UKH

Post 1 - Four Nations

Thread 52.  I was going to do a retrospective of the change over the last year, but having just been through the year, it can wait.

Back to the present....  Cases have been falling in England and Wales, stagnating in Northern Ireland and rising in Scotland.

There's a bit of a stand-out jump up in the last data point on cases for all the nations; I think this is down to a return of growth landing just as the day-of-week effect resets from a low to a high, which is only partially filtered out by my de-weekending.  Hopefully that's all it is...

Link to previous thread - https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_51-...

Post 2 - England I

As said above, the most recent data point on cases looks like a big up-tick; this isn't borne out by the week-on-week comparison in the next post, which sees only very moderate growth, so hopefully it's not indicative of things to come.

Admissions look to be rising despite the sustained recent fall in cases.  My best guess is that this is associated with the very brief rise in adult cases around the end of October - masked from the top level plot by aa greater fall in school ages - and that this apparent rise will end up developing in to a brief plateau with more decay after it.  If that doesn’t rapidly become the case, it raises an important/uncomfortable question about what’s changed.  

Post 3 - England II

The rate constant for PCR data measured by the week-on-week method is I hope about to max out at the top of a wobble - typically I think associated with the weather, and in this specific instance the very cold period around Guy Fawkes (*).  So, again I hope to see this turn back to decay in the next few days of data, and if it doesn’t, it again raises difficult questions.

The more lagged demographic plot suggests shows how the swings in rate constant are bigger in child ages - a consistent trend recently - so hopefully the growth in adults will be more moderate than the top level plot suggests and likewise illness and hospital admission.

Plot D1.c hints that the growth - when it comes to this lagged data - is not going to be in the most elderly, and is not likely to be in parental ages where the apparent link to collapsing school aged cases remains very visible.  This should be good news for hospital admissions.  As with the last couple of weeks, to me this looks like the dramatic fall in school aged cases is leading a fall in parental ages where the driver of household transmission is removed, and that something - presumably the 3rd dose rollout - is leading to a dramatic and sustained fall in the oldest.

Plot 18 made me twitch a bit and start reaching for the Z-day preparedness bag.  I had to remind myself that the far right side of this is highly provisional and can be over-sensitive to change at the leading edge , and that the demographics of this rise and weighted away from the highest risk ages.  Still, another plot to watch for rapid improvement.

Something I pondered towards the end of the last thread is how far away current true infection rates are from those in a “covid is now endemic” scenario with low levels of control measure; and how that would translate to case rates. Once we get there, we'd expect a reasonably number of daily cases (rough order of magnitude like what we see now), with both seasonal and short term weather modulation (more in winter, less in summer, and "weather wobbles" throughout).

(* Or perhaps it's more accurate to say "the typically cold period around guy Fawkes which fell amongst atypically warm periods before and after".  Is anyone else pining for that magic November from 2010?  I recall going for a walk with 6’ deep snow and temperatures of -18°C  in the lowlands of Northern England)

Post 4 - Scotland I

Scottish cases continue to rise, but all other measures now appear to be falling.   The demographic data in the next post might explain this.  I’d be interested to hear if the new antivirals feature in this….?

Post 5 - Scotland II

The demographic plots show that growth is coming hardest to the youngest ages, despite mask rules remaining in schools, where-as they’re falling in England despite a lack of mask rules.   As with England something is lowering cases dramatically in the oldest age ranges, again the 3rd vaccine dose is the obvious candidate for explaining this.  Supposition on my behalf though.  I dare say a compelling analysis of the real world effects of the 3rd dose campaign will emerge in submissions to SAGE presently. 

I’m assuming this is another instance (as with the European plots) of lower level restrictions failing in the face of winter and delta.   That's happening almost everywhere except for England.  The reasons - whilst argument provoking on past threads - don't seem scientifically controversial.  The big question for me is if the levels of immunity now present in school aged children in England are enough to hold out indefinitely against the march in to Winter, or if cases will eventually tip over in to growth here, as with Scotland and beyond.  

Cases are falling in the older brackets despite the top level growth, which is why I don't think it's particularly odd that admissions and deaths are falling in the top level plots above.

Post 6 - International Plots

Things are not going well beyond our borders.  It's worrying really - runaway cases in a mixed population of vaccinated and unvaccinated people seems to be a good way to raise the mutation rate, and to then amplify any variants that escape the vaccines.  A reminder that no good can come of Covid getting out of control, regardless of if it's inside or outwith our borders.

The "phase space" plot is a dog's dinner with so many nations on it, but squint and it has a lot of information on it.  Really it needs to be Web 2.0-ified with check boxes to select specific countries.  The day I start doing Web 2.0 stuff for a hobby however is the day I check myself in to the local Betty Ford clinic. 

Switzerland, Netherlands, Ireland, Germany, Belgium and Austria have all passed our current (and static) death rate with their extrapolated “locked in” rate.  Norway and Italy are likely to pass us in a couple of days and Spain within a week.  All these nations currently have cases rising rapidly.

Some nations are close to locking in a higher death rate than our peak rate from winter 20/21; we know that was enough to catastrophically affect our healthcare provision.  Hospital levels aren’t directly comparable across nations but this is a massive warning flag to me.  Austria is about 1.5 weeks from this locking in point, Belgium two weeks.  As I’ve said before I’m not predicting this will happen, and the expectation is action will be taken to swerve cases.  Austria are going for a lockdown for the unvaccinated [1] - plenty of opinions to be shared on if that’ll work or not I expect….   There are more calls from experts in Belgium for lockdown measures and the Netherlands are heading for a period of lockdown [2].  Looking at the timing of various announcements, the common theme seems to be that healthcare is going to be rammed before measures kick in.  It's enough to give me pause for thought about what exactly the plan might be in those nations.

Various Eastern European nations on this plot have actual or "locked in" death rates in excess of the UK's peak from early 2021.  Hungary looks to be going for a rate much higher than the UK's historic high; what's notable there is that this wouldn't be the first time they've had such a high death rate; to me this goes to show the absolute importance of vaccination to improving the situation the UK is in.  There's very little English language press coverage of the situation there, but I can't imagine it's a happy one.

I note that the entry on this plot is for the whole United Kingdom; with the significant falls in cases recently in England and Wales and the rises in Scotland and Northern Ireland, it’s worth keeping in mind that you’re looking at an overall picture here.

It's interesting to look at this plot in light of a past UKC discussion - https://www.ukhillwalking.com/forums/off_belay/why_is_our_infection_rate_so_hi...

[1] https://www.bbc.co.uk/news/world-europe-59245018

[2] https://www.brusselstimes.com/news/193418/dutch-government-announces-short-...

Romania is an interesting case study. They also have falling rates like England (guess what the common theme is with the two countries).

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

The shape of their infection curve is interesting however.

It leads me back to my point I made about a month ago I.e. why didn’t UK cases follow the modelled curve I.e. a lot up and then a lot down like Romania and is it really pure chance that our behaviour is moderating infection levels so that they remain broadly stable.

Which leads me back to the point that I made even before that. I.e. Covid is now behaving in an endemic manner, individuals with no immunity are now such a small percentage of the population it doesn’t drive cases, albeit we still have a subsection of the population who are susceptible to dying despite their vaccine conferred immunity.

Thanks as usual.

I noticed there was a significant step reduction in the daily number of LFT positives last week when PCRs were also coming down quickly, but LFT positives have now stepped back to previous levels ("step" is the correct term). I assume this is something to do with school half terms but it's a bit weird because I thought half term for most people was the week before the drop in LFT positives happened.

Anyway, thought it worth mentioning...

It's clearly flattened in England for some time and no matter how reckless the Tories are it isn't growing exponentially.  It's also pretty much flat in Scotland although not for as long.

However the steady state infection and sickness rate is pretty damn high.  We've filled up our hospitals, we are creating a lot of long Covid cases and potentially a lot of long term illness serious enough to stop people working and load down the NHS for years. Even if the deaths within 28 days figure is below some psychological number we are not OK.

Also, it is way too early to assume this is just another endemic disease based on a couple of months of stability.  We have had three major variants in less than two years. There could easily be another, even worse one.

My view is there's far too much optimism and not enough caution in the UK.

Wow, a whole year. Thank you, as ever. There have been times in the last 52 weeks when I've felt like I was hanging on to sanity by my fingernails, and your unflinching objectivity has been one of the things that has kept me going.

Lizzie

Agree there is a big risk of variants. I don't want to address the question of whether we are at close to the eventual endemic level of infection because I don't think any of us have a good guess. I agree the current level seems high. However, isn't it a mistake to think that it's possible to control that level? I think (?) your post implies that with more caution we could have a permanently lower infection rate, but once an endemic stage is reached I'm not sure that is practically true. The level of infection will be largely driven by a balance between rate of generating immunity through infection and rate of immunity waning. If (eg) you introduce some new social distancing measures, then the rate of infection would likely decrease to begin with, but that would reduce immunity levels and later cause some level of rebound. Even if the measures are permanent, does the infection level return to a lower steady state? Perhaps a state with lower troughs in summer and bigger seasonal peaks due to loss of immunity? And, could the average disease severity be worse due to the longer period between infections? I think the only way to interfere with this that we know will work is to artificially increase immunity levels through vaccination. And that is where regular boosters come in. For me the only real policy question *long-term* is how many people it is worth giving boosters to, vs allowing them to get the virus regularly enough that immunity stays adequate. And that might require quite a high infection rate. I think I've posted this question before: but for someone in early middle age, if not offered a booster, do you think they're better getting the virus once a decade with hardly any immunity, or once a year with a decent army of antibodies still hanging around? It's not at all obvious.

There's articles in a couple of the papers this morning about ending free PCR testing, test and trace, self-isolation, and self-isolation payments early next year. (Mirror link, ads++). I suspect part of it is the usual government policy of "leaking" something, checking the public response and then modifying accordingly..

https://www.mirror.co.uk/news/politics/operation-rampdown-plan-get-rid-2545...

While some other European countries scrapped free PCRs, they also have cultures where you pay for part of your medical care, so it would be normal to get one anyway. I can't imagine many people going for one in this country, particularly if you don't have to self-isolate anyway. 

You're then putting people in the terrible situation of having a bit of cough, not being tested as it costs money and then giving covid to an elderly relative, where the IFR remains at a few %, and the risk of hospitalisation much more, despite vaccination. (the vaccination surveillance reports show a CFR of 12% for the vaccinated over 80s)

So test and trace will be going sooner rather than later - good.

We can’t reach a true endemic equilibrium until all control measures have been withdrawn and TT&I is going to be putting massive downwards pressure on the R rate.

Good on the government for having the balls to do it.

Hmmm. In the long run it may be impracticable to require 10 days' isolation after a positive test, but I hope they don't ditch that before the end of the winter. The article said April I think.

If the requirement goes, we need a culture where it is unacceptable to turn up to work with a cold/sore throat/ sneezles etc and an end to the pressure (self-imposed as well as from others) to soldier on through that sort of thing. I am not optimistic; we seem to be spring-loaded to return to "normality".

What would you have us be doing, right now?

I have sympathy with some of your points above - the current strain on hospitals and the variant risk in particular. 

I can see Si's point about the trade-off of restrictions and waning immunity - although I can also see the current level of pressure as being a reason to err towards some level of restrictions now and hope the waning immunity problem can be deferred to the spring and boosters/winter prep better sorted for next year (assuming some degree of seasonality will be a long term feature, perhaps the boosters need to be earlier to temper the winter spike?)

But on the other hand to the long covid concern - *if* cases this level are what you can expect from a fairly unrestricted country with fairly high levels of immunity, then the only ways to get that lower are permanent restrictions or more immunity, either via generating more cases in the short term in the hope that the higher immunity pays off with lower cases in the long run, or more boosters and so on.

It's not showing much pandemic potential any longer in England, but I don't think it's "truly endemic" either - in terms of society wide immunity I think we're in some sort of immunity building hinterland where it spreads like a slightly trigger happy endemic state, and where infections probably cause a lot more harm than they eventually will.

In reply to Si dH re LFTs:

Thanks; there is something a bit odd about the last couple of weeks of data; I don't understand the timing on LFTs, it looks like they took a bit of a break last week but like you I didn't think that was half term for most people.

In reply to Si dH re endemic:

I think the Europe plots above make that pretty undeniable.  If we're not going for elimination (a fairy tale based on magic future technology by this point) then the temporal dynamics of immunity need to be included in the thinking.  And that says that.... 

Quite.  

In reply to tom_in_edinburgh:

I'm getting like a broken record on this point, but I do not think the last few months have been "steady state".  That's a totally inappropriate way of describing it or thinking about it.  

The state of the system is a full description of the demographic distribution of immunity, the demographic distribution of cases and the current "connectome" or network of links along which viral transmission is possible.

Repeat x 100 [That state is changing.  Lots.  The state is not steady.]

Measures like cases/day or deaths/day are not the state of the system.  They are various measures.  The measures can remain relatively level whilst the state changes dramatically.

The top level numbers may have pogod about a relatively level value, but lift the veil and this is not the result of a steady state process.   It is not steady state.  The state is changing.  The output may not be, but steady state is talking about the state of the system, which has been changing dramatically under the scenes.

