UKH

Post 1-  Four Nations

A brief set of plots this week, after a rotten start it’s been a corker of a day to be out enjoying the autumn instead of making plots and waffle.

Plots 6,7,8,9 and18 might look a bit different as I’ve advance the trailing edge by two months to make more space for the leading edge.

This week detected cases are decaying everywhere except Scotland, which is very close to decay.  We saw this trend emerging for England last week.  I’ll waffle a bit about in later posts  about how much this might indicate decay in infections for England.

Big picture though - still no runaway exponential growth in any of the nations despite the shifting seasons.  This is in big contrast to much of Europe as we’ll see later.  This still makes me think it wouldn't take much ratcheting up of control measures to drive a sustained decay in cases and infectionsi

Link to previous thread - https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_49-...

Post 2 - England I

A confusing set of developments - caesura cases are falling pretty rapidly, hospitalisations were doing a good impression of levelling off in the first half of the last week and are now rising again, the rise in occupancy and deaths looks to be slowing.  

It’s not clear to me how much the big fall in cases reflects a fall in real infections - it’ll be a couple of weeks before the ONS random sampling surveys illuminate this, and I’m cautious because there are two conflating factors at work

• Reduced LFT testing in particular during the school half term - potential for a drop in cases not representing a real drop in infections
• Reduced school based transmission during half term - potential for a real drop in infections that is not sustainable

The rate constant measurement of admissions in plot 9e is heading for decay at the right kind of time to confirm that cases have turned to decay, but the data has either been unusually noisy over the last week or there’s some short scale structure that makes this rate constant measurements even more provisional than the leading edge usually is.  The next post looks at how real and sustainable the fall may be…

Post 3 - England II

Plot D1.c has a lot going on so I’ve added a second copy with some annotations scrawled on it.

• The most aggressive exponential decay is in school aged children; it’s very synchronous across the ages including 0-5 where I didn’t think much LFT testing was happening, and it seems to start too soon to be due to changing testing behaviours around the half term.  So I have hopes that this is real, although I wouldn’t bet on it until we have another week of data in.  With how much the virus has been spreading through children it really couldn’t keep that up for much longer, perhaps this is real emergence of decay due to rising immunity; every time anyone has thought that before though it’s turned out to be a fake-out.  The latest ONS antibody survey just landed [1]; this doesn’t cover younger children but does have ages 16-24 which has seen something of a home-run in antibody levels towards the end of September corresponding in part with a big rise in first vaccine doses in this age group.  So, we wait and see if this decay holds for another week; definitely not growing rapidly any longer which is always reassuring.
• Younger adults have gone in to decay which might in part represent reduced household transmission from school children - these are the same ages that had the clear downstream links from school ages back in mid-September.  The timing does't look right for that though but it could be an effect masked by other things.
• The worrying part of this plot is that cases in older adults - 55 to 80 or so - have remained in mild growth.  This is masked in top level cases plots by the aggressive decay elsewhere and represents a very bad demographic shift to the cases.  This shows the clear need for good messaging over cases so that people in the more at risk ages have a fair idea of where they stand.
• The oldest age bands are showing decay - perhaps that’s a result of the booster program?  I haven’t found a demographic plot of third doses yet, if anyone has one it might be illuminating…

The week-on-week method rate constant plots:

• The top level plot shows we’ve had.7 consecutive days with week-on-week decay in England; a mild rate constant but a large absolute decay given the high number of cases it applies to.  The plot split by demographic shows how much stronger the decay is in school ages.
• The turn to decay has a very organic shape with the rate constant gradually changing which looks much more like the typical weather associated wobbles in rate constant than the sudden jumps that happen with sudden changes in testing behaviour.

The onset of the latest turn to decaying cases was very synchronise across all ages compared to the last few months, and the week-on-week plot is giving me strong weather vibes; so soon enough we expect that effect to reverse.  Harder to correlate with temperature if the link is behavioural in origin as we're getting a lot of warm (for the time of year) but drab, windy and wet weather that puts most people off going outside so much...

So, watch, wait and see if the rate constant bobs back in to growth, or if this latest round combined with ongoing vaccine roll outs in various ways has led to a fundamental shift in our situation.  All together now - we need another week or two of data...

The regional rate constants in Plot 18 have a lot going on:

• This perhaps shows that the first regions to turn to decay in cases are now seeing decay in hospital admissions, it’s hard to be sure because the English Regions (top plot) and NHS Regions (middle plot) don’t fully correspond.
• More shocking in plot 18 is the emerging rising deaths signal in the bottom plot for the South West.  I’ve copied over links to an article "davidalcock" posted on thread #49 [2]  and to a Twitter thread []] from Victim of Mathematics the article linked.   

[1] https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/con...

[2] https://www.opendemocracy.net/en/ournhs/i-raised-an-early-alarm-on-pcr-test...

[3] https://mobile.twitter.com/victimofmaths/status/1454094552269262852

Post 4 - International Plots

I've been trying to condense a lot of information down in to a compact space with these plots...

All the data is sourced from Ourwolrdindata’s daily GitHub download.  All daily case rates (cases / million people / day) are filtered with a 7-day running average due to significant day-of-week effects in the data for many nations.  Rate constant measurements are done over a 2-week period to mitigate noise a bit more with all the day-of-week stuff and the noise in places with low case rates.  This means the measurement is a less current than the week-on-week method plots I’m doing for England; so this plot lives a bit further in the past.  Where rate constants are rising on the plot, they could be higher over the last few days; where they're falling they could be lower.

The first plot is a “phase space” plot showing the value of the cases rate (cases / million / day) on the x-axis and it’s normalised rate of change expressed as a rate constant and characteristic time on the y-axis.  

• I’ve put two versions of this in with linear and logarithmic x-axes.  Log is more naturally suited to the exponential growth as every doubling in case rates is a fixed distance translation to the right, as indicated by the scale bar.  Linear gives a much clearer focus on the actual values of the case rates and just how bad the situation is in a couple of places.
• The fading trails show values over the last three weeks, with the 'x' being the leading point in the data.  Colour is used only to help discriminate different trials and their labels, no other meaning.
• Nations will generally follow a certain kind of trajectory through this phase space, as the rate constants tend to change gradually and as rate constants (y) determine the future case rate values (x).  Over a long enough time we might expect the trajectory for a country to “orbit” in clockwise elliptical circuits as it goes through waves of growth and decay.  Orbits can be different sizes depending on the sale of the wave.  
• It’s critical to remember that this is infections detected as cases, and detection differs massively between different nations, with the UK having one of the better detection rates.
  •  So if this was true infections, everything would shift right, and most nations would shift right a lot more than the UK.

