m)

"All" domestic restrictions are not being dropped on Monday in England, with for example:

• Symptomatic testing and isolation for identified cases remaining in force
• Contact tracing derived isolation orders remaining in force
• Mask restrictions remaining in force on various public transport infrastructure in various major metropolitan areas
• Mask restrictions remaining in force throughout the NHS

Edit:  Don't you think it's time you did the respectful thing and email the site owners to discuss your original ban, and engage with them in good faith to return permanently to the site, rather than working through an apparently endless set of burner email addresses to set up endless new accounts, for ever getting banned?  Anyhow, I'm now 95% convinced that you're one and the same as one of the Covid denier trolls; one of the last times you got banned the other account was on the thread literally within minutes picking up your argument for you, a few weeks later they go off the deep end on denialism and land a ban.  That was when you were previously mixing up your sock puppet accounts on the same thread IIRC.

From Johnson? Fat chance.

Anything politically inconvenient from spineless coward Johnson is unlikely.

Unfortunately that is unlikely.

I'm aware of that, but it doesn't mean we should be resigned to the point of not pointing it out.


 

You're just nitpicking without addressing any of my point.
To be honest I'm not interest in discussing with you, every single time you lash out in your aggressive and petulant style, whatever the hell I say, only to see you making exactly the same point as mine a week later on another thread.

And no, I'm definitely not the Covid denier account, even though you seem to have convinced the moderators of it. Well done on your disinformation campaign.

Here you go, I'll leave you to it to have the last word since you like it so much.

Nobody said otherwise. Yes we can worry about several things at a time, but it is also possible and recommended to worry about different things to a different degree depending on how important it is.

In reply to RomTheBear/RomTheBear2/Alyson28/Alyson30/Malaka2/Malaka3333/malice2/LukeEllisWorn/KriszLukash/leahgoodall/leahgoodall2/leahgoodall3/VsMaxMax/VsMaxMax2/mcdiff/Sainigh:

I’m pointing out falsehoods.

Funny, from my view you tend to start out arguing an over simplified and wrong point, drag the other poster (there have been many other posters, not just I) round a 30 post loop and end up agreeing with where the other poster started, contradicting your first point and claiming that was what you were saying all along.

I’d taken it as a highly dedicated form of trolling, but perhaps you need to get better at expressing yourself rather than leaving someone else to drag it out of you over 30 posts.  

The problem is as long as you continue to lie and deceive through a multiplicity of accounts why should I believe a word you say about yourself?  This is the part where you normally tell me I can check out your posting history, conveniently ignoring the bit where you refuse to tell me your full list of accounts, you having apparently operated over more than 20, some created half a decade in advance.  So no, I can’t see what your posting history has to say.

I certainly have done no such thing, and you were getting banned regularly before I started to notice the overt similarities and timing “coincidences” with a denier account / suspected troll.

Before then, you weren’t getting banned at my request either.  

Now, bear with me, this is just a working theory, but…. You keep getting banned because instead of engaging with them over your first ban, you choose to dishonestly and deceptively cheat it with endless pre-existing and new sock puppet accounts.