• We've had a dramatic change in social connectivity (schools returning) and increasing disengagement from basic control measures
• We've had sufficient seasonal shifts to send the rest of Europe in to significant exponential growth (despite their stricter measures) that is only yielding to lockdown level control measures - again densifying the connectome is one way to look at it.

Each time things go against our favour we should see a return to exponential growth (like the rest of Europe) but then it seems immunity levels are catching up and the growth stops.  

So, nothing about our state is steady.

The last few months have not been steady state.  I think if the state was the same as it was 3 months ago, we would be having rapid sustained exponential growth in cases like much of Europe.  We are not.  Because our state has been changing.  In particular the immune component of our state has been changing a lot over the last three months.  

Their could, and the odds are it will come from outside our shores given absolute case numbers globally and where they're rapidly heading in Europe in particular, and given their weaker vaccine coverage providing a proving ground for escape variants.

So the question for the UK is how best to protect ourselves from a vaccine escape variant that is more likely to arise abroad.    Immunity beyond the spike protein seems like a key way of protecting against such variants, as escape is probably going to be heavily influenced by the rapid host adaption of the RBD on the spike. ..

In reply to mik82:

At some point contact tracing has to end, and there's something increasingly farcical about aspects of contact tracing now given what the shadow policy has been for some months.

Loosing mass testing is a big blow to a data driven approach to understanding this. We'll see where we are by spring!

I've put a recent plot on CFRs from the English data below.  Vaccination has seen a massive reduction to the CFR, but a detected case is still bad news for people in their 80s.  

What I don't know is if that "bit of a cough" turned out to be some other respiratory virus, how lethal would that be to someone in their 80s?  

We don't measure and instrument other respiratory viruses to the same level, and so we're in the odd situation of comparing one source of lethality that's highly characterised and on everyone's minds with others that are generally never even though about.   

Big picture - for someone aged 80, one detected case of Covid has a similar probability of killing them to one year of life without Covid; the answer is not to go for a test for Covid at "a bit of a cough" but to avoid visiting people in their 80s or to use adequate transmission control measures (relevant PPE, ventilation) to avoid passing on whatever the cause of that caught is, Covid or not, as any sort of respiratory infection is a significant contributor to their mortality risk at this point.  There's a chance for perverse incentives here where someone gets a negative Covid test and decides they're fine to visit, and promptly goes on to give them some other respiratory infection that needs hospital treatment, and that's the start of a pretty clear pathway.

Will the true problem be that people will have to pay for testing for symptom free Covid, or that they don't have access to paid testing for the symptom free states of other respiratory viruses?  I don't know where the balance lies.

Actually understanding where Covid falls in the pantheon of pathogens is going to be important to rational decision making; next spring seems like when this really needs to get some solid answers emerging.  A job for Martin Clarke of the GAD?   

In reply to BussyLizzie:

That's my view.  The massive shifts to WFH open this up for far more people.

That's also my view...

Roughly the same as Germany, maybe a little more.

I think the best policy when there is uncertainty and substantial risk is to slow things down.  So I'd keep measures like masks on public transport, I'd encourage work from home, I'd keep testing and tracing, I wouldn't worry too much about p*ssing off minor industries like nightclubs and I'd run a lower level of infections.

At some point it will be time to decide this is an endemic disease. But right now treatments are getting better fast, there are new vaccines coming on line, and we are learning quickly, time is on our side and  there is no sense in rushing. One of the most important metrics would be just how many people were getting long term serious illness. 

I'd be assuming it was annual or bi-annual booster jags for several years and I'd be determined that most immunity came from vaccination rather than infection.

If it turns out that there is a horrible long covid or covid related organ damage problem then I'd want to adapt society.  For example a general switch to more home working and deliberately reorganising the annual calendar so winter involved less person-to-person contact than summer e.g. by switching school terms around.

We've had true endemic equilibrium (effectively zero cases here in the UK) for dysentery and cholera here in the UK for a 100+ years. We still retain control measures of not shitting in each other's water supply by having a sewage system and treated tap water.

It's ideological nonsense that all anti-disease measures should be withdrawn. I quite like not having death rates of the Victorian era.

Isn’t that the blind eye we’ve been turning to influenza for the last century, despite knowledge of effective measures from the last pandemic?

Look at figure 4 in here - https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriage...

Over 800 deaths/ day in the excess winter spikes in some years.  It apparently takes far milder measures to suppress flu than covid, and we’ve known these measures can suppress flu for a century.

In many years it’s widely reported in the news that the winter respiratory load in the NHS is placing it under extreme pressure.  I’m not sure I recall any UKC threads on it,

Our position is not well integrated on Covid, and stepping back and finding a clear view of its place is really difficult, as it’s uniquely instrumented and reported on.

To be clear I think it’s still stand out bad news right now; I hope/think that is going to change significantly with the third dose.  

In reply to tom_in_edinburgh:

You want us to have cases rising exponentially and days away from surpassing ours, and with a much higher CFR such that estimates of the death rate “locked in” are twice that of the UK and rapidly rising?

Or are you taking about a different Germany?

I want us to do roughly the same level of precautions as Germany or a little more.

The question was 'what would you do' not 'what would you like the outcome to be'

The situation in England is that there's already been so much death and infection when you combine that with the vaccination you get flat with less other interventions than Germany.  

If you put German level interventions on the England level of immunity then you would get less infection than currently in England. You certainly wouldn't get cases rising exponentially by increasing control measures in a country where they don't rise exponentially currently.

Yes, I understand that. 

Not immediately, no.  We’d get less in the short term.

But there are many timescales.

With the effects of winter ratcheting up over the next two months it’s not clear to me we’d remain free of exponential growth over the coming months; look how soon in the changing seasons almost all of Europe has tipped over to rapid exponential growth, way sooner than happens for a typical flu season.  

There’s a lot more seasonality to come I think. 
 

The situation in the United Kingdom

Also we have a much higher vaccine uptake in ages where it matters most than some parts of Germany.  Although the focus of a lot of conversations here drifts to infection acquired immunity, I think the demographics of vaccine uptake are just as important, are what’s really exacerbating the immediate problems elsewhere and are what’s really in the UK’s favour.

It would be nice if the standard response to any kind of viral respiratory infection is to stay at home for a few days, rest up, and avoid spreading it to work colleagues. I would always avoid seeing friends/family with a cold if possible, but couldn't avoid going to work.

I raised this point at a work meeting (healthcare) when we were discussing what to do about employees who were unwell with coughs/colds and didn't fit the "core" criteria for a PCR and the response was that they were expected to be in work.  The response was given by someone, sat round a table with us, who had a cold.  Basically I think we're returning to normal.

It just seems a bit early for them to be proposing dismantling everything. The English Test and Trace does seem to have been an incredible waste of money however, especially as it was pointed out at the time that local health protection teams did a much better job of it. There's still going to need to be some kind of surveillance system to identify clusters, particularly those growing at an unusual rate and requiring a rapid response with sequencing etc. 

I appreciate you strongly disagree with VS's views. But thinking through the logic of what you just said, it only seems to make sense if covid can be eliminated (or otherwise kept to absolutely minimal levels). There seem to be several reasons now that elimination is infeasible. Amongst these is the high transmissibility, the fact it is respiratory and transmitted via aerosols, the fact it is now at high prevalence in many parts of the world that are relatively undeveloped and can have no hope of controlling or eradicating it, the fact it is often asymptomatic and therefore difficult to detect, the fact it is known to have multiple animal reservoirs eg mink, domestic pets, bats (I think?) and would therefore likely come back even if we managed to eradicate it from humans across the globe. It's here forever now.

Without any prospect of elimination, we need to consider the benefits of restrictions in the context of it being an endemic disease. I don't think either dysentery or cholera are relevant because we can prevent them from becoming prevalent even in a population without any significant level of infection-induced immunity. We can't currently do that with covid. I think the only feasible hope of getting to really minimal covid cases would be new and far more effective vaccines, but it seems unlikely that even this would ever be enough given just the numbers of people who are vaccine hesitant or have weak immune responses (but we should strive for it).  In the long term (not this winter, for which there are different considerations), I don't think additional restrictions should be considered without better understanding the answers to the questions I posed in my previous post.

It illustrates the ideological driven nonsense on giving up on disease prevention for diseases on a continuous spectrum of zero to many cases in the UK. We don't give up on disease prevention just because we can't eliminate it and when we do maintain effective elimination it is only by maintaining disease prevention.

I too think that people should stop going to work with colds. To be honest, even forgetting peoples' health for a minute, I used to dislike the approach taken by many people in the past because (as a manager of 40-50 people for a few years) I knew that the impact on our business performance of someone coming in and making several people sick would be more than if they just stayed off work. The challenge though is that if an individual has an objective they want to meet, they often feel like they have failed if they have to ask for help due to illness, and so most of the time they come in anyway. I've been guilty as an individual on many occasions in the past and only really stopped being once I saw the problem from a management perspective. This needs a culture change amongst everyone, maybe covid will precipitate it.

It does raise questions about how far you go. Of his first half-term and a bit in school, my son has had colds for about half the time. Same for many other kids I think. Keeping him at home would have been extremely disruptive for his education - as a parent I'd rather he just got on with it unless he was too unwell to go in and concentrate, which hasn't happened yet. And kids need to build up their natural immunity to things anyway. Where do you draw the line?

I think you need to answer the questions I posed in my earlier post. To be clear, I'm certainly not my idealogical about this. I don't think we know the right answers yet.

I don't know the answers for year 3 of a 2 year old disease either. I do know political ideology is not the answer.

Got flu?  Need to go on public transport to go to your busy, poorly ventilated office whilst exhaling a potentially lethal virus willy nilly?

youtube.com/watch?v=OIrIyRrgnOs&

Shove yourself full of temporary relief from symptoms and crack on, spreading your illness where-ever you go, playing your role as a link in the transmissive chain leading to 30k excess winter deaths and an unsustainable winter peak on the NHS.

Such behaviour is so normalised that TV adverts are hung off it.

The sheer pandemic potential of Covid at the start forced us as a society to recognise our ability to control the spread of respiratory viruses, and now it puts them in the fore of people’s attentions.  The quest arises for a rational, evidence based way of integrating all the different views and perspectives.

In reply to Elsewhere:

Watch the advert above.  Look at the figure in the ONS report I highlighted. Look at last winter’s flu season.  We had given up on disease prevention for flu. We’d not even tried to determine if it was possible to eliminate it or not (turns out near elimination was possible) and we’ve not maintained effective disease prevention for a century - with even TV advertising encouraging behaviour that spreads it.

VS’ position may or may not be ideologically driven (I’ve shared my opinion there in the past and continue to argue for more caution than their stance) but it’s hard to call it nonsense in terms of the wider context.

In reply to Si dH:

That last point is the key for me.  Nothing good comes of depriving small children from a typical gamut of immune stimulation.  

Answering that without leaving another wedge driven in to society is a big challenge ahead.  “Somewhere in the middle” is my cop out.  Big picture for me around schools is improving staff safety - especially for older staff - as the “healthy” exchange of illness runs riot in the kids.  One of the “cons” on my list for old job was the increasing respiratory hammering I was taking each winter from prolonged exposure to a large, multi-national student cohort whose social lives were optimised to maximise illness.  Standing in front of a class of 300 constantly coughing and spluttering and sneezing people in a poorly ventilated room for an hour.  Even without covid I’m not going back to that, end of. 

I say “healthy” in a holistic sense around immune system development and immunogenicity as well as immediate impact.  

My views aren’t ideological on Covid. It’s just common sense.

If we were to suppress the virus using artificial interventions (mask, TTI, limiting social contact) you have a population that isn’t immune to Covid. This puts us massively at risk of future variants escaping vaccine conferred protection and significant outbreaks each winter.

I’m getting pretty fed up with the morale hand wringers who pretend they’re concerned for public health, but yet demand measures that are almost certainly going to do net harm. The only way out of this is Covid becoming fully endemic - this shouldn’t be controversial.

TIE has conceded that one of the reasons why we’re in a better position than the rest of Europe is our higher levels of natural immunity, but at the same time wants restrictions in place to reduce the spread of Covid (reduce the rate at which natural immunity increases) - it’s just madness.

You want permanent measures in place to reduce the levels of Covid - seemingly ignoring why we’re in a better position than the rest of Europe and ignoring the long term harms of such an approach. 

What you want will kill more people in the long run - I’m absolutely certain of that.

Which specific measures that you think I'm in favour of will kill more in the long run? Please list them as you seem far more certain about my views about year 3 of a 2 year old disease than I am.

Unless you can tell me what my views will be next year your "I’m absolutely certain of that" is nonsense.

I do expect my views next year will be informed by data, events and science of 2022 and basic hygiene learnt as a toddler onwards.

In a word “suppression/ elimination”.

Supporting suppression/ elimination now is the same as supporting let it rip at the start of the pandemic.

We should call it out for what it is - murderous.

That's unimpressively certain nonsense about my uncertain views now and the even more uncertain future consequences of current events and events that have yet to happen.

You could make a claim to common sense if you weren't promoting policies that would actively increase covid levels in the middle of winter when there's no NHS capacity to deal with it. It will cause thousands of unnecessary deaths.