  •  Nevertheless we see that several nations have higher daily case rates than the UK and a lot more are 1 to 2 doubling times away from being larger than us, with their doubling times being short (bad) and getting shorter (worse).

The final plot (left) show bounds for rolling case fatality rates for each of these nations - what percentage of recently detected cases are dying?  This is bounded to what I consider a reasonable range, such that a longitudinally determined CFR for recent deaths almost certainly falls within that range.    It’s clear the UK is one of the lowest CFRs by this definition, which with reasonable assumptions implies a mix of factors around younger demographics of infection and better testing, although it's likely some of the worst values may also include a level of healthcare depletion.

The final plot (right) is not a prediction.   

• This is way of interpreting the present to try and understand how the case rates compare on a more level playing field. 
• This plot multiples the current case rate (cases / million / day) by the reasonable bounds for the recent CFR to give an indication of how many deaths would be locked in per day now, if the CFR remains constant
  • The CFR won't remain constant.  It will change because... demographics will change, testing will change,  new therapeutics will get deployed,  a hundred other things will change. 
  • This is not a prediction, it’s an attempt to contextualise the present.
• The red/blue lines show how far the bounded value would shift in the next 7 days if the current rate constant for cases remains unchanged. 
  • Again, this is not a prediction.  The rate constant will change - that's half the point of this plot.  For some places it will go up, for some it will go down.
  • These red/blue annotations put more information in to this plot as a way of contextualising the present.
  • Note that the x-axis on this plot is logarithmic - this is not because we’re looking at an exponential process as that doesn’t apply here, but just because there are some staggeringly high variations in this value with incredibly dynamic range in the plot.  It drives home how the situation in Eastern Europe is really concerning, and how much of Europe could be locking in worse daily death rates than the UK within the next couple of weeks if nothing changes.  I am not predicting that this will happen, I am not saying that all the nations are on rails, I am showing the current position and the current trajectory.  Things will change.
  • Of course we expect things to change including responsive control measures from Western European nations, although Austria, Ireland, Belgium and Germany and the Netherlands are standing out as concerning.

So, I think we can put to bed the idea that the UK’s high case rate over the last couple of months makes us the failure within Europe.  With the transmissibility and likely increased lethality of the Delta variant, there’s no easy way out of this, seasonality has been a looming concern and it looks to me like it's manifesting at large across the whole of Europe now.  

I’ve argued against the idea that the UKs situation has been the worst over the last couple of months, and I’ll argue against the idea that the situation is becoming worse beyond the UK in Western European nations looking likely to overtake us in death rates.  Different policies, different timings, different curve shapes; comparing any of these at one limited timepoints is bias-prone cherrypicking.  

Eastern Europe is a different matter, large scale vaccine refusal and a failure to control cases going in to autumn are leading to some shocking stories coming out of those nations.

This is not a happy plot, although it does look like a good advert for the Mediterranean climate.

The phase space graphs are very interesting. Obviously as you say they suffer from all the limitations of the data feeding them in terms of detected cases and what have you (what's the source for the UK detecting more by the way - I've seen this stated elsewhere  but realise I am not sure how we know given infections are not known), but then I guess by the time you get to locked in deaths you've potentially reversed some of it out (you have cases/million * deaths/case).

As for your prediction of where things are going.......

<Sorry, I jest! >

The way I put it was "one of the better detection rates" rather than "more".  I don't have a definitive source or peer reviewed analysis; rather some wooly thinking from applying reasonable assumptions about IFR to rolling CFR graphs and from comparing the random sampling surveys and cases data in the UK and realising there's not much practical room for being better other than mass random sampling.   In short - a very large CFR probably implies low testing and a very low CFR probably implies a very young demographic.  Recently, cases have been falling in the USA whilst deaths rose there.  That implies madness beyond belief. 

Exactly; as long as the relationship between cases and infections remains constant (of course it doesn't, not perfectly) then that relationship drops out of the "locked in" plots.  The major problems for comparing case rates drop out of characteristic times as well. 

Trick or Treat!

A tranche of JCVI Covid minutes was released on Friday:

https://m.box.com/shared_item/https%3A%2F%2Fapp.box.com%2Fs%2Fiddfb4ppwkmtj...

It gives a pretty good insight into the thinking of those involved in decision making.

The minutes of the discussion about vaccinating children is below:
https://m.box.com/shared_item/https%3A%2F%2Fapp.box.com%2Fs%2Fiddfb4ppwkmtj...

p.s. Great work as always.

Good reading in those - thanks.  Reaffirms how glad I am we had JCVI in advance of this and for their unique position.  Interesting to read their grappling with the issue of definitions over long Covid, and their summary of the evidence of health risks to children from the second dose of the mRNA vaccines as part of their decision making.  Funny how nobody starts one-sided threads about that.  

Point 26 bullet point #5 - they’ve minuted it.  Been an elephant in the room for a long time, that one.  

Nail on the head. It’s why I pulled it out for the thread.

I've not read and digested yet (just skimmed so far) but many thanks!

You might even manage to make me more optimistic!

Yep, it looks like the GOBSHITE*  got an official sanction there which our caring government duly implemented!

*Great Ongoing British Schools Herd Immunity Threshold Experiment

I love your sperm graphs (although I'm a bit shocked you've not thought to supply an "O" instead of an "x" as the leading data point). But they confuse me a little.

A positive rate constant for cases means that the number of cases is growing day on day, while a negative rate constant means that they are falling. So how is it that for some countries case rates are falling on your graph while the rate constant is still positive (e.g. UK and Romania)? I see from paragraph 2 of the post to which I am replying that the x axis is filtered over seven days while the y axis is treated over two weeks to smooth it better, which I presume must be the explanation. Is that correct? (Go easy on me - I'm a bit frazzled from being forced to fight with people I thought were allies elsewhere on here!)

Interesting source of data here on Covid in children  (that can take a while to load up)

https://www.ilpandacentrostudio.it/uk.html

If you look at the graphs for Covid19 DAILY New Cases in England (touch the lines for details) was some sort of threshold for 10-14 year olds reached at the end of September?

I thought they looked like comets; ‘x’ is just a better data marker.  Certainly a portent of doom and not of life.

I think your interpretation is correct although it’s a bit more involved.  The case rates are filtered over 7 days to mitigate the day-of-week effects. The data marker uses the most recent point from the filtered time series for the x-axis, and a comparison over the past 14 days of that filtered time series for the y-axis.  So the rate constant is an average of sorts over the past two weeks and lags the cases number, hence the early turning behaviour.

Ideally the rate constant measurement would be symmetrical about the corresponding cases value, but I don’t have a time machine and we live the leading edge.

Re:frazzled; it’d be a dull life if two people agreed fully on anything.  They’d have nothing to talk about.  I decided not to comment on that thread despite having some points I wanted to make, nobody leaves a discussion like that happy…

It looks like it’s become “gobstopper” to me.  You can see the same threshold arriving the demographic week on week method rate constant plot; before then during school term change comes first to the red (school aged) data markers and then follows in black (adults) suggesting in that period school aged infections are driving parental infection, and case rates explode in school aged.  Then the leadership of change switches to black (adults) as school aged case rates decay - schools are no longer the driving source of parental infection.  Talked with a lot of anecdotal data on infections amongst parents I know.

Absolutly no undergraduate spike this term at the national level, and some universities had showed the ability to hit 3-day doubling times pre-Delta. 

I think you are all over interpreting that particular bullet point in the JCVI minutes a bit. The way it is worded (particularly the additional 'There is an argument that...' as distinct from the other bullets in the same list) seems clear they are not necessarily endorsing said argument but need to recognise something in the minutes because it was discussed.

The more interesting bit to me is reading the latest set of minutes where they actually got towards a decision on 16-18 yos. Even for that group, reading between the lines it seems to me that JCVI were not convinced and needed their arm twisting a bit, and that at that point they were fairly clearly against vaccination of 12-15yos. (Various studies and data discussed in the meeting are also briefly discussed in the minutes including an estimate that 45% of school kids had already been exposed by the summer). As we know, JCVI later used the get out clause of passing the decision to the CMO on the basis that vaccination might help reduce disruption to education. From the news at the time this was clearly under political pressure. If I was the parent of a 12-15yo this would all make me think twice about getting them vaxxed, if I hadn't already. And it puts the recent US decision on 5-11 yos in a very interesting light.

Also, surprised to see in the news today that NI has relaxed restrictions that until now required masks and social distancing in hospitality venues and has re opened nightclubs. Surprised because I had assumed that was already the case. It's surprising NI rates have been as high as they have with these restrictions remaining in place?

It is just one of many bullet points, and like all the pros and cons there it comes without any quantitative measure attached to it (theirs is not an easy job); I just find it notable that it’s actually been minuted.  As you say it’s just summarising discussion, and this was from before Dingwall left.

Yes, and the FDA are passing their approval over to the CDC for a decision on what to actually do.  I was surprised when I read Pfizer were submitting for approval in this age range beyond those with vulnerability.  We now wait and see what the CDC say.  There’s a lot of trump inflicted damage there to be repaired.

The other interesting and related discussion in the minutes was about if prior infection makes the myocarditis risk to the young of a first dose comparable to that of a second dose for someone without prior immunity.

Yup.  A real risk of fuelling broader anti vaccination sentiment in parents beyond covid to a much larger detriment of child health.  I remain unconcerned that the UK has a stand out different approach to the vaccination of children, holding at one dose for now other than for those in vulnerable situations.

When Scotland did this it seemed to cause a brief flash in the pan, it suggested to me a different pool of susceptible people was involved to those driving the general high cases, especially with reference to the demographics.  There was no clear, sustained rise in either England or Scotland from the reopening.  So, good luck to NI…

Yes, I had thought they would have worked out the root cause of the myocarditis issue by now but it seemed fairly clear they weren't sure whether it was caused be some aspect of the spike protein or some other aspect of the mRNA vaccine, so didn't know how/if prior infection would add to the risk. It seemed clear there was no significant signal from the AZ vaccine. Would have helped to resolve some of the discussions on UKC a few months ago.

Also noted happily (given that my son was infected last year) the notes about the strength of antibodies and wider immune response produced by young children, even though most have very mild infection.

On the international bit, it's notable how low Norway's CFR is. They don't have a tiny case rate nearly 200/100k) so it can't be put down to a low number of infections making their detection easier. Their vaccination levels are fairly average within Western Europe. Either they have more effective healthcare or more likely are doing an exceptional job of finding cases (or both). Perhaps a lessons learned exercise is in order...

Edit: although their current test positivity is pretty high! https://www.vg.no/spesial/corona/ very confusing. Maybe it's the Viking blood.

https://pubmed.ncbi.nlm.nih.gov/34406358/ ???

That was published a fortnight after the minutes I'm referring to. Having said that, whilst I don't understand much of even the abstract, it doesn't seem to obviously answer the question?

There's a theory that the myocarditis is caused by injecting IV rather than intramuscular. The paper I linked is about some trials done in mice that seem to add weight to that.

Edit: good précis here https://www.dw.com/en/when-do-side-effects-happen-from-covid-19-vaccines/av...

Who came up with that silly acronym?

It’s just a bit depressing to see how many educated people’s views - I assume you’re a teacher or involved in education - are stuck in 2020/ early 2021 I.e. that catching Covid is a bad thing for everyone.

Herd immunity (the only way we escape this mess) is still considered taboo. 

The reason that I'm personally disgusted by your constant banging the drum of everyone catching covid for herd immunity (like you're in no.10 in March 2020) is because the consequences are lots of lots of dead people who wouldn't die otherwise. You argue that they'd die anyway, and you're completely wrong, because you refuse to acknowledge anything other than the facts that support your silly fantasy that the pandemic is just going to end when some magic threshold is reached.

I understand the argument that we're out of the pandemic phase in which we see exponential growth and everything falls apart in a few weeks, due to much higher population immunity, and that's a good thing. The threat of exponential growth is thankfully no longer the concern.

The problem is that the hospitals are already full, and cases are way, way too high.

You refuse to acknowledge this problem, and so I won't take up the thread with any pointless back and forth with you. But every time you promote your horrible destructive idea that high infections are good on a new thread, I'll point out again that the hospitals are full and we cannot afford the level of infections we have. Thousands of people are going to die, not just from covid when they could otherwise have picked up immunity from boosters rather than infection, but from the collapse of the NHS, which is in full swing, and it's October, not winter yet. We're in for a bloodbath winter again, and it's because the government allowed the covid case numbers to get to absurdly high levels by the autumn. Yes, had numbers been suppressed then there would be the threat of higher growth during the winter, but the threat of high growth from a low base with NHS capacity and control measures in reserve is an infinitely better place to be than staring down the barrel of thousands of deaths from untreated illness with no strategy left, no plan, just being told to suck it up and don't blame the government who've made "inspired" public health decisions. 

On the previous thread, you said that you agreed we needed to operate with headroom in NHS capacity. And then carried on saying how brilliant high infections are how herd immunity is round the corner. It's impossible to have a rational discussion if you what you say is in direction contradiction to the facts. You've also said that "long covid is a disease of the mind", whatever the implications of that are supposed to be, showing that you simply have no interest in, or respect for, scientific evidence that doesn't fit your narrative. For these reasons, I don't think anyone should listen to a word you say, because you're promoting policies that will kill thousands and ruin thousands of lives, by pure, malicious dishonestly.