The next thing you'll say is "I appreciate that there's no NHS capacity" and then repeat that you want everyone to catch covid because then it will go away. That's not common sense, that's nonsense.

No. If you suppress the virus a lot and don't vaccinate then you'll decrease population immunity. If you suppress the virus so that levels are within NHS capacity while ramping up vaccination as hard as possible, then you save thousands of lives and disruption to lives through disease.

There is no "way out", we have to manage covid with the resources we've got.

The permanent measures we should have in place are the ones which are benefits to us, not costs. Not going to the office with a cold is a benefit to everyone. Lots of people catching covid has the benefit of stopping exponential growth of covid, true, but the right policy is one which achieves that with the minimum cost. Your "everyone catch covid, it's great" approach would achieve sufficient population immunity to  stop exponential growth, while thousands die of everything else because they can't get treatment. Oh great, the covid chart looks good. Pity my parents are dead - oh well, that's just the cost of getting the covid chart in shape.

While you want to kill as many people as possible this winter because you don't care that the NHS has been destroyed. And you justify this by saying that if anything is done to reduce case numbers then we'll lose our hard won immunity and go back to exponential growth, which is not true.

It always looks like increasing case numbers is what you want to achieve, because you have a false belief that the more cases we have, the sooner covid will be "over". That's incorrect, no matter how many times you say it's the case. We don't know what covid is going to look like in 2 or 3 years time, but we do know that the NHS has been destroyed and people will suffer and die from lack of care this winter.

The reason your view comes across as ideological is because all you seem to care about is "getting to the end", i.e. having no covid measures in place, without considering the consequences of maximising immunity through infection with a health service which can't cope. It's a selective way of looking at the situation to serve an end-goal which has no value (the appeal is some emotional idea of "freedom" I guess). If we have permanent measures in place which cost us less than a higher level of infections, like changing our behaviour when we're sick, getting tested so we know if we've got a virus that could kill someone, etc, then that's a good thing. Lower levels of disease, lower costs.

Avoiding lockdowns is a worthwhile goal - lockdowns have large costs. Avoiding any measures that keep disease levels lower in society is pointless. As much immunity as possible must come from vaccination rather infection to keep people out of the hospitals and at work. People need to not spread the virus to vulnerable people to keep them out of the hospitals. Spreading the virus as fast as possible is not going to help keep people out of the hospitals and at work - it'll just kill a lot of people.

You are right that it would be counter productive to attempt to drive cases right down while not successfully increasing population immunity with vaccination - that would lead to a return to exponential growth in the medium term. But this doesn't mean that the opposite strategy of everyone catching covid now is good. The right policy has to maintain population immunity while keeping people out of hospital - you seem to have no interest in finding this policy, only in removing controls. That's ideological, and will lead to thousands of deaths and enormous damage to the economy. The fact that you call this "common sense" speaks volumes.

As usual I mostly agree with you Jon.  However…

1. This sentence is not compatible with reality as shaped by the JCVI decisions.
2. It seems likely that sufficient vaccination to prevent a wave of delta once controls are dropped is never going to be possible - for two very different reasons.

So, we have to face this inevitability at some point, and winter seems to be forcing that issue sooner elsewhere.  Facing this before everyone eligible has had a chance to receive a third dose is unwise it seems.  More haste, less speed and better protection for the vulnerable has been and remains my take.

I agree the NHS is in bad shape. As I and others have pointed out it’s far from clear that Covid is driving the capacity issues. To me it seems more likely it’s the result of the populations health deteriorating due to Covid measures being put in place.

In the first lockdown everyone I knew who worked for the NHS commented on the lack of people coming in with heart attack symptoms. Where are those people who ignored chest pains in 2020 now? Probably calling an ambulance as they’re having their second heart attack.

We can’t overwhelm the NHS, but I don’t think we are from Covid. It’s a systemic pressure.

Boosters are important. Aside from children (where the cost benefit trade off is marginal) who’s left to jab? No many judging by the data.

I disagree. Covid will become endemic like every other novel disease. There is a reason why we don’t have waves of Spanish flu ripping through the population today.

So personally I don’t believe there are any permanent changes which would benefit us. Society optimised itself pre-pandemic. However ignoring my personal beliefs, if you look at the great work wintertree is doing it now appears incredibly unlikely that Covid will overwhelm the NHS given how cases are trending. Mostly due to the one thing we’ve done better than everyone else, maximising natural immunity in the population. 

The “free-dumb” day crowd were, as hindsight has shown, advocating for a 4th wave in the UK. 

So we have an NHS that won’t be overwhelmed by Covid and we’ve seen the benefits of natural immunity…

Covid won’t destroy the NHS this winter. Systemic demand will push the NHS to the limit. I’m under no illusions how bad it might be (thank god we released control measures when we did).

I strongly disagree. Higher population immunity will always result in Covid becoming truly endemic faster.

“Freedom” does have value. No sane person wants to live in a society where the state controls the basics such as what you can wear. However what I’m advocating is minimising harm. The NHS can’t be overwhelmed, but nor can we delay the path to sufficient population level immunity. Ignoring either the NHS or population level immunity will cause harm.

The argument of yours that I struggle with is the vague assertion that there’s plenty of people left to be jabbed. Aside from children and hard-core anti-Vaxer’s who’s left? Boosters should be given to those who need it, but that’s not quite the same as jabbing the unvaccinated. 

I’m glad we agree with the first point, but I don’t believe that we can significantly increase population immunity any further through vaccination (see my point above). We must protect healthcare, but the answer can’t be “vaccination, vaccination, vaccination”, simply because there’s so few people left to jab.

The reason why we’re in a better position than the rest of Europe is the addition immunity we’ve gained through natural infection. The outcomes of this have been relatively moderate (minimal death, which look to fall further with the therapeutics coming on stream).

I don’t think our positions are two far apart. I just don’t think more vaccination (aside from boosters) will help our current situation.

In addition I do question whether it’s beneficial for younger healthy individuals to have immunity topped up by vaccination or natural immunity. 

While covid is going be endemic, it's unlikely we're anywhere near a stable endemic stage yet. The 1889 "flu" pandemic may well have been caused by a coronavirus and it wasn't over in 2 years.

In what way are the following measures going to kill people?

• Improved ventilation and hygiene in public places, schools and workplaces
• Encouraging people to stay off work for a few days if unwell
• Testing for respiratory illnesses when unwell to monitor disease levels

It's not just covid - the burden of infectious respiratory disease is huge, particularly over the winter period. Loads of people with conditions like asthma or COPD get admitted/risk dying yearly. A generally healthier population, rather than everyone in work, dripping with snot, is probably a good thing for overall productivity and happiness.

First two points I don’t have an issue with at all (aside from the caveat below).

Re your third point. Testing is expensive (very expensive). Do the beneficial health impacts outweigh the knock on health impacts from the cost of testing. No clear answer.

Caveat: We like to talk about “basic hygiene” I.e. not going into work when ill ect. In the short term this is clearly beneficial (you don’t get ill). Is it beneficial in the long term? We already live relatively sanitised lives and it’s suggested that this is one of the reasons of increase rates of childhood allergies. Does the immune system need a regular workout to keep it in shape? Not my speciality so I won’t try to answer it, but food for thought.

That remains to be seen.  I’ve been shocked at how soon seasonality is manifesting in rising cases across much of Europe; that it’s not doing so here strongly suggests to me that the societal immune barrier against rapid exponential growth is much higher than elsewhere.

But - and this but is the kind of but Sir Mixalot can not lie about - …

• We are in the middle of a mild autumn, and the pressures from seasonality must barely have started; this is well before a typical flu season kicks off for example.
   
• Nothing I’ve seen in the data gives me confidence that our societal immune barrier is high enough to prevent loss of control and rapid exponential growth further down the line, and unlike much of Europe our healthcare has been held at a high level of covid cases for months.  There’s also nothing to say it isn’t - because the full effects of seasonality without strict control measures are a great unknown.  So the data can’t speak to the issue until we get there, and the bounds on the inputs to the modelling are wide enough that I look at it as rather indicative, not prophetic.

> Mostly due to the one thing we’ve done better than everyone else, maximising natural immunity in the population. 

Paid for with blood money, and done perhaps without sufficient consideration for the more vulnerable even over recent months.  That we appear to be in a less awful situation than our neighbours now is not, I think, ever going to balance the books over the whole pandemic, nor should it fairly justify much of what has come to pass, but right now we are where we are and we move on from where we are.

As Jon Stewart said: “The right policy has to maintain population immunity while keeping people out of hospital”

That right policy has felt within grasp recently - with natural immunity forming a part of it - but we’ve not I think realised that policy on all fronts to the best of our ability.

Paid in blood money - maybe. But also maybe we got the best deal. Paid the least amount of blood money to get our natural immunity.

Infection a few months after initial vaccination, might be better than infection 12 months later (with or without a booster). Potentially Europe might have to reroll out the booster programme to all of their population to get the same fatality rate as we had.

In terms of the vulnerable I agree the messaging has been poor. But what did you expect when the previous messaging was everyone is a risk of Covid. If you were a male in your late teens or early 20s the odds of you dying in a car crash were much higher. From a government that pushed the message “you’re all at risk”, it’s pretty hard for them to not push the message “you’re all safe”.

Nuance is pretty hard. People being thick is the main reason it’s hard.

Personally I don’t see much scope for the exponential growth you fear. Yes seasonality is a key factor (as with all respiratory disease), but if there was the potential for exponential growth we would have seen it now in my opinion.

Edit: I don’t actually disagree with much of what Jon is saying. The key points where we do disagree are:

1. To what extent vaccinating the currently unvaccinated will help population immunity (I don’t think there’s really anyone left to go aside from children).

2. Whether post vaccine natural immunity (a broader immune response) is better than a booster for under-50s.

3. The philosophical question of how hard the NHS should be pushed this winter to avoid issues down the line.

Is that just a hunch though?  I’ve got a hunch on this, but I’ve found no way to test it so I’m putting no stock in it.

The LMH analysis shows that lower temperatures lead to higher rate constants.  I have only shown this in a small passband where most conflating factors can be rejected (because they cause slower or faster change) but it’s a clear correlation with high statistical significance. 

It’s not a big stretch to imagine that the same weather vs rate constant relationship extends across longer time scales and is a key driver of seasonality - the correlation is present regardless of if it’s a hot or cold time of year - and if that’s the case, the change to our rate constant from temperature by January could be way more than enough to put us in to sustained growth.  But - societal immune levels are still rising which offsets this to some degree - as it apparently offset the return of schools for example.

I doubt anything on the range from informed hunch to the best modelling can call it correctly - but if we do switch to sustained growth, with case and hospitalisation and occupancy levels already so high, even moderate exponential rate sustained growth is almost immediately really bad news.  There’s two to three months of worsening weather ahead of us.  

Where I am the wait for an emergency ambulance (heart attack/stroke) is 5hrs. For an elderly person with a fall + injury requiring assessment it is 12hrs+. You'll be on the ambulance outside A&E for hours too.  The number of people in ICU with covid is comparable to just before the second lockdown. It's basically being pushed hard against a brick wall and it's currently 12C, sunny and still Autumn. 

Unlike last time we don’t have 2 weeks of exponential growth locked in. To suggest that Covid is even close to being as bad as it was last winter is disingenuous.

If Covid disappeared tomorrow I think the NHS would still be up against it, but it’s not Covid itself driving the problems.

To me the bulk of the issue seems to be worsening population health due to Covid interventions. Why else would demand be so high. To put more interventions in place to mitigate the damage from previous interventions seems somewhat foolish in my opinion.

I'm not suggesting that covid is as close to being as bad as last winter, but responding to the point about "how hard the NHS should be pushed", and to be honest I think the NHS is already in a worse state than it was last winter, and has been for months.  

The local hospitals normally run at 90+% capacity. I haven't seen any worsening of population health due to covid interventions, if anything the neglected conditions (such as people not going for cancer screenings etc) are unlikely to be the things causing emergency admissions. All I have noticed is a return to the usual illnesses going around, and normal injuries as transport and sport etc returned to normal. So essentially the 90+% has returned.  The issue is that on top of that we now have had months of an additional 10% due to covid and there is absolutely no way of it being pushed harder. 

Back to squinting at daily changes in the rate constant plot.

I'm just about keeping the faith with today's update that this return to rising cases is another "weather wobble" and is about to level out and hopefully turn to decay.

I've done a slightly different demographic plot that looks at 0-14 and 60+, as with previous interpretation this shows that the growth is not landing so much in older adults; hopefully good news for hospital admissions etc.  Edit:  There's some really interesting stuff going on in this plot over the last few months.

Plot P1.c is back after a long break - I hope it illustrates why I don't like the phrase "steady state" as applied to the situation in England; squint and you can see that the fraction of cases in the most elderly is decreasing, and that the demographics in younger children and adults are becoming less divided, in part as the massive school-age outbreak collapsed back down.  There's nothing steady state about it at all, it seems like more-or-less a coincidence that the top-level cases have been changing relativity slowly - with that change being burned under the more rapid weather wobbles, giving the false impression that things haven't been changing.  

So, I still hope this rising phase is going to break, and to show as another wobble in the rate constant, and that the decay returns back down to where it was a week ago in the data, such that the long-term average trend is still for decay, but if that long term trend doesn't drop much lower we'll be in trouble by Nov 22nd if the trend to a blocking high in some of the weather models firms up... Ω

With reference to an earlier comment about dystopia, is anyone on board with the shit going down in Austria?

https://www.bbc.co.uk/news/world-europe-59283128?at_medium=RSS&at_campa...

Don't know. I see the concerns. But, these people will kill others unecessarily otherwise. Viewed that way it seems reasonable. 

Austria (and Greece) have little time left to take drastic action if they don’t want healthcare to go to the wall by Christmas.

What’s the alternative to locking the unvaccinated down at this point?  Telling them they can do what may but will not be admitted to hospital if they catch covid?  Locking everyone down and blowing all public support for covid policy amongst the vaccinated?

Difficult times, and if this doesn’t work (can’t see much enthusiasm for either policing it or for obeying it), there’s going to be scant little time left for a plan B.

I suspect if free PCR testing is dropped we will see the end of PCR testing. It's hard enough to get people to go for a test, if they have to pay for it, forget it.

One classic example was 2 of my guys at work were onsite together and both tested positive. They were working with one of our customers maintenance staff so I rang the guy to let him know. His answer was he felt fine and he was not going to get tested because he had tickets for the Euros final and paid a fortune for the train tickets too. 

Confess I think the Austrian policy is rubbish.

Everyone who is still unvaccinated either has good reasons for it, in which case locking them down is morally very questionable and they are likely taking precautions anyway, or doesn't, in which case they are likely to be the sort who is disinclined to follow a lockdown strictly. It will be impossible to properly enforce.

If you need a lockdown, have a lockdown. With everyone.

(Edit to add, and as we know, vaccinated people still get infected and transmit delta very easily anyway.)

As I said in my final sentence in that post, I can’t see much enthusiasm for obeying or policing it, so clearly I don’t think it’s going to work either. 

This is true, but the issue here I think is that it’s highly prevalent now, and it’s the unvaccinated cohort that can supply enough hospitalisations to overwhelm healthcare at this point; it’s not about preventing transmission across society in general, it’s about preventing those who represent a clear liability to healthcare from catching it.

So I think we both agree it’s a crap policy, and I doubt the Austrians are under many illusions about it, so I do wonder if the real purpose is as a giant incentive to the vaccine hesitant middle ground…

If I was facing another period of trying to work and to home school at the same time because of an unvaccinated minority, my cup of civic feeling would runeth empty.  This step in Austria is setting the unvaccinated up as a clear target for frustration and anger if things get to the point of global lockdown - and if this apartheid-lockdown doesn’t work that won’t be far away.  

This could all get real ugly real fast, and I doubt the far right over there will take long to capitalise on it.  

What a god damned mess.  Despite all that has come to pass, I am thankful that I am where I am this winter.

People didn't get medical issues addressed during the worst of Covid because the NHS had become a virtual single-condition service. Not because of 'Covid measures being put in place'. Inadequate control measures were put in place, too late, which is why the NHS came under such strain, and people couldn't get treated for other conditions.

We are where we are. The NHS is under strain again, and it's quite likely that some pressure is a result of those delayed conditions. But a significant fraction of it is still being used to deal with Covid. Now is not the time to make matters worse by allowing Covid numbers to rise. That will not only not help the current situation, but it will also pile up additional delayed conditions that will need to be resolved later. By treatment or death.

Agreed.  Without those covid control measures, the consequences for the NHS would have been far, far worse.  The news coverage out of India made it clear what the alternative looks like.

> Now is not the time to make matters worse by allowing Covid numbers to rise

The saving grace is that we know how to make covid cases fall away now.  That we’re hovering around decay with few restrictions means further restrictions short of lockdown should send them in to decent decay.  

Whilst I recognise that additional restriction to control cases is parking problems over gaps in immunity for our future selves to deal with, this is a “live to fight another day” kind of war of attrition, not a “death or glory” situation.  
 

Scotland has mask rules and vaccine passports, it is closer to Germany.

Scotland has also had far less death and infection over the course of the pandemic which is why, despite having slightly higher vaccine uptake than England it's not been flat for as long as England.

East Germany isn't in the same place as West Germany yet, it takes a long time to fully integrate an ex-communist state.  In fact, most of the EU countries with a vaccine uptake problem are former communist states that have swung to the right after the warsaw pact collapsed.  Right wing governments Trump, Johnson, Bolsonaro and in the ex-warsaw pact states have all done poorly. 

If we hadn't had Covid interventions the infections would have risen exponentially and the Covid effect on the NHS's ability to do other work would have been worse.  People would have been scared to go anywhere near a hospital.

The idea that if you didn't do interventions then everything would just go on as usual is total nonsense. 

There's also the 900,000 people with Long Covid symptoms.  We are loading down the NHS with another large and growing cohort of long term patients.

One thing we could do is try and mitigate other diseases where there is 'low hanging fruit' to try and free up capacity.  For example, they could give flu jags to younger people to reduce flu cases and maybe create some headroom.

Using UK dashboard total deaths as of today for England and Scotland, OWiD for Germany and populations from Google:

• Scotland 9389 / 5.45 m = 1722 / m
• England 124435 / 56.0 m = 2222 / m
• German 97677 / 83.2 m = 1174 / m

Scotland is closer to England than Germany in terms of deaths per million, vaccine passports or not.  I dislike being reduced to this petty level of numerical comparison - I prefer to look at where things are going - but sooner that than allow misrepresentation to be told about the data.  

But - and its another big but - I think what sets the UK apart from some other nations is not the past deaths; as I’ve said before the drift of conversation to infection induced immunity detracts from the very real differences over vaccination, and that I think cuts to why Scotland is much more like England than Germany in terms of the current situation.  Scotland is showing much milder exponential growth than Germany right now, in that sense it’s closer to England than Germany.  Like England, Scotland has achieved very high levels of vaccine granted immunity in the most vulnerable.

You’ll note I expanded your “situation in England” to “in the UK”.  There are two other nations in the UK Tom; Wales in particular seems close to England, NI closer to Scotland, all four nations are far removed from what we’re seeing in much of Europe now.  This is an observation of the reality of our situation, you don’t have to turn that in to a Scotland vs England thing.  

Don't bother with the long Covid argument, VS thinks it's "all in the mind" 🙄

https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_48-...

Edit: added evidence in form of link to previous post

I’ve been surprised and disappointed with a couple of friends and colleagues who have come out with similar dismissiveness over ME/CFS, post viral fatigue and long covid.  Amazing how dismissive interpretations persist as the weight of medical evidence keeps on stacking up.

I hope that one of the silver linings from this pandemic is driving sufficient research to fully understand and eventually cure this class of ailment.  I can see concrete possibilities.  

We do.

Now if only we would deploy that knowledge...

Thats been mentioned  as a potential "plus" several times in Private Eye since their medical correspondent speciality is in helping kids with ME/CFS.

Thanks again for all the hard work.

Latest on the hard realty faced by ambulance trusts and the real world  impact of patient delays.

https://www.theguardian.com/society/2021/nov/14/patients-are-dying-from-bei...

Ferguson was saying it makes sense to give boosters to under 50s. I agree, if supply can be expanded sufficiently to still be able to deliver vaccines to poorer countries. This is what the government should be focusing on. Periodic infection to top up immunity will send a certain % to hospital and to the graveyard, even among younger people (perhaps not younger, healthier people but there are a lot of not particularly healthy people who don’t count as clinically vulnerable).

I get that I might make sense to stop tracing as it doesn’t work very well anyway as far as I can tell. However ending self isolation and free testing is pretty crazy. You’re right that a few EU countries have ended free testing but that’s partly because they’ve introduced vaccine passports which are actually vaccine / recent PCR test / recent disease passports. In that context it makes sense to end free testing to encourage vaccination. 

Thanks as usual. A case of wait and see over the next couple of weeks. My prediction is that cases etc will continue to rise but at a relatively slow rate, before topping out again a little shy of 50k (7 day rolling average). Happy to be proven wrong…

I’m more with TIE on control measures right now. It might need to be a seasonal thing until such time as we reach endemic levels (don’t think we’re there yet). I think your comment on Germany is a bit unfair. We were ‘lucky’ to get hit by Delta from May onwards. Most other countries are playing catch up but I suspect it’s a general catch up with Delta (as well as Covid generally - they had lower death rates last year) and only partly due to them retaining more measures.

One factor which hasn’t been discussed much on these threads is our 12 week vaccine doses gap vs 3 weeks in most other countries. Perhaps the 12 week gap confers better / longer immunity after all.

Another factor I’m wondering about is vaccine fade timelines, assuming the 12 week gap doesn’t provide longer immunity. We had a great early start but does that mean that over the coming months we will see hospitalisation and death rates increase for those who don’t get boosters, more so than in other countries where the initial vaccination drive was slower? Given that not everyone is able or willing to get a booster, does that mean we could end up with higher rates in, say, Jan-Feb? I don’t know but I suspect there are a few more twists and turns left in the international comparisons. That said, the situation in many EU countries looks pretty dire.

The numbers speak for themselves.  Clearly Scotland is between England and Germany and closer to England. I'd like it to be closer to Germany and we could have been if we were independent. Germany has had only a little more than half the deaths of England.

Where we are now, coming to the steady state, the deaths to date number is very instructive, it tells us which strategies worked and who f*cked up really badly.  Scotland did significantly better than England despite not having control of many of the most important levers and Germany did massively better.

I don't disagree with that.  Scotland has significantly less death and disease than England 1722 is significantly less than 2222 but nothing like as little as Germany.  Scotland has the same vaccine supply as England and slightly better vaccine distribution: its vaccination rates are just a little better but not much in it.  So Scotland is leveling out a little slower than England.  My guess is when it settles down and we look over a long period the end state in Scotland will be at lower cases/day than England because of the mask rules and vaccine passport.  But, worse winters, more week to week variation due to being a smaller country and things like different school terms dates and large events like COP can easily cause England to be better at some points.

Wales doesn't have as many powers devolved as Scotland and is closer to the large population centres in England, I think it is always going to look a lot like the regions of England near it.

Northern Ireland is a different deal completely.  It would be more accurate to say it was closer to Ireland.  It is doing better because there is a sea between it and the high infection rate in England.

It would make sense over the winter months, to reduce pressure on the NHS at its busiest time. Drop most restrictions around April and see how things are looking by next September. More boosters would no doubt be needed - quite possibly for younger people as well by then. We’ll be dealing with this for a few years yet. Simply giving up on all measures doesn’t seem sensible to me because relying on immunity through infection is rather expensive in human terms - especially over the winter months.

So let it rip is murderous (= bad) but supporting some degree of suppression now is also murderous (= bad), so instead we should let it rip now (= good) so that we don’t have to let it rip later (= bad).

By the way, no one is advocating elimination. That ship sailed a long time ago.

Years of underinvestment with an ageing population.

Huge backlog as a result of operations / treatments being cancelled due to having to deal with Covid.

7,000 people in hospital with Covid currently, of whom 1,000 are in ICU. This might not sound like a lot as a % of total capacity but it reduces free capacity drastically - free capacity is always the top slice and it’s always thin.

The impact of previous measures could be a factor but it’s fairly low down the list. 

The BBC monthly outlook has been forecasting below average temps in late Nov for a while and they’re getting more confident. As I’ve said before, I’m not convinced that temperature variations have that much impact below a certain level 0, 5 or 10 degrees is all cold enough for most people to want to congregate indoors). However we shall see.  

The thing is, if a government makes a law, even if it’s not strictly enforced, at least some people will abide by it, while others will get vaccinated to keep on the right side of the law. I guess that’s what they are hoping for. Having said that, a green pass scheme for most places including workplaces, as in Italy, seems a better way forward.

Yes I do think long Covid is all in the mind.

Prove me wrong and point to a physiological cause - oh wait you can’t…

We’ve spent hundreds of billions on Covid and yet we still can’t find a cause for long Covid - go figure - it doesn’t exist.

Let me Google that for you, Doctor

https://lmgtfy.app/#gsc.tab=0&gsc.q=pathophysiology%20of%20long%20covid

Nothing you linked proves a physiological cause.

Prove me wrong - surely it should be too hard right?

I’d go as far to say there’s more evidence of Morgellons than there is of “long Covid”.

Its the media’s fault. In the early days of the pandemic we pandered to a minority of mentally ill people and now everyone is reporting symptoms.

When several thousand doctors publish peer reviewed papers about Long Covid in prestigious journals and someone says it doesn't exist without stating any relevant experience or academic credentials I will go with the doctors.

I don't need to prove anything to you. I'm just telling Tom not to bother mentioning Long Covid to you as an argument.

My study of n=2 (a close friend, and my own brother) tells me it isn't in the mind. One is at about 80% of former self now after 18 months. Can still get waves of exhaustion if he overdoes it. The other thinks he was pretty much back to normal after about 14 months. It isn't just tiredness, there is physical pain and discomfort (usually the chest/throat). I don't expect you to believe me, but I see no evidence for it being a disease of the mind and, knowing my two subjects, it just isn't/wasn't for them.

Just because something is hard to work out doesn't mean it doesn't exist, if that's your argument???