I've spent my weekend with friends in the NHS and with my family including the older generation. Hearing people promoting spreading covid makes me sick.

As I said, I'm just highlighting where your viewpoint sits in the context of the real situation this country faces, and the reasons you can't be trusted. I won't take up any more of the thread.

https://www.theguardian.com/society/2021/oct/29/nhs-winter-pressure-already...

https://www.independent.co.uk/news/health/nhs-england-waiting-list-patients...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056514/vv

There are two ways the Covid pandemic ends.

1) Elimination

Or

2) Herd immunity

You might find what I’m saying unpalatable, but please explain how elimination is possible/ desirable if you disagree with me.

The great barrington declaration was dismissed as you can’t isolate and protect a proportion of society. The same still holds true now. 

The pressure on the NHS is a completely separate point. We could presumably tip cases into decay relatively easily now. Whether that’s desirable is a completely different question.

False choice. There is a sliding scale of how we transition from pandemic to endemic.

It's the central reason we need to make choices about policy, it's what causes people to either live or die, whether the economy can be open or closed.

No rational discussion to be had here, interrupts the thread.

Just pop your head inside your local A&E and ask yourself why it might be a bad idea to chuck even just a few thousand more sick people into the system.

Then pop your head out of your arse and crack on with the rest of your life unhindered by a ridiculous opinion.

I’m perfectly aware of the pressures that healthcare is under at the moment. As far as I can tell it’s a combination of :

- Covid

- Other respiratory virus making a comeback against a background of decreased immunity

- Catch up stuff due to people not seeking/ not being able to get the help before

There are risks/ benefits of going at different speeds towards herd immunity. 

My question to you is “when do you want the Covid cases?” We could shift them to next summer. Would that be better?

When they won't cause additional deaths by NHS overload.

Discussion over.

But what happens if that causes even more deaths due to waning immunity in the rest of the population?

Your presenting this as completely one sided - I.e. any Covid infection is bad. It is not.

The positives of going quickly are:

- reduce the risk from future, potentially more lethal variants 

- maximum immunity from vaccines

- society returns to normal more quickly 

The positives of going slowly are:

- less impact on healthcare

- new therapeutics/ boosters

It’s an incredibly difficult balance to be struck at the end of the day.

Vaccination.

Wrong.

"perfectly aware of the pressures" yet you're depressed that people still think catching covid now "isn't a bad thing for everyone"??? Sorry, but those two statements are contradictory.

What exactly are the benefits of letting rip two months prior to traditional peak Winter healthcare demand when the system is already in a state of active collapse?

When we're able to cope with them. At the moment we can't even cope with the basics.

https://www.manchestereveningnews.co.uk/news/greater-manchester-news/nhs-pr...

This.   Absolutely this.  The situation with healthcare is getting beyond conception for a developed, per-capita rich developed world liberal democracy.  It's getting beyond conception for places with some of those qualifier words missing.   

The point I hoped to get across but that was rather lost in last week's train wreck of a thread is that the UK appears to be very close to being able to dramatically reducing Covid hospital admissions; despite abandoning most control measures (except contact tracing and isolation orders for detected cases) we just can't sustain aggressive spread of the virus.  

I know one poster is suggesting this is because per-person cases are so high, but

1. The infections are still so low (1-in-50 by the latest ONS estimates) in absolute terms that most people an infected person meets are not infected, so this seems like broken thinking to me now we're using pretty mild isolation orders in classrooms etc and the lack of isolation requirements on double vaccinated close contacts.
2. Other countries are sustaining and growing far higher rates in terms of detected cases per head of population, with reasonable inference that their actual infections are higher yet.

So, to repeat the post - we are not able to support aggressive spread - for each person detected as a case, we get little more than one person detected as a case down the infectious chain (words chosen very carefully here).  This has been the case for 3 months now, and the international plot is making it clear that's almost unique in Europe with the changing seasons.

The likely reason for our position is provoking a lot of noise.   People have dug in in the last year and our situation now can be painted to retrospectively justify positions taken a year ago, even though those positions are diametrically opposed.

But we are where we are, and what I think that means is that it would not take many control measures (compared to past waves and compared to many nearby European nations) to send cases and then hospitalisations in to significant decay and to relieve the Covid component of pressure on healthcare.  We've spent a lot of bloody money over the last year, and now is the time to use what it has bought, not least because what it has bought is not going to last forever.

I think the economic costs of the control measures needed to tip us over to constant, reasonable decay are not large, and the costs of letting the NHS situation spiral much further are large. 

But, to do this, the government need to own the solution - all of it, including how we got to where we are now - to get some coherent messaging on why we need to embrace mild restrictions to do improve the immediate healthcare situation.  They need to do this because the political costs of this decisions are potentially significant - from both sides of the polarised debate.  What is deeply concerning for are the various allegations Offwidth in particular has brought to the table that gagging orders are being used to keep the news quiet on the true story within much of healthcare - that does not sound like a government preparing to admit some control measures are needed to preserve healthcare, it sounds more like a government who want to break healthcare.  What really worries me is that if you and I clicked our magic fingers and plucked this f*****g virus out of circulation today, things could still go terribly wrong for healthcare this winter.

Whilst I'm rambling on, to shunt topics slightly: 

Herd immunity as first proposed was a murderously stupid concept, and much of the problems in UK healthcare now seem to me to tie back to a failure to control the spread of the virus at times these murderously stupid people were getting a lot of attention including private meetings with the then American president Trump and with our PM.

Herd immunity now seems unachievable to me - in the sense that population immunity levels are never likely to set R < 1 in a sustainable way, probably not since Kent/Alpha and almost certainly not since India/Delta.  We can't realistically make the virus go away except for limited, containable outbreaks, by having high immunity in the population - there is no herd immunity against infection.

What there hopefully is is a level of immunity at every age achieved through immunisation on a schedule that changes with age, and an age-dependant rate of occasional (re)-infection that keeps immunity at a sufficiently high level population wide that most people brush off infections like we do for many other viruses.  This will probably fail towards the end of people's lives, just as it does for other respiratory infections.  With immune wanning regardless of the source of immunity, there is clearly a limit to how slowly this can realistically be achieved.  Healthcare concerns are a clear limit to how fast.  The optimism lies somewhere in the middle ground which at least needs people to be able to recognise the realities of the situation, including the JCVI guidance on vaccinating adolescents and the consequences of that.

Option 3, endemic -- why are you continuing to ignore that?