Of the many people with long covid symptoms, I think we can be certain that some of them have physiological effects still hanging over from, or caused by, covid and some have psychological effects. What we don't know is the proportions. The question you should ask yourself is, why is one seen as a more valid illness than the other? They are both problems and both need treating.

For completely different reasons I am sceptical of the strength of the long covid argument. It's still mostly made based on anecdote. Whenever someone presents data from a study it just defines long covid as anyone with mild symptoms remaining after 3 months. That's not a strong enough case to influence anything.

I’ve no doubt that debilitating long term effects exist for some people post covid.  I’ve no doubt due to both scientific publications including evidence towards mechanisms, the personal attributes of a couple of people I know brought low by this (the sort who’d be in work in front of their students the day after losing a leg to a shark attack), and by the weight of pre-covid evidence for post viral fatigue.

I’m skeptical that the problem is as large as the various claims that are made - what is the trajectory of the people reporting symptoms after X months?  How many are slow recoveries vs how many have problems that aren’t going away?  The later class undoubtedly exists but it’s not at the scale of the former I think.  Several of this parish are still laid low after a year, and I know offline contacts likewise.

I’ve seen no data on the effects of vaccination on enduring debilitating illness (vs slow recovery).  

It must be very difficult to be one of the people suffering effects after a year or more.

Boosters are (hopefully) coming https://www.theguardian.com/world/2021/nov/15/uk-vaccine-advisers-set-to-ap...

Do you just make stuff up Tom?  Because that’s what it looks like.

Over the last few months, NI has been and is following a route much more like England than Ireland.  Just look at cases data on the dashboard and OWiD.  It’s had a persistently high per million rate (much higher than Ireland, very much like the other U.K. nations except perhaps higher per person), where-as Ireland has shot up in recent weeks from a much lower rate to a much higher - and rising - rate.  Like much of the rest of Europe.

Why do you insist on writing words with no relation to any reality?   You have good points but you invariably end up in some fantasy land where you say stuff that just isn’t true and that as always shifts the blame to England.  

Have you not understood what I’ve had to say on why I think this is not steady state, or do you disagree with it?  

If this is the eventual steady state I’ll eat my hat.  

How can we have a steady state when 3rd dose numbers are rising significantly day by day?  Many other factors abound too. It’s facile and lazy to assume that it’s steady state because you can’t see the change that is there in the top level data let alone the glaring changes going on within its constituent parts.

It's actually this kind of crappy discourse in the media that fuels anti-vaxx sentiment. Anyone with an ounce of wit is thinking Long Covid is being overblown and used as a tool for coercion in the media. There does not seem to be any sort of severity index applied to categorise long Covid discussion to categorise things in a meaningful way (see above in reference to 900,000 extra cases of 'long covid').

Couple this with BBC drip feeding propaganda stories about people dying and wishing they'd got a vaccine. Now you see what places like Austria are doing imposing selective lockdowns and us enforcing vaccination for Healthcare workers - even though we know that the vaccine is not a panacea for halting the spread of the disease.

These policies all have the opposite effect of what is intended. I don't see the vaccination status in the UK moving much more now - people have made their minds up at this point. Maybe it could have been different, but you can see why in some countries more naturally suspicious of government the rates are even lower.

BIg change in the messaging on boosters this morning which changes some of my own thinking.

- offered to eligible (post 6 months) 40-49 yos now

- JCVI reporting apparent high confidence that booster doesn't just restore immunity to post second dose, but significantly increases it  (93% against all symptomatic disease, which is potentially game changing for spread); they also seemed to think it was likely protection would last longer than that from second dose did (potentially "many months")

- in answer to questions, JCVI also said they are monitoring for signals of waning in younger adults and would definitely recommend that boosters are given if/when that signal is apparent

Personally I still feel these doses should be going to other countries as a priority but in terms of a selfish UK prognosis this looks like very good news.

They have time yet to decide on <40s.  Even if you were first off the <50 mark with the minimum 8-week  gap, your six months isn't up until early Dec.  

Officially, yes of course. But what I wrote above is almost exactly what was said by Wei Shen Lim (JCVI covid group chair) in response to questioning in this morning's press conference. The obvious outcome is that younger adults will also get recommended to have boosters as immunity is bound to start waning eventually - we just don't know when yet.

Hopefully they will get improved take-up in the older age groups in the meantime. The important thing about all this for under 50s is not the timing, so much as the knowledge that you can at some point get your immunity topped up through vaccination rather than (or before perhaps) natural infection. All previous official comms I had seen implied that boosters would be only for those at more risk, ie over 50s, and frankly, given ongoing high case rates that implied an incentive for under 50s to get infected while they still had good immunity from their first two doses rather than after it had waned.

I figured they'd get around to it before the time came, but it's nice to have it confirmed. Too many double-vaxxed people seem to be getting quite poorly of late.

The other news not mentioned here is the recommendation for a second dose in ages 16 and 17.  It'll be really interesting to see what effect the longer gap between doses has on efficacy...

Yes, better to think of it simply as a 3rd dose; I do wonder how much of the boost in efficacy is down simply to a 3rd dose and how much to the gap between #2 and #3...

In reply to thread:

Back to rate constant spotting.  So far, for England, the current rising cases still look like a weather wobble - rate constant has stopped growing and is perhaps slightly decaying.  So, still no turn to consistent high-rate growth as with many other places.  I've put in the current weather passband plot which shows the rate constant (black) and central England temperature (red) when filtered to reject very rapidly and very slowly changing components of the data.  Hopefully the next few days don't disappoint...

The different demographic breakdowns show how the return to growth is looking more moderated with increasing age; the yang to that ying is that decay can also be more moderated in older ages.

I'm not talking about just the last few months. I was talking about the whole pandemic.

The line for England has been flat for a few months.  I'm calling that steady state.  I'm not stating it will continue indefinitely but its been steady like that for a while and there's not much sign of it doing anything else.  I realise you might disagree because you're more tea-leaf reading about the way its heading where I'm just looking at a fairly flat line.

I see four long term outcomes: virus mutates and things get worse, vaccines and medicines improve and solve it, natural immunity builds up after repeat vaccinations and infections and solves it or we get some kind of steady state similar to today where we have a serious new disease which isn't going away and is reducing quality of life and life expectancy.  

I would agree that the steady state level we have seen for the last few months is unlikely to be the same in 6 months or a year.

There's been a lot of 3rd jags given and the line still looks fairly flat.  The program is designed to get you a 3rd dose 6 months after the 2nd one which would suggest maintaining rather than increasing immunity in the population.  Of course the 3rd jag being Pfizer when many of the 2nd ones were AZ might help.

Just seen the 'Boost' advert; hasn't caught up with the recent change in policy. Still saying 50 or over...

To my eye - and to some informed frequency domain analysis - it's been slowly descending with a series of wobbles.  I have shown as much.  I appreciate that you had a lot of difficulty understanding the pass band stuff, but it's there.

I repeat myself.  Have you not understood what I’ve had to say on why I think this is not steady state, or do you disagree with it?  

I'm leaning towards the idea you haven't understood what I've said at all, because my comments are retrospective about the non-steady state nature of everything over the last 3 months, not "tea leaf reading" which implies futurology.  

I suggest that going to some effort to understand why the last 3 months have not been steady state helps to read the tea-leafs about what's coming, but that is entirely incidental to understanding that the last 3 months have not been steady state.

I've explained in really clear words and pictures how the state - which comprises not just one output (cases/day) but various internal variables (transmissive links - densifying greatly with schools, immune levels - increasing constantly with infection and now with boosters, seasonality- enough to send most of Europe in to rapid exponential growth) are changing all the time.

My disagreement with you has nothing to do with tea leaf reading and everything to do with looking at the data not making stuff up as you appear to do.

• JABS.  They're called JABS.
• The top level line looks to me  like a gradually descending baseline with higher frequency modulation and interrupted by something of a reset when schools returned.
• Also.  Wait for it....De-mo-graph-ics.  Dramatically different behaviour in different ages ranges has been adding - more or less by coincidence it seems - to produce the top level figures where the slow change is obscured by the high frequency wobbles.
• Regardless, what is happening to the level of cases in older adults of the age currently receiving the boosters, Tom?  What does plot D1.c show?  Is that steady state?  

> The program is designed to get you a 3rd dose 6 months after the 2nd one which would suggest maintaining rather than increasing immunity in the population.

Rather than pulling a theory out of nowhere based on nothing, you might look at what the studies are saying on the efficacy of the third does.  For many people it represents a big increase in immunity.  That's going to be even more the case for ages 40 to 50.

You do however have form for promulgating misinformed crap over vaccines, such as your sentence above. 

Are you wearing out your refresh button?  I figure there's no rush as I'll not be eligible until the new year anyhow...

Jags in Scotland. And NI I think.

Don't think refresh works on TV adverts...

The eligibility is an obvious limiting factor; I'm not eligible until next year, and I'm 58, and booked my first jab on the first day the opened it up to my age...

I presume you still need to book an appointment, and if everyone is getting boosters, they're likely to be as busy as they were then. So some sort of advance booking seems reasonable...

The Scots call them jags. Always have.

I think it's become a bit of a affectation used by some to show just how Scottish they are...

OK. I will make it simple.  It looks pretty f*cking flat to me. I don't really give a f*ck it it is wobbling a bit or even pointing down slightly.  The big picture is it is flat.

I have no difficulty understanding pass bands in filters.  I'm just not that interested in your second-order theories.  I realise you are obsessed by this stuff. I actually think it is fairly clever and probably valid. But I think there are bigger factors and it doesn't interest me that much.

I don't read all your stuff.  There's too much and I'm doing this for fun not as a job.

They are only called jabs in England.

Jags in Scotland, shots in the US, Spritze in German.  I'm Scottish.

Yes, I'm not taking any time to f*ck about squinting at something which is pretty much flat and persuade myself its not.  I'll wait until its obvious it is doing something else.

I don't give a f*ck about your D1.c plot.  If you want me to analyse your work it will cost you £100/hour but I will take random shots from the sidelines for free.

You are an Astra Zeneca fanboy, every rich country in the world has replaced it. It's the vaccine of choice for countries that can't afford the good stuff.

Don't think even the Scots can agree on that.

No one who knows anything agrees with you here. The evidence that long covid is real and isn't explained by your facile nonsense "it's all the mind" is overwhelming. But that makes no difference to you.

Last time I posted a paper on long covid that showed some up to date thinking, but you've got no interest in finding out what's actually going on. You just pick some belief that suits your world view and then stick to it in the face of overwhelming evidence that your belief is false. You're quite willing to look in great deal at evidence that fits your pre-existing beliefs, and completely impervious to any information that means you have to adjust beliefs and integrate that new information so what you believe corresponds to reality. You're simply unable to reason, new information has no impact.

English Tory colonial bastard trying to impose your language on the oppressed Scots.

(Most of whom say jab).

Wintertree's point is that, whilst the headline figure has been fairly stable for some time, underneath that, there have been significant changes in how those case numbers are constituted. That isn't a steady state; it is a system in flux.

The swan is serenely moving across the graph, but under the surface, the feet are paddling furiously...

https://twitter.com/tweetolectology/status/1449978555383824387?t=R9_NNh8uB3...

If you've got a Clubcard, you can now get 4 for £2 in Tesco's:
https://www.tesco.com/groceries/en-GB/products/307760429

Right.  I'll make it simple.

Do you understand that a single, top level output being pretty f*cking flat" is not the same as "steady state"?

Do you understand the difference between "state" and "one isolated output"?

The wobbles are important.  They tell us a surprising amount of important stuff.

Also, by proving scientifically their link to the weather, they can then be removed from the data to give a clearer view of the longer term change, and that view is not steady state.  But because it changes more slowly than the wobbles, they obscure it.

Past epic discussion on here disagrees.

Funny, you seem very interested in commenting on the data but utterly disinterested in trying to understand it.  

What's that all about?

I think that's because you can't conceptualise what the pass band stuff is doing - it's not showing the temperature effects to be limited to short duration effects like the wobbles, it's just using a happy coincidence that there is a timescale on which the weather changes where most other sources of variation in the Covid rate constant are rejected, to allow a link between the two to be evidenced to more than 3 sigma significance. 

It doesn't mean the effect doesn't persist over longer time scales, just that its much harder to prove directly.  I see this as forming a pincer manoeuvre with the data on seasonality, both coming at the true mechanic from opposite sides.

Funny how you're interested in making noise but not in understanding.  What's that all about, ey?

Do you understand the difference between one output being "flat" and what "steady state" means?  Have you ever made a complicated state machine with more internal states than outputs?  Bet you have.  All sorts of things can be changing inside without much sign - until suddenly the output flips.  

Well, it is highly inconvenient to your idea that we're in a steady state, because it shows clearly and simply that we're not. 

But do you understand how it shows that, or would you like to explain where you're confused so I can help you to understand how the situation has been highly dynamic, not steady state? 

I can't conceive of any reason I would want you to "analyse" my work frankly.  Plenty of other people to ask when I'm stuck or want someone to give an impartial view on if a method idea is reasonable etc.

No, no I am not.

I'm just not a blithering idiot so ideologically obsessed with my bizarre viewpoint that I paint anyone who disagrees with me as a "fanboy" etc.

My comment was in response to you saying this

My comment was nothing to do with vaccines brands or manufacturers, but pointing out that you seem wilfully unaware of the data showing how a 3rd does achieves far more immunity boost than the wanning since 2nd dose for many people.  Regardless of what those first two doses were.

Bollocks to that. I don't pay more than 25p for a magnum stylee choc ice; Poundland recently had some nice german ones at 6 for £1.50.

I am relieved, I was starting to worry I'd lost any ability to communicate concepts.  Thank you for simplifying and amplifying my point.

That's superb, I hope to be able to use it one of these days!

I clicked on the link.  I wish I hadn't - I now have an unshakable mental image of a turd on a stick.  A metaphor for the some recent contributions to the thread?

I've got some of those nice ones with an ice-lolly outer around an ice-cream core in the zombie day freezer.  Perhaps if I eat one or two of those it'll dispel the mental image.

I think you need more fibre in your diet...

Mmmm... Big Choc

https://world.openfoodfacts.org/product/4316268433372/

I think this is the second time now you’ve said you replied to me, without reading what I’ve written in the post you are reply to, “for fun”.

Its very hard to take that as anything but a direct admission of trolling.

Perhaps I’m missing something, or perhaps you should find a different way of having fun.

Er, it’s kind of in the name, isn’t it? Ultimately caused by SARS COV 2 and the consequential effects thereof which seem to imbalance the immune system and various other bits.

Indeed, most under 40s won’t be eligible until the New Year. My GP started doing 40-50s in mid March, which was quite far ahead of the curve considering the target was 50+ by mid April. I got my second dose on 8 June, a couple of weeks later than I could have done but bang on 12 weeks. So 10 Dec would be the earliest for the booster, ahead of most 40+, never mind under 40s.

Is it a good thing? Personally, of course, especially if it improves protection overall and because I got AZ which seems to suffer from more vaccine fade for antibodies than Pfizer / Moderna (less so for T cells from what I’ve seen).  In the scheme of things, arguably we should be prioritising sending the doses elsewhere. On the other hand, vaccine hesitancy seems to be a bigger issue in many countries than supply, though to be fair I don’t know what the situation is like in developing countries - it could be very different to Eastern Europe for example. Then again, lack of vaccine delivery infrastructure could also limit uptake in poorer countries. Anyway, I’ll take it when offered… 

I agree with you, but splitting hairs is interesting…

Maybe, maybe not.  To me, “long covid” implies that the covid virus itself has long term effects related to the virus itself, but I think many long covid effects have their origin in the body’s response to the virus, not the virus.  In short - post viral fatigue happening at an unprecedented scale.  I can’t prove or disprove this, the top level aggregated data is too anecdotal.

This.  Exactly this.

The key detrimental effect leading to long covid seems to be immune dysregulation leading to the production of auto-antibodies.   In terms of the detrimental effects, there is probably no memory specific to the SARS-nCOV-2 virus, rather it’s memory in the form of the f*cked up response it elicits from an adult human body with no prior immune exposure/knowledge/memory.  That dysregulated response is far broader than the virus.

Covid is by no means the only virus to bugger up the immune system, leading to the mass production of auto-antibodies and corresponding immune memory cells, but an awful lot of covid has happened in a short time interval making it the dominant cause of this kind of illness.

The direction of travel has been to roll out single shots to younger people (down to 5 or 6 year olds in the US I think, though I’d be a bit surprised if they go lower than that), second shots for younger people (now for 16-17s here), boosters for younger people. More vulnerable cohorts rightly get prioritised but equally the roll out expands as more evidence is gathered. Makes sense as fundamentally we know the vaccines are safe and effective but don’t last forever.

D'oh! I cant count... Early December it is for me, too...

Indeed, I was being flippant. Immune disregulation is what seems to kill people as well, at least in many cases.

Good points have been made above about long covid being a rather ill defined term and a lot of it being relatively mind (but no doubt annoying - eg loss of smell is not a biggie for most people but pretty annoying I suspect). By its nature, it will take a while for the effects to be properly understood and quantified.

Well don’t rely on an accountant to count for you 🤣

 Now which previously notorious account does that remind you of? Just saying…

Apologies.  I’m incredibly bad at spotting flippancy and sarcasm.  I’m not much of a people person, hard as that is to believe…

About ten years ago, I had a very mild cold.  I ordered my favourite hot curry from my favourite tandoori as a takeaway, walked home with it and sat down.  Nothing.  No smell, no taste (basically the same sense).  The process of eating it without sensation was one of the most nihilistically soul destroying experiences of my life.  By any objective measure I’ve been to far worse places and muddled through far tougher times (as one would expect for someone half way to their death), but that meal without taste or smell is one of the absolute stand out moments for inducing negativity in my life.  Perhaps that just shows what a charmed life I’ve lived compared to many of my ancestors and to many people alive elsewhere in the world right now.

Perhaps it’s a question of terminology. I used the term steady state earlier to mean that the headline numbers have been oscillating within a range (definitely not flat though!). You pointed out that it wasn’t steady state in the scientific sense of looking at the underlying numbers and of course that’s correct. Perhaps TIE is just not thinking about the terminology (like I didn’t until you corrected me). Or perhaps I’m being generous there.

Have to say your temp / cases graph is very convincing. I might have to eat my words about the correlation weakening at lower temperatures. In fact I hope I do! Fortunately I have a couple of spare hats to cope with the said lower temperatures.

https://www.instructables.com/Despicable-Me-Tortilla-Chip-Sombrero-Copycat/

Indeed; and that’s a reasonable start; but three times I suggested to TiE that the “state” was not steady, just the output, and three times they ignored it.

The funny thing about terminology (as Veteye brought me up on a couple of weeks ago) is that it shapes our thinking, and so pedantry over terminology is critical.

TiE is quick to cite their (electronics) engineering experience to justify their position, but this betrays how much of their commentary is faux-naïf trolling.  You don’t spend years doing FPGA stuff without understanding the difference between state and output.  Typically the state space is far larger than the output space.  With an FPGA it’s literally an area/perimeter relationship.

I meant to reply to that.  My - largely unevidenced - hunch is that a lot of this is behavioural. so I expect you’re right, there is some saturation point where worse weather doesn’t make the rate constant worse - indeed, add enough snow and ice and the effect reverses because people are snowed in, can’t travel and so don’t intermix the virus between households.  However, to a point, people low pass filter out seasonality by changing their clothing, their central heating settings and even their physiological set points.  I don’t go out for a long walk when it’s 25oC, I go out for a long walk when it’s a stand-out nice day for the season.  Likewise I’ll eat outdoors in winter in warm clothes on a dry day, and indoors in summer if it’s drab and windy.  

I really want an epic winter this year.  Although I’ve lost my hat.

Steady state:

Like a lava lamp is. 2 grannies + 8 kids is not the same as 8 grannies + 2 kids. There's nothing 'steady'. Everything's changing but somehow managed to sum to a slowly changing case count. Why is this so hard? 

Boosters:

IMO it's time just to admit the vaccines are a 3-dose course that are 94% effective. I'm ok with that. Also we have plenty to use *and* give away. Easily enough stock to booster everyone and send millions abroad. Why they're not being sent out faster is for someone else to answer.

Europe:

Very informative plot here for anyone interested illustrates a worry common to a number of European countries: https://mobile.twitter.com/flodebarre/status/1459958446342774787  

Not sure what population count they use in France, hopefully it's a really incorrect one. You really don't want your pensioners to be the same people as your antivaxxers. Really don't. When convolved with wintertree's locked in rates plot, this shows the building winter wave could get bad on the continent. And coupled with our high population immunity that we got the very hard way at great cost, reinforces the point that the UK might not be in the shittest of shitty places, relatively.

Looks like someone's already eaten that

There's a note added on the website that booking will likely be available from next Monday, although not sure for where as the big centres nearby have reverted to being hotels and leisure centres. 

See the govt is floating the idea that you won't be considered fully vaccinated for travel/non isolation purposes if you don't have the 3rd dose. 

Have you tried booking on the NHS site? I wasn't sure so went on it and, despite the wording, it let me book: https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/...

My wife could not book yet.

I'm not sure why this is. I'm mid-40s, but my 6 months is up in a few days and the appointment I got is after the 6 months. I did seem to get my first jab earlier than most so maybe I have a qualifying underlying health condition (it's possible I suppose, though I'm not sure why it makes me more vulnerable - I never asked).

That's a very uncomfortable plot for France.  

You really, really don't. 

I've been surprised at the level of push-back suggesting this - led by data - has received.  

One big difference is how much less resourced our healthcare is than many comparators.  If flu kicks off in a bad way later this winter, Covid is perhaps going to be the least of our worries for healthcare.

There's already stories of stroke victims waiting in ambulances outside a&e until it's too late for the effective treatment.

A good argument for suppressing COVID whilst NHS overloaded.

I don't exist as far as NHS Digital is concerned... Hopefully, my GP practice may have sorted that recently...

There are, and it seems it's a problem caused more by the inability of hospitals to discharge non-Covid patients in to long term care than by Covid admissions.  

The gods alone know how bad this is going to be come Black Eye Friday.

A better argument still for

1. Pouring resources in to fixing NHS overload, including in to the care sector where as I understand it training and qualification levels are different than many NHS roles.  Money spent on create a bed in a care home buys a space in an NHS hospital.  Perhaps I'm missing something obvious here...?
2. Reducing immediate load on the NHS in the most appropriate way.

Re: 1. It's a complex log jam and problems need tackling at its sources. Whilst reducing immediate (not long term or net total) Covid demand is something that can happen much faster, if there isn't a commitment to fix the problems at source, perhaps we just end up in an indefinite mild lockdown to keep people out of the NHS and with the immunological gap widening again, re-charging the pandemic potential.  

Seems to me like there needs to be a high level position and knowledgable advisors specifically tasked with getting the NHS through the coming months - with authority and budget to act as needed to break the log jam.  Take Covid away, add flu and we're back to the same problem, perhaps worse.  

Re: 2. Why single out Covid as the lever to pull to reduce demand in to hospitals?  It's behind a minority of admissions and occupancy, what other levels could be pulled?  Why wouldn't we step back and evaluate the most effective way of reducing load, that works in the best net total interests of public health?  If the last few week's of developments haven't made it clear that suppressing Covid through control measures in a post-vaccination society is just storing up problems for the future, I don't know what will make this clearer.  Is the NHS going to be any better placed to handle 5 weeks of suppressed Covid spread when everyone goes on a Christmas bonanza?  Or is it just storing up a level of trouble that will be utterly beyond the system's ability to process?

Another lever - for example - banning alcohol sales might be a fairer way of handling this than locking people down to prevent the spread of Covid.  What level of control measures are going to be needed to keep Covid in decay for the next 4 months whilst the NHS is under winter pressures?  As we're seeing with Europe, as the seasonality winds up towards winter, stronger control measures - and the consequences of longer periods with stronger control measures - are failing - we have more immunity headroom in the UK but it's far from clear we have enough to last a whole winter.

Stepping back to the wider perspective - what's the wider public support for tougher Covid control measures to help the NHS?  1/10th the level it was last winter?  1/100th?  Regardless of whatever I may want, I can't see the political will emerging at this point, not by a long shot.  From what I can tell with interactions outside the school gates, going in to a big city, going shopping and otherwise noticing the world beyond my usual bubble, I just can't see people accepting more restrictions now they've all been vaccinated and there aren't big scary numbers in the news daily.

What is a sustainable and immediate solution to this crisis?  More to the point, why is there so little commentary from government about it and a mostly fatalistic attitude in the press along the lines of que sera, sera?

As it is, I hope that the high and rising levels of immunity in the younger age ranges from recent outbreaks and the increasing effect of the 3rd dose rollout see the recent trend towards decay become more definite and sustained, and that this plays out as a continuing reduction in load.  How much this is eaten up by seasonality is another issue, as it continues to work against us for a few months.  Both JVT and the Oxford vaccine group have been sticking with "a hard winter, much better by spring" line and given that it's notable there's not a more obvious central response to the unfolding NHS crisis.   

In reply to thread:

Looks like the Austria lockdown is having the intended effects - https://www.bbc.co.uk/news/world-europe-59298323

Since the measures tightened, more Austrians have been getting jabbed. Long lines have formed outside one Vienna vaccination centre. Some were coming for booster shots, others for their first injections.

I have no concerns that the majority of the public will follow plan B. All along, the cynicism about behavioural tolerance for the majority response has been part of the UK pandemic planning problem. People talk up exceptions and ignore the majority behaviour has been surprisingly good when restrictions were in place.... as a contrast, cutting out booze is a daft suggestion, despite the clear benefits it would give if it could ever be enacted without major political fall-out.

It's not strictly relevant that covid is not the biggest cause of admissions, as it is both one of the biggest and the more crucial issue is the impact of covid infection control on hospital function. Plan B is one of the few fairly painless levers we have.

Care capacity and quality has just been reduced where it matters most for the winter (especially in the most struggling part of the sector that still takes council referrals at a funding loss) by booting out tens of thousands of unvaccinated care workers with no obvious mass replacements available. I strongly suspect alongside a heavily creaking NHS that action will kill more in care than full vaccination would have saved.

Let's see what JVT and the Oxford vaccine group say if the NHS winter turns out to be a total catastrophe. I'm pretty sure the scientific majority consensus is Plan B should have already have been enacted.