Option 4, Eradication

Do you actually know what herd immunity is? What do you think the herd immunity threshold is when an endemic state is reached? I'm sure you've been given plenty of arguments so far to show that herd immunity may be impossible to achieve with this virus, why are you ignoring them?

Ok, I'll ask a different question: what do you think the herd immunity threshold for OC43 or NL63 is?

"> There are two ways the Covid pandemic ends.

False choice. There is a sliding scale of how we transition from pandemic to endemic."

Can you explain what you mean by this please Jon? I confess I don't see a sliding scale. To me, if we don't achieve elimination (now not viable) then the disease will become endemic and the level of infection will be what it will be with the vaccination levels achieved and behavioural factors in our environment; in the long term there is very little we can do to change that unless we accept a need for permanent restrictions which is, I think, also not viable. Where does a sliding scale come in?

(I think people get hung up too much on terminology and language in these debates; the words herd immunity perhaps mean different things to different people.)

Endemic / Herd immunity = same thing in my mind.

We’ll never get herd immunity like we do with some childhood diseases e.g. rubella - but we’ll get it the sense we have herd immunity against flu.

Sorry, not the clearest expression. We are all agreed that elimination is not an option (so, "false choice").

Given that, there's a sliding scale of policy options on how we transition to - and manage in future - the endemic disease. We could go for the Dominic Cummings (and certain UKC posters not on this thread) type policy of enforced covid parties, especially for the elderly (cheaper than vaccination) so they don't clutter up the country any more and we can all pay less tax. At the other extreme we could live under harsh social restrictions forever so that covid, and all other transmissible diseases, were minimised and with the resources we've got our healthcare could be exemplary, although sadly our lives would no longer be worth living. And everything in between. That's a sliding scale of covid endgames.

Right now, the question (although the answer is so obvious I find the discussion absolutely worthless) is whether we need to bring case levels down so that the NHS can operate on all its priorities over the winter, or whether we should be rejoicing at high case numbers because once we hit the fantasy herd immunity number, cases are suddenly going to decrease to close to zero, relieving the pressure on the NHS and the pandemic will be over.

Obviously, you'd have to be a complete idiot to think that the latter was an option.

Ok, this is where you are going wrong. You are conflating two very different concepts.

Herd immunity means that there is sufficient immunity in the population that the effective reproduction number (R_e) is less than one, so an introduced case, on averege, fails to generate more than 1 other (new) case. 

An endemic situation is where there is sufficient susceptibility in the population (either through birth or waning immunity or antigenic evolution) to sustain a moderate level of new infections. This can still happen if we magically reach some threshold of immunity based on a static world view (ie no reinfection or additional susceptibles added into the mix). If SARS-CoV-2 is like other coronaviruses, newborns may have some short term immunity based on their mothers antibodies, but this will not last long (~6months?). This kids will then be susceptible to infection. Given a high enough birth rate, in the absence of childhood vaccinations, or even reinfection, we could continue to have new cases even with closed borders. This is what measles and whooping cough looked like before we had childhood immunization programmes.

Please show your thinking/working.

So in short we completely agree that herd immunity/ endemic phase/ sufficient population immunity is inevitable and all we can do is control the speed of transition to that phase?

I think we’re exactly on the same page.

Thanks for putting that to bed.

Perhaps in your simplistic world, however in the real world there is a problem that health-care workers are vastly more exposed to catching Covid and are not available to work. My wife's practice has one doctor off so 33% less staff but the same patient demand so appointments are pushed out further. My local hospital has reduced the night nursing staff due to staff shortages due to Covid and increased ICU demand.

Fortunately the Germans and Austrians operate on a hospitalisation traffic-light system and are already reacting, most areas near me are tightening up again on the various restrictions to reduce transmission.

I’m surprised we didn’t get a traffic light system announced here, that then got summarily ignored until we’d sailed past the red.  They’re not even pretending to try this time around it seems.  If cases don’t start a convincing fall in older adults real soon now it’ll be time to open a poll on the date of the next lockdown in England.  Which is mad, given how simple it should hopefully be to nudge them over in to proper decay.  In boosters we trust?

This ^ .......  talk about potentially snatching defeat from an awfully hard won path to victory (great summary further above btw).

Just to be clear, the English NHS gagging allegations don't come from me, they come from the well known NHS management commentator, Roy Lilley, who has been privately informed by thousands of NHS staff including a good number of Trust CEOs. It's a fact. I'm aware of some local gagging, as are some other regulars here. Having a UKC regular's mum waiting two weeks in hospital with a broken bone for an operation that should have happend in 36 hours (for the best medical outcomes) is the hard reality of what that gagging results in (the hospital concerned should have declared an OPEL 4 emergency and stopped being the trauma centre for the East Midlands).

On a different subject, some interesting stats discussion on covid, pregnancy and vaccinations:

https://www.theguardian.com/theobserver/commentisfree/2021/oct/31/what-prop...

Ok, makes sense. However I think you have conflated the transition and the end game there. Forgetting the transition for a minute, I'm still struggling to see there is a sliding scale of end-games because I don't see that's it's feasible that permanent restrictions will be maintained. It still seems like a single end game to me unless we can effectively change peoples' behaviours to reduce infection levels through guidance or other non-prescriptive means. Maybe we can but it won't happen with this Government so seems theoretical.

I think that's unfair. I haven't seen anyone suggest in many months that reaching a magic number will then make cases reduce to zero. What people have suggested is that once we reach a certain level of population immunity, one would expect cases to reach a new endemic equilibrium level, which hopefully would be lower than the rate we're currently at. That's a pretty mainstream view. I think the question you are saying has an obvious answer is whether we need to bring case levels down so that the NHS can cope over the winter, or whether we don't. But that's only a question about the transition, not the end state. And it leaves a difficult follow-on question, which is - if this number of cases does eventually turn out to be about what is sustained at an endemic level - do you think we should repeat the same process every year, or should we instead invest in the NHS and solve the other issues causing problems for it (social care provision, recruitment shortages etc) such that it can cope with the same covid demand moving forward if necessary?

Fair. I think they are fundamentally conflated at the current time where we seem to be out of the woods as far as exponential growth is concerned. I can't untangle them as I have no idea how far through that transition we are.

It seems really obvious to me that the pandemic will change "endgame" behaviour in terms of working from home, getting on the bus when you've got cold/flu symptoms, how we use and fund the NHS, procedures within the NHS, thousand other things that affect the transmission of disease. A good example is that I expect to be wearing a mask for the rest of my career, and I hope that the employment policies and social norms around me going to work, and patients going for an eye test, while you've got cold/flu symptoms have changed forever.