At some point, the infection control processes over Covid have to be normalised in line with others; its' quite possible that influenza is going to represent a worse risk if transmitted within health care settings later this winter.  Hopefully institutional lessons learnt over air handling in healthcare settings improve this dramatically for all respiratory illnesses going forwards... 

Yes, and to me this should be a clear focus rather than an attempt to control Covid cases to a sufficiently low number all winter.  Other nations across Europe have tried controlling case numbers and, despite your increasingly anti-prophetic protestations a few weeks back, the governor fell off, things are spooling up fast and it's already at the point of partial lockdowns in some of them and many more risk breaking their records soon - in a bad way.  With winter barely even a hint of chill in the air at this point.

It seems clear to me that the way to move forwards has to be sustainable above all else.  

Subsidising and incentivising recruitment and training in to the private care sector seems like incredibly low hanging fruit.  You seem more knowledgable than I on this issue - what am I missing here?  Why aren't we doing this?  This is a far more obvious and sustainable solution than Plan B, especially if a flu wave appears with higher than normal pandemic potential, which could be a major problem even if Covid was plucked out of existence.

What a I missing here?

Just reading my emails: they include Roy Lilley's suggestion for expanding good practice and 'putting it on steroids'. I don't think it's possible across the NHS as the system is too heavily controlled by government and there are too many risky unknown potential political consequentials for them to allow it, but we do need to think outside the box and this could be part of it:

 You have a mismatch in certain areas where there is high demand but no care workers in the area. Or you have high unemployment in the area but not much demand. Talked to a care home manager  who paid  way above the going rate. They had to mini bus workers in to fill the spaces.She explained how it worked.

Plenty will do part time, but not 12 hour shifts. Overnight rates are poor.Plenty work in Agency but do not want permanent roles.

Other more attractive jobs for percieved low skills.

There is a whole range of issues which subsidising recruitment and training barely scratch the surface.

And of course capability to  recruit from a pool of Eastern European workers has in effect vanished

What are you missing on care solutions?  The political reticence of the govenment and the fact it is slow and so probably too late now for this winter. It's a likely U turn that will help in the spring. Also the care system is many thousands of bits working independently and needs reform and so will struggle to respond in an ideal way even if recruitment routes from the EU or elsewhere are reopened.w

To borrow your quotes, I wasn't strictly speaking making predictions about Europe I was usually warning against prediction but pointing out western EU governments do seem consistently more responsible than ours so their worse position in immunity tems will be countered by better action. Plus people respond when frightened as per your Austria link.

I was certainly guilty of hoping blips in German and Belgium data were a possible indication of an improvement.

Instead, we'll probably just throw vast sums of money pointlessly at our mates in 'management consultancies'.

Thanks for the broad range of comments. Is some of the staffing problem down to growth in other sectors as things bounce back from the economy then?

This sounds  mostly like solvable problems - all be it with a price tag, but one that should be much cheaper than the costs of worsening disruption to healthcare.  Which segues in to Offwidth's reply...

Oh, I get the reticence and slowness - it's laid plain by the lack of action.  But "plan B" has the same issues of reticence and slowness - compounded by the level of U-turn it would (will?) now need.

It seems like the issues in the care sector are in effect a fundamental and critical issue to the delivery of NHS provision in hospitals, and that focusing only on plan B sidesteps the core issue of a lack of progress by government in tackling the critical issues.

Indeed - and as I said at the start, it was clear that this more responsive action was being taken by some of those nations.  What's interesting (and concerning) is to look at how it's been going for them since then.

Good man.  Beware the leading edge, it's treacherous.  

Plan B isn't a U turn it's an effing part of the plan ! It would likely signal a need to take things more seriously, which would provide a magnifying factor over and above the restrictions... including encouraging extra improvements in vaccine uptake. I simply don't believe the reticence for Plan B is there for the majority.. .all the opinion polls indicated the opposite. Plus the stick is, if people don't behave we might need even tighter restrictions. 

The government may have missed an ideal window soon. The need for Plan B type things won't go away if say covid infections half over the start of the winter (not a prediction) but the political justification will be a lot harder.

The western EU nations have a similar rock and hard place but if numbers keep rising that just means harder restrictions and a bit more economic and social damage (where the UK are well ahead in the cumulative stakes). As yet they are nowhere near our state of way too many people watching their life or quality of life slipping away as that ambulance still hasn't arrived in a handful of hours versus a target (for good reasons) of more like half an hour

Downvote *for telling Edinburgh folk how to speak. It’s jags here. Always has been( at least with folk I work with)

* changed my mind upvote for top trolling

The current employment market clearly does not help the current situation.

You know that and I know that, but the messaging is pretty clear and consistent, and so is the way a change in that is going to be presented.

Thankfully the current government is very experienced at U-turns.

In England, cases in the more vulnerable are falling pretty consistently of late, hospital admission and deaths are falling with increasing clarity.  If (and it's not proven yet), the booster program in older folks and the raising immunity in younger people continues to out-weight seasonality, these measure should keep falling.

What are the gains from controlling a single, specific pressure on healthcare when that single, specific pressure continues to decay?  Ever decreasing gains.

Are ever decreasing gains going to fix the problems?

No.

There is a much more fundamental problem here - and a much more terrifying one than Covid.  More restrictions are critical if the admissions load on hospitals starts rising, but if the situation continues to improve then the gains they can bring continue to fade away by the day. 

Not really - here we're seeing more signs in the demographics that the potential for runaway exponential growth is gone.  They're seeing proof it's there for them, and the demographic differences in vaccine uptake are stark.

Similar amongst themselves, not similar with the UK.

If there is a UK decline going on (I'm not convinced yet), Plan B now would help with that and currently the government has the arguments on its side (we expected a faster decline but what we have is within the modelling range..  .we must help the NHS  blar blar). Even with that hospitalisations lag by a month and hospital infection controls won't change much in months.

The overall situation in the NHS is really serious and will likely last months  and get worse (without intervention)  before it gets better and most of the population don't realise that yet,  partly due to NHSE media manipulation of Trusts' comms..

There are plenty of stories in MSM about the state of the NHS , Radio 4's Today is currently doing an overview this week.You only have to click onto the Guardian to read links on it.I would say its almost daily news somewhere.Heaven forbid even seen stuff on it in the Mail.

So I am not sure so called NHSE media manipulation is really any good.

I don't think so, the care sector (like other low paid sectors such as hospitality, cleaning, agriculture, industrial fishing etc.) has been heavily dependent on migrant labour for many years.  Due to the collapse of the Pound and improvements in the economies the labour historically came from the financial driver for migration has gone. Brexit making people want to live near their families to avoid travel problems has reduced migration.  The pool of migrant labour has simply evaporated. It's not just migrants from the EU either, there's plenty of Filipinos in fishing and healthcare who have gone home, plenty of Antipodeans who aren't coming. There is no fix for these problems until the economic and covid situations change, and that doesn't look like happening anytime soon.

Correct. It's getting people out of hospital and cared for either in the community or care homes is the problem.

Indeed.  I had no idea about the 'immunological amnesia' measles could induce by binding to CD150+ve memory B cells and antibody-secreting plasma cells.     

https://www.bbc.com/news/health-50251259

BTW, have you seen this?

https://www.nature.com/articles/d41586-021-03110-4?utm_source=Nature+Briefi...

https://www.nature.com/articles/s41586-021-04186-8

This suggests that we should be looking at the viral RNA polymerase as a vaccine target, and that (I think) this might just produce the kind of sterilising immunity we really need.  It also suggests that a marker called IFI27 might be a sensitive early marker for coronavirus infection, even in asymptomatic, seronegative, non-infectious people who are successfully aborting an infection.    

Yes, NHS problems have been very big on the BBC this week. Headline news and the articles have contained references back to the state of it pre pandemic, historical funding levels declining, etc. Basically just what the Tories don't want. However, tbf to Offwidth that wasn't the case for the preceding couple of months.

I agree with Wintertree on this topic. He has written it more eloquently than I would have done. I also think we should pay social care workers a lot better (I recognise that might not be simple!)

Admissions in England (I did say England, not the UK) are down about 10% over the last 10 days if you account for the day-of-week effect in admissions data.  

If things are falling, further control measures can only give diminishing returns, and the problem is larger than this - especially if we end up with a bad flu season.  It could well be that stronger control measures end up being necessary due to that and not Covid.   Flu vaccine efficacy has generally not been great, there was a lot more uncertainty over this year's strain, and there's been twice as long for naturally acquired/boosted immunity to decay as in a typical flu season.  Some of the measures in place (screens in shops, older people more proactively managing their exposure risk to Covid, ventilation) are going to help, but the uncertainty is palpable.

In reply to Toerag:

Except spending more.  It seems mad to me that we'll get the checkbook out for the hospitality industry but not the care industry, when funding the later can apparently liberate existing NHS resources where new space and people just can't be built / recruited and trained in time for winter.  Breaking the NHS because we won't meet the wage requirements to staff the care sector seems an epitome of short term destructivism.  I hesitate to get too political, but wasn't the idea that reducing the use of imported labour would lead to a better jobs market for the locals back home?  For that to happen it needs follow through funding plans in place.  We did make a plan for Brexit, right?  

In reply to Si dH:

The big picture problem was made very clear to me by the BBC graph showing how much the annual NHS funding increase was in % above inflation each year, and how that's been slashed since the last departure of labour from office.

We're not there yet, but there's a clear problem with relying on an above-inflation funding rise every year to keep the wheels on.  It is not sustainable.  The maths simply doesn't work out in the long run.  It literally can't.

Yes, the reports from Offwidth and a couple of others on other topics are why a few people now think I can see a month in to the future.

In reply to thread:

Another day of rate constant data.  Still looks like a transient weather wobble heading back to decay.  Growth still looks more moderated in adults than children, and perhaps even remaining in decay for ages 60+.  This apparent age-relationship prompted to do a bit more plotting, measuring how correlated the temperature and rate constant signals are in the medium frequency passband vs age etc.  That's the new plot.   Not shown are covariance matrices between the ages for each passband, because I'm still scratching my head over them and thinking no good ever came of interpreting a covariance matrix.

New plot:

• This shows the R value vs age, and vs gender, and for PCR confirmed LFT data, and for PCR tests only. 
  • An R value is how well correlated something is; -1 means the temperature and the rate constant are perfectly anti-correlated, 0 means no relationship, 1 means perfectly correlated.  Here it's negative - when the medium term change in temperature is hotter, the rate constant becomes more negative (weaker growth or stronger decay), and vice-versa.
• The errorbars and their middle markers show the mean and standard deviation of the R values for the years 2016 to 2020 inclusive.  
  • This functions as a "null hypothesis", as whilst the weather data has the same seasonality and general temporal characteristics, anything on a timescale of weeks should be completely unrelated to the spread of Covid in 2021.
  • As expected, the mean R-value for the null hypothesis is about 0, and all values fall somewhere quite close to 0.
  • The secondary x-axis above the plot shows how far the 2021 correlation is from its null hypothesis - lots of standard deviations means it's very unlikely the 2021 value arose from random noise.
• Interpretation:
  • School aged children (but not infants) have less coupling to the weather than adults.  Some pure speculation - children have to go in to close proximity inside at school regardless of there weather, where-as adults are more likely to pick an outside venue when its nice.
  • The oldest age ranges are increasingly decoupled from the weather with their R heading to close to zero; this isn't low numbers noise as the significance vs the null hypothesis remains.   

Broken link but I found it; that's mad.  Perhaps it's also the start of a customised therapeutic approach for fixing some auto-immune disorders....? 

I had not, interesting; thanks.

I’ve seen a paper on serial passage experiments showing the Covid viral polymerase can rapidly evolve around a synthetic nucleoside analog, so I wouldn’t rule that option out for neutralising antibodies which have a similar mechanism of action in my cartoon view of it - get stuck to the critical parts and jam them up.

But having a couple of different vaccines effective as neutralising agents against different viral proteins starts to vanish the probability of such an escape.

More generally, what about the potential for shared epitopes leading to auto-antibody production?  Whilst viral and human RNA polymerases are very different beasts, form often follows function so some shared motifs may appear in critical places…?  I think the software for analysing and de-risking some of this is going to see some changes after lessons learnt from the DNA vaccines.  Certainly a lot of PR noise being made about deep mind’s protein prediction capabilities going on around the public launch of Isomorphic Laboratories.

Also mustn’t forget the mitochondrial RNA polymerase, this appears to be derived from a viral polymerase that was co-opted and replaced the original bacterial RNA polymerase long ago; these I think are phage derived and I’ve no idea how long ago they parted ways with the coronavirus family RNA polymerase.  But we wouldn’t want to upset them.  Never upset a mitochondria, that's my motto.

Presumably the children interpretation (forced inside whatever the weather) could be applied to the elderly as well - stuck inside regardless of the weather - as some of the older cohorts gradually become less mobile and less independent that weakens the correlation of the group as a whole with the weather versus younger and on average more active/able adult cohorts.

Delve into the Guardian. It’s been commenting on it for sometime. 

The point you are missing is the Trusts are not reporting honestly as they should. They are deflecting based on NHSE orders. The stories come from the unfortunate victims and the likes of Roy (who has been featuring it for a month). NHSE can't stop that.

 Go ask a sample of people if the NHS is in crisis right now. Most seem clueless.

Quite possibly; I wondered if they’d show more correlation on a longer lag as they get secondary exposure to the weather via case rates in visitors.  Then I went out to split logs for two hours instead of testing that...  The core looks like a medieval drawing of a comet, a clear portent of the epic winter to come.

10% decline in a week is near enough steady state* for practical purposes, it barely counts as decline unless sustained for months.

*sorry for including your trigger word/phrase

It’s a much less inappropriate phrase when applied to admissions than to top level cases.  Although the “state” still lives in infections not in admissions, what’s wrong with saying “is near enough level”?  That’s a more accurate description that does not imply something untrue.

A 10% decline is a 10% decline.  It’s real, measurable and translates to a measurable reduction in stuff happening in hospitals.

If it’s reversed by next week it becomes a mostly irrelevant blip, if it compounds it’s the start of something more.  With cases in older adults having shown mostly decay in the last 7 days and looking like they’re heading for more decay, I think it’s going to start compounding…

Shouldn't get ahead of ourselves…

There are clues in the BBC reporting. The use of the word 'whistleblowers' ought to tell you something. The message is not coming out via official Trust press offices, but via front line staff risking their jobs to let us know what is really going on.

Looks like a spider plot.

Or a diseased tree...

I was mulling your comment over this morning.  Big picture - the data is a strong hint that this comes down to individual agency over setting / environment.  This can work in another way with a similar effect - care homes and schools have institutional pressures over ventilation that don't apply to households.

Which starts to make a case that the underlying causal mechanisms are behavioural, and not to do with the physics of viral transmission changing dependant on time varying air properties.  The papers I've read on seasonality have a really difficult time with conflating factors here.

The response of cases/deaths after lockdowns etc were implemented indicate that changes in behaviour can clobber Covid*. Or allow Covid to clobber us. 

*and flu

Yes.....  and.....?

I'm obviously missing something here.  Would you like to remind me that fire is hot whilst you're at it?

It's astoundingly clear that control measures limit the spread of Covid whilst they remain in place.  That's a talking point for the OWiD plot for the next thread as Latvia and Romania are now seeing deaths going in to decay for those reasons.  This much is plain as day.  

My reply to AJM is in the very clear and specific context of their comment on an analysis of the link between temperature and rate constant vs age.

What I mean in my reply to AJM is that the data hints strongly that the link on the timescale of a week or so between temperature and spread of the virus  is behavioural, as opposed to being related to physical mechanisms affecting the spread of the virus (UV-C / humidity / air drying capacity being factors considered in the literature on seasonality).

It's bloody obvious that behavioural factors are one critical part for a virus transmitted by human interaction.  The physical mechanisms are also in play - this is why I have my office window open, why masks are recommended and why I run a portable HEPA filter when we have an elderly visitor at home. 

There is in the literature however a great difficulty in separating behavioural factors and physical mechanisms when it comes to weather and seasonality, because behaviour shifts with the seasons and its all conflated.

Except when you have to go to school or have to be in a care home.  Then you have less agency over setting and your behaviour is more invariant.  So, perhaps the age based weather correlation plot gives a starting point for un-conflating the link, and perhaps that can be used to make seasonal inferences given the common factors.

We don't normally instrument the spread of flu or other viruses to the level of hundreds of thousands of test a day for a year, so this data isn't there for previous viruses to look at this for sub-hospitalisation level cases across the whole population.  Our Covid response provides that data.

I think in England we'd have to work quite hard to get Covid to clobber us right now.  

Yep, it's truly impressive foot shooting that our government have achieved that, albeit mostly covid clobbering by proxy decisions. The NHS is in a serious condition and areas that could been used to help have been ignored or sometimes gone the exact wrong way. This government covid action was all supposed to be about protecting a functioning health system. No restrictions, mixed messages, block bad news, push a care system in crisis closer to the brink by booting out tens of thousands of desperately needed staff using Daily Fail sensationalist logic, with the subsequent horrible extra strain on the NHS over winter locked in.

But yes covid  exponential growth in the UK looks very unlikely without some new nastier variant.

You seem almost disappointed that unlike the rest of Europe we’re not heading for another lockdown this winter.

The lack of restrictions have played a key role in this. Europe f@cked up, we played a blinder.

If I put you both in the beamline and cranked the power up to 11, I think an opinion close to reality might emerge.

In reply to Offwidth:

They haven't "achieved" that.  

They've failed to curate the healthcare services to a minimum safe level of provision for winter, Covid or no Covid.  It's worse with Covid but going in to a pre-Covid winter at this level would not be pretty with a flu season.  The seeds of this were sewn long before Covid came along.

In reply to VSisjustascramble:

Hard to appreciate our achievements when the plan apparently rested on having a high but not insane Covid caseload passing through healthcare for a sustained period including going in to winter, when the execution of the plan has so thoroughly failed to keep the wheels on healthcare.

In reply to both:

We're perilously close to snatching defeat from the jaws of a successful exit here.  Can't call it a victory given how we got to this point.

Since we are drifting into pantomime territory here: "Oh yes they have"

"It's behind you"

That's a delightfully good misrepresentation. There are a lot of clever people working in the NHS and in associated areas and they always knew that this winter planning was always going to involve covid, staff shortages, possibly flu, and uncertain covid outcomes (that's why Plan B was there);  reading between the lines the line of caution seems to include support from the leading  scientific advisors, the CMO and CSA. The non political leadership knew what needed to be done and it hasn't happened, and instead the government make things worse by picking fights with health and care staff, and trust CEOs and there is a culture of silence from health leaders on why that is tolerated. I know the govenment bully down culture exists as people close to me experience it (including in national meetings with reps from government). It's pretty clear to me the government lacks the confidence to let those who know best get on with it (with due oversight) and worse still are playing politics that will cost lives; more so since Javid took over as the lead minister. As another error, Simon Stevens should never have been allowed to leave until the pandemic was over but he was much more of a thorn in their side. We have been lucky with flu so far.. I hate to imagine how bad things could be now with a normal level around.

I feel pretty insulted being regarded as the other side of the coin to a herd immunity cheerleader who claims long covid doesn't exist.  The NHS ambulance delays are hardly Cassandra territory. But hey I've had worse... do you fancy a job with the BBC breakfast with all that two side equivalence and half- way nonsense. I don't hate the tories but although I've always disagreed with their political philosophy I can normally debate political difference without anger, but this lot are particularly unusual...they are following a playbook that is more polite Trump than conservative...win at any cost and damn the consequence. The PM even got a ticking off from Hoyle today in PMQs.

I remain incredibly greatful for your efforts in these threads and patience in dealing with well intended posters who get muddled. We mainly seem to disagree on how much politics are appropriate and when people are facing life risks, I'd say a lot. You're not the first scientist I've known that makes me wince with comments made with good intent that look very odd in context. Nor the first where I really like and respect them but they fell out with me a bit for reasonable debate that was maybe uncomfortable for them (not that they were wrong but I was concerned that maybe other things mattered to other people as well, so needed airing).  I'm guilty myself at times of the same thing and try to guard against it, but humanly fail occasionally. I sometimes ended up defending such people in formal procedures after complaints!

I think you mean to we screwed up last year and last winter, which means it’s quite hard to screw up again. I wouldn’t call that playing a blinder. I’d still prefer to be in NZ’s position even with Covid making a resurgence there. 

OWiD latest cummulative covid deaths per million

UK ~2000

NZ ~7 (but will increase a lot now)

If you look at the covid stringency index on OWiD NZ had higher peaks but a much better avoidance of lockdown on average, with lots of time with very little restrictions, so overall much lower economic and social impact.

A more local example would be Norway and Denmark

Denmark~500

Norway~170

Both countries have an OWiD stringency index mostly below the UK but sometimes at or slightly above the UK.

https://ourworldindata.org/coronavirus-data-explorer

Wintertree: They've failed to curate the healthcare services to a minimum safe level of provision for winter, Covid or no Covid.  It's worse with Covid but going in to a pre-Covid winter at this level would not be pretty with a flu season.  The seeds of this were sewn long before Covid came along.

Offwidth:

I think you've fundamentally misunderstood what I'm saying (again) and apparently read an agenda in to it that isn't there (again) and responded to whatever you're imagining I'm pushing (again) .

What I mean is that healthcare has not arrived at this winter in a fit state for the winter, regardless of if we have Covid at near-present levels or if we have no Covid going forwards over the coming months.

I'm also meaning that some of the factors making healthcare provision worse have been going on for long before Covid - this is not to deny the bloody obvious and ma-hoo-sive impacts a global pandemic has had, nor the impacts of policy that has come along because of this pandemic and is not always perhaps necessary (e.g. the care workers mandate where I agree with you on pragmatic terms).  To be clear, I am not saying we would have arrived at this point, now, if there had been no Covid.  I can only assume that's what you mis-read in to my post given your reply. 

So, I really don't know what you think I'm mis-representing here.

I'll spell out where I think my view differs from yours.  You are calling for more Covid measures in response to healthcare that would still be under bad and worsening pressure without Covid.  If you can't see how that won't fix the problem - just plaster over it for a bit - I don't know how to help you see that perspective.  A secondary issue is that there proposition to the public of embracing restrictions on their liberty to preserve healthcare during a healthcare-quaking pandemic phase if utterly different to the proposition of embracing those restrictions because healthcare has not been carried through the pandemic phase well enough.  I wouldn't be at all surprised if this ends up having to happen over flu rather than covid, and it would be hard to regard that as anything but a disgraceful if necessary state of affairs, where-as during the early pandemic it was simply necessary. 

It's just as well I didn't call you the other side of the coin then, and we were not talking about long Covid here.  

Recognising that two people are each making valid points about different aspects of the situation is not the same as a Fox News debate, although that is increasingly the level these threads are being dragged down to.

To be honest, I remain very unclear on what you actually disagree on, but I am increasingly clear that you disagree a lot with many things.

From my view you've becoming increasingly agitated and irrational when faced with presentation of data that isn't Bad News, both through replies on here and off-channel communication.  You remain very happy with the presentation of data that is Bad News.

A few weeks ago you stepped in to effectively claim I'm deliberately omitting data ("What Wintertree didn't tell you...") before going on to present some fantasy land qualifier that was not well evidenced by past data for many nations, and certainly has not come in to play since.    Far from it in some cases...

You clearly misunderstood my well explained CFR values where I was trying to show how the situation in the UK was not as far removed from elsewhere as some persistently claimed, and you dug right in on that arguing against a point I wasn't making, missing the clear point I was making - and one that continues to be borne out.

Since then I think the developments across Europe - now making headline news in the UK and abroad - suggest that perhaps, just perhaps, there was no agenda to my posts a month ago other than the usual ones of trying to pull as much understanding out of the data as I could, and to communicate what I found when doing so - namely (1) that the people claiming the UK had an exceptionally high (~15x) daily case rate were missing key information from their comparison that made it all but meaningless and (2) the UK is in a position almost entirely unlike any of its European neighbours.

That's a good way to put it.

But, as I've said before, I think the demographic differences in vaccine uptake between the UK and other nations are another critical part of what is setting us apart.  These differences were decried by the usual idiotic Top Trumps a couple of people were playing a while back focusing just on the top-level number, but they're - shock horror - absolutely critical when there's a near exponential dependance of IFR on age.

So we've also succeeded almost uniquely in vaccinating near to the limits where it matters.  We move forwards in a different position as a result of both our successes and failures.

Absolutely.  It's hard to think of anywhere that's done better by their people.  

People might wonder why I've been so interested in watching what the weather does to cases over the last couple of weeks.  Read on....

Another day of drip-fed rate constant data shows the weather wobble wrapping up and turning to decay.  The peak growth rates are now landing in the more lagged plot D1.c; it looks like cases just about remained in decay in ages 65 to 90 which is an interesting development - if decay in older ages becomes persistent under weather perturbation (presumably due to the booster) and if the effect continues to increase in strength and lower age bound from ongoing booster rollout, that makes a material difference to the level of hospitalisation getting locked in, despite what case rates do in younger adults.

So....  Since the start of the thread, the cold spell due to land around November 22nd has really firmed up, all the models and ensembles are converging on this, and it's not beyond the realms of possibility that I'm going to see some snow..

So far we've not seen a switch to sustained growth in cases unlike the rest of Europe. Assuming the temperature effects persist outside of the passband used for the weather analysis (used because it allows me to reject other effects than the wether, not because I think the effect lives only in this passband)I think this could be "the big one" that finally tips England over in to sustained growth.  Which - as I think everyone is in agreement on - healthcare can't take.  

So, it's about 10 days before the coming cold spell lands in the rate constant data; in that time about 3 million booster doses already given in England will kick in as immunity, and those are still going in to arms at pace.  

Palpable tension over how this goes.  I'm aware that's manifesting in guidance being sent to institutions in at least one big sector.  

Hope for the best, plan for the worst.  If this does send cases in over 45s in to signifiant, sustained growth there's going to be little-to-no time to enact the necessary control measures.  If cases in over 45s don't go in to significant growth, I think that becomes a major milestone.

Calm down. I'm just echoing the