What I said was "suddenly going to decrease to close to zero, relieving the pressure on the NHS and the pandemic will be over.". This is the exact impression I get from VS's language of "so close to the end" "there are two ways to end covid...herd immunity, etc". I think you're defending nonsense.

We don't know whether it's the transition or the end state. Depending on how effectively the NHS is destroyed, and how bad other pressures are, we could be in exactly the same position even with endemic covid at significantly lower winter levels than the current plateau. 

Different, and very important question now. My view has been from the start that the government's job in 2020 was to rebuild the NHS so we did not have to have harmful social restrictions this winter. And the winter after that. Unfortunately, they killed the NHS, in no small part due to Brexit (look at vacancies). And so, I want them to burn in the hottest corner of hell for eternity, and I have absolutely no time for anyone who defends them, because they are complicit in the needless killing of my neighbours and the destruction of my country.

The true end game is certainly not until  hospitals step back from such high levels of pressure, and by then we will very likely have better medication, and certainly much higher vaccination levels.... and hopefully low enough population infection levels that mean the most vulnerable don't need to shield. I'm pretty sure you don't think its inevitable that the millions of vulnerable and/or very old will catch covid with the current horrible outcome probabilities  (which was the clear brutal implication from VSisjustascramble)?

I think what we do with those vaccinated vulnerable and/or really old still choosing to shield is the biggest remaining issue in terms of proper medically informed discussion and public health messaging. 'Do the math' and it's certainly millions really need to shield for months yet, or tens of thousands minimum will die (an upper limit maybe of around a hundred thousand if everyone catches it),  including deaths from a few thousand old religious fools, especially far right catholics, who are not vaccinated due to the foetal cell issue and shielding (despite, in the case of catholics, the pope saying they should vaccinate).

The rate constant for cases is turning round and heading for growth again.  Looks very much like the typical weather wobbles, and the problem is that the long term average value is slightly positive so cases keep ratcheting up despite them occasionally bobbing over to decay.    

So, probably heading back for growth soon enough, and it's going to be another 6 days or so before the effects of this weekend's miserable weather lands; can't imagine many people were meeting or eating outdoors this weekend or opening their windows...  

On the weather front I was revisiting the "LMH" analysis in an attempt to motivate myself to write it up properly; as well as being unusually across the board in demographics the most recent decay didn't correspond to a burst of higher than average temperature in the "M" passband - the red line has stayed above y=0 on the "M" plot where the black line has dived down.  It probably won't dive so far down once the next week of data is in...

I was also wondering if we're going to see an effect associated with COP26 - looks like a lot of extra people travelling by rail (or not in the case of Euston today...)

(The weather analysis is holding up nicely across the year, a correlation coefficient of R=-0.6 for temperature and rate constant in the M passband with that value having a significance of σ=3.5 vs the null hypothesis - not bad given the temperature doesn't capture a lot of weather information, and this analysis is across the whole of England and both temperature and Covid vary more locally).

Apparently 24% of people who catch Covid don't get antibodies.

https://www.nature.com/articles/s41467-021-26479-2

That’s not my take home message from the paper, and it’s hardly new knowledge that very mild infections have less immune response. 

I was going to post some quotes from the paper to show how you’ve cherry picked one number out of many, but people would never believe me. 

My take home message was that there’s a great immune response that confers protection from severe disease for much longer than it confers protection from becoming infected.  More evidence is lining up to suggest endemic covid is going to be very little like pandemic covid.

Re: the one number you cherry picked, it’s long been known that very mild infections aren’t so antigenic, so its just as well we’ve got a vaccine and everyone is encouraged to get vaccinated.   It’s very clear that it's orders of magnitude safer for adults of any age to get their first antibodies by vaccination.  

There is other help as well: the NHS is rolling out nMABs soon for those with low antibody levels.... as I said, the question of what we do with the millions of vulnerable shielding in the next phase doesn't seem to register with the "everyone will catch it and we will soon be free brigade".

OK, so I 'cherry picked' the result from the study the paper authors decided to put up-front in the paper abstract,  3rd sentence and the first two sentences are about what they did, not stating results.

Maybe it isn't your 'take home message' is but the paper authors seem to think it is important or they wouldn't have put it in the most prominent sentence in the paper.

"Understanding the trajectory, duration, and determinants of antibody responses after SARS-CoV-2 infection can inform subsequent protection and risk of reinfection, however large-scale representative studies are limited. Here we estimated antibody response after SARS-CoV-2 infection in the general population using representative data from 7,256 United Kingdom COVID-19 infection survey participants who had positive swab SARS-CoV-2 PCR tests from 26-April-2020 to 14-June-2021. A latent class model classified 24% of participants as ‘non-responders’ not developing anti-spike antibodies, who were older, had higher SARS-CoV-2 cycle threshold values during infection (i.e. lower viral burden), and less frequently reported any symptoms."

“.... as I said, the question of what we do with the millions of vulnerable shielding in the next phase doesn't seem to register with the "everyone will catch it and we will soon be free brigade".

Thanks for saying this.

Exactly 

Quite, because you quoted it without any of the context that they also felt important enough to put in the 3rd sentence.  

I see that this time you have managed to post the text without cherry picking a single context-free number from it.  A great improvement.  The full text you now post suggests that the people not showing an antibody response are a mixture of the older, those with lower viral loads and those with milder infections.  More detail abounds:

The absence of seroconversion is more common following mild vs. severe disease (e.g., 22.2% vs. 2.6%, n = 23612) and in asymptomatic vs. symptomatic individuals (11.0% vs. 5.6%, respectively, n = 2,54713). However, the contribution of other factors, including viral load, has not been comprehensively assessed.

So, as I say, that doesn't appear to be anything unexpected.  It's one of several very good reasons it's better why for people to get their first round of antibodies from vaccination not infection, and why for older and otherwise more vulnerable people the boosters are so important.

Which, I think, almost everyone is already on the same page about.

So I'm not sure what your point is?

The interesting question now is how much immunity is reinforced and boosted by immunity moderated infection.  That's a very different question to the one of what happens after a zero-prior-immunity infection.

I guess I probably fall into the “everyone will catch it brigade” - in fact I definitely do.

My question to you is how can they avoid being exposed to it?

They can shield indefinitely (rather sad given the odds are still stacked in their favour), but what’s the alternative? Yes cases will eventually drop, but Covid will always be in the background and unless we have a quantum leap in medical science they will always be vulnerable. I’ve said it before, but it’s a sh&t time to be vulnerable. I just don’t see what the alternative is.

I disagree that the odds are always so stacked for the older and otherwise more vulnerable, certainly not before the 3rd vaccine dose.

To be supported with legal and practical protections and clear information in shielding until the pockets of people with no prior immunity have been exhausted through vaccination and infection induced immunity, rather than somewhat given the impression Covid is basically fixed.

This can't be done through vaccination alone without a legal mandate to forcibly vaccinate adults against their will (which I haven't seen a single person support, and which would probably have me rioting with my pitchfork and flaming torch) and given the JCVI guidance on vaccinating children.  With regards to the later, it seems to me an unintegrated position for some to oppose what's been going on with schools but not to oppose the JCVI guidance.  These are interlocking pieces of a jigsaw puzzle that needs solving to move on towards an end to shielding.    

Then we wait and see what the infection levels and viral loads look like once the reservoirs of immune free individuals are lowered hopefully to insignificance and at worst to their lowest achievable levels.

Then we stop, evaluate and think about the next steps.  If the next steps still look like some people are much safer by indefinitely shielding, something more is needed.  But we get in to the can of worms opened by Covid here - it turns out a lot of deaths from flu could perhaps have been prevented for decades by using weaker NPIs than for Covid  (given that they apparently stoped flu in its tracks in many nations but not Covid).  There's some big bioethics and medical ethics thinking needed here and I don't see much signs of any honest approaches to it. 

More haste, less speed.

No quantum leaps needed - the MAB cocktails coming through the pipeline that have been modified to increase their functional lifetime in the recipient provide a way of giving temporary immunity to those with poor immune systems.  As with anything ending in -mab I doubt they'll be cheap, but it makes a material difference and it will hopefully not be required indefinitely as immunity levels across the rest of the population continue to increase.  Various immune modulating therapeutics continue to work through the pipeline, as do antivirals.  Therapeutics are a massive symmetry breaker in terms of changing the fatality rate when infections are deferred in to the future.  There are other symmetry breakers that work the other way, but they're a bit ineffable.

Yup, amazing how consistent the turning point behaviour is in this plot.  Latest update below and we're almost back to growth.  That period of decay didn't go anywhere near far enough to winding back the recent growth in cases, and isn't anything like the decay needed to take the pressure of healthcare.

As always, the demographic data is more lagged than the top level data, and has Interesting Things happening.  It'll take another 4-5 days of data before it's clear where the growth is coming from by age, but I don't think it'll be good news for hospitalisations.

My best guess is that we're seeing four effects conflated here - (1) a transient, nice weather induced reduction in the rate constant, (2-3) some reductions in both detection and transmission from half-term and (4) infections having got to the point in under 18s that there's a rapidly diminishing pool of susceptible people.

Something has to give soon; it feels a bit like we're getting back to playing chicken between the virus and policy...

Someone pointed out me that Paul Mainwood's brain-o-tron (available on Chitter [1]) is also indicating a likely return to growth - as I understand it, this uses a model of the reporting lag of by-specemin-date data to extrapolate from the leading edge of data coming in about what's probably in the lab pipeline.  I pretend to look smart and thought on it for a while; I'm pretty sure these are two orthogonal hints that rise is coming - one is phenomenology applied to the rate constant plot which uses recent past data, and the other is model fitting and some assumptions applied to emerging data.

[1] https://twitter.com/PaulMainwood/status/1455244295125049346

Well said. 

Latest:

https://www.theguardian.com/politics/2021/nov/01/law-group-threatens-to-sue...

https://www.theguardian.com/world/2021/nov/01/one-in-four-35--to-54-year-ol...

I think this week's thread is doing a much better job of getting more common ground out there over the noise...  Let's hope that continues...   

Immensa - I want to know why the serious fraud office aren't literally smashing doors down to see if there's even a fully equipped laboratory behind the operation, and why PHE aren't having toes held to the coals over why they weren't automatically monitoring data at the aggregation stage for positivity more than 3 sigma from the mean.  I suspect this lab would have been a six sigma event...

Every time I read a story like this, I think "and yet despite all this low compliance, the virus is doubling incredibly slowly - it really would't take much to send it in to decay and take the pressure off healthcare".   It's there for the taking, I'm as convinced as I can be.

Every comment you disagree with is either lying or cherry picking according to you.  You are incapable of not getting the last word no matter how ridiculous your position.

On you go - its free, I'm not going to respond.

That’s simply not true.  I have extensive disagreements without ever suggesting the other person is lying or cherry picking.  Perhaps that is not the case with a few individuals with clear, endless evidenced form for posting misinformation, cherry picked data and other such nonsense in pursuit of their - sometimes embarrassingly transparent - agendas.  These people thankfully form a small minority of posters, and I’ve made a habit of not hiding my views over the last 18 months.  It is a shame that you seem to be descending in to their ranks, it really is.  

There is lots of reasonable disagreement on these threads, and I rarely resort to suggestions of cherry picking but rather engage with the content.  Where as last week you pulled a blinder, putting together a cherry picked comparison that painted the UK in a false context five times worse than reality, and where several people immediately called you out on your deception.  For some reason you didn’t have a problem with the other posters calling you out, only me.  What’s that all about ey?

The irony of you posting to say that instead of engaging with any of the thought out, on topic content in my reply isn’t lost on me.

Yes, my ridiculous position.  Got it.  

Fantastic. 

Chumocracy.

Conveniently re-branded...

Because the private eye name of Serious Farce Office fits them quite nicely? If they did decide to get involved they would probably raid the competent labs instead and contaminate everything.

Sorry for not replying sooner, I’ve been away for a few days.

Yes, I do have a background in education, that’s why I feel passionate about what happens in schools.

At my local secondary school, run by a decent Head, about 25% of staff and students tested positive for covid this term. The student’s education has been severely disrupted.

One member of staff died of covid last week.

GOBSHITE is an appropriate acronym.

Really sorry to hear that. 

I found out yesterday that a colleague who tested positive last Christmas and has been double jabbed is now in hospital. They are in their mid-sixties, so not sure about the booster. 

A good read here out today - including some choice quotes - on Farrar leaving SAGE

https://www.wsws.org/en/articles/2021/11/03/farr-n03.html

An article from the Byline Times I from a few weeks ago on a new cross-party group of MPs on the subject of Covid.  Just unreal.

https://bylinetimes.com/2021/10/07/founders-of-koch-backed-covid-disinforma...

Lots of words being written about case numbers in Europe now... 

More good UK news

https://www.theguardian.com/world/2021/nov/04/uk-is-first-to-approve-oral-a...

Belgium and Germany have indications of levelling off on cases (much quicker than I expected), albeit something weird is going on on the Belgium OWiD case plot not matched on Worldometer.

Re: Belgium you need to look at the raw data (“New per day”) in the OWiD dataset, not the default 7-day rolling average. The normal 2-day weekend reporting break was 4 days long, which will break any two week comparison of a 7-day rolling average.  There’s not enough data out yet to understand the consequences of this, but I certainly wouldn’t suggest it’s rolling off.

Re: Germany, despite some posters insisting on interpreting the first versions of my comparison charts as predictions, I pretty much opened this discussion with a quote from poster “jimtitt” indicating that further control measures were about to kick in over there in respond to rising covid levels...  

erm...... https://www.dw.com/en/covid-germany-cases-hit-record-daily-high/a-59715864

The recent turn towards rising cases at the top level for England hasn't been sustained.  Adults cases did have some week-on-week growth for a day or two (and may have more in the lagged demographic data once that's out) but top level cases are back to decaying, driven by significant decay in school ages.  

If I squint at the last couple of months of wobbles on the top level rate constant plot, I could almost convince myself that they're overlaid on a falling baseline - each peak is lower, and there's a sort of asymmetry to them.  The low frequency passband in the LMH plot seems to agree. (Edit - the right edge of the low passband data is very provisional as it's going to change with a lot of weeks of future data.)  Musical interpretation -  youtube.com/watch?v=XBZUz4C6kqk&

It'll be interesting to see what happens with the last few days once they land in the rate constant analysis - as close to snow as it's felt since the spring, and provisionally the coldest spike in the weather passband for some months.

I'm not much of an artist, but today's data for Belgium gave me an idea for a cartoon to illustrate what "cherrypicking" means, given that we had some confusion over this last week.  

Erm what? ....German cases were increasing fast (to record levels) and are now showing indications of levelling off (at that level).

In reply to Wintertree

I agree with your point on caution which is why I said they "are showing indications" (rather than "are" levelling off. The 'long weekend' would explain the weird data on OWiD rolling average. I did look at daily cases but only on Worldometer which doesn't show the same 'long weekend' effect.

If you keep fondling your ego like that your going to have to wipe off your keyboard.

Paging Mr wintertree, Paging Mr wintertree...

https://www.theguardian.com/world/2021/nov/05/ventilate-home-stop-covid-spr...

Classy.  A daft cartoon with no personal attacks on anyone and what I thought was a conceptually nice if badly executed indication of how prone data with a day-of-week bias is to cherry picking.  

Still you managed to do it without attacking me for being English so it’s progress I suppose.

Do you mind if I start dismissing all your contributions on a similar level instead of trying to engage on the data in good faith? 

Stone the crows.  That’s really promising.  

Next they’ll be recognising the role of portable HEPA filters in locations where ventilation isn’t possible or where people in fuel poverty can’t afford ventilation and heating in cold periods.

Yes, I thought of you when I read that.

Ten days ago at work I had to be in a smallish room with a dozen other people and closed windows. I stomped around rather crossly opening windows. Two of those present tested positive three days later (and are properly poorly).

Re Germany; we (Bavaria) are back to FFP2 masks in the secondary schools, entry to clubs and disco's only for vaccinated/cured and so on, where surgical masks were allowed it's mostly back to FFP2 as well. Mostly they are measures for the younger people but some companies are starting to put pressure on the unvaccinated with things like segregated canteens though the legality of this will probably be challenged. Track and test expanded as well.

So you inadvertantly made me laugh and think of those most guilty.  Got it

What on earth happened to your work place covid H&S?  Places of work have a duty of care to look after staff so have to prioritise covid measures much higher. I'd be formally reporting such an event as an near miss / accident.

I'm really glad about the ventilation initiative but as ever with Boris and co it's too little too late. Not many will start to follow it in winter in a fuel cost crisis. If it's impractical or too expensive in a house, government could advise to dress up warm and meet outside as an alternative (or in a better ventilated public space where precautions are in place)

People.  People happen.  I've been on a bus where the air was thick with foul, blue diesel smoke from a leaking exhaust and people were still getting up to close the window I'd open for fresh air.  Because it was cold.  It turns out, people really don't like being cold.

Many workplaces will be mandated to; I gather our local authority is budgeting for a 50% increase in gas usage from following the CIBSE guidance on Covid and ventilation this winter; this was avoided for much of last winter by dint of lockdown. 

A shame that the last year hasn't been used to fit more mechanical ventilation heat recovery systems, and more HEPA units where the MVHR isn't possible - a far better use of money than paying to heat the outside through open windows.  My radiator at work is immediately below my open window...  I like a cold office and don't mind wearing a jumper like its 1821 however, but I'm in quite the minority.

In reply to jimtitt:

Thanks for the updates.  

Will be interesting to see how that pans out...  

Yeah sorry... to be fair the article does say ventilate you home and goes on about homes and public ignorance (caused by terrible to government messaging: it's like they expect people to have some psychic connection to SAGE information).

Meanwhile, in Glasgow...

Thanks for saying this. It's a good response, likely to have a positive effect, and I need to be doing it a lot more often myself.

In the building I'm currently working in we've just had a new ventilation system installed. It switches itself off automatically after an hour. Fortunately the installation engineers showed me the overrides, so every hour, on the hour, I wander over to a corner of the building and switch the system back on again.

Today one of the staff saw me and asked, "What's that you're doing?" I'm now kicking myself (following wintertree's "people" comment) for being too slow-thinking and telling them the truth. I should have told them it was the override to turn the heating back on instead.

I think a couple of successful drug therapies announced this week. Fingers crossed for reductions in death toll.

Indeed; much wider benefit from keeping people out of hospitals, and that's going to be increasingly important for the UK and for much of Europe in the new few weeks I think.  

Perhaps I am missing something but I can only find the MSD anti-viral in the EMA process, not the Pfizer one.  

https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threat...

Interesting to see what happens with these around flu...   I assume but don't know that stuff authorised/licensed under emergency/conditional terms can't be proscribed off-label...?

It's called Paxlovid (PF-07321332), Pfizer stopped the phase one trials because it was very effective (89%, the death toll in the placebo group was too high). It's been in stage 2/3 trials since end of September. The UK has ordered 250,000 doses apparently. It's an oral treatment which helps things as well.

Sorry; I wasn't very clear.  What I mean is that I can see that the Pfizer compound has been submitted for emergency/conditional approval to the regulators in the US (FDA) and UK (MHRA) but I can't see any sign that they've started the approval process with the European Medicines Agency.  

Yup.  

Probably too early, they are examining a number of treatments. The EMA isn't prone to bowing to political pressure and rushing.

As I understand it, the review is initiated in response to the opening of submission by the producer/supplier, and the regulator then sets the timeline for analysing the data and for their decision making.  So it's the case that (if I'm not missing something), Pfizer have't started submission yet, noting to do with EMA timescales... ?

Possibly, my wife who does the odd clinical study says the EMA are involved in the earlier clinical studies as well in an observational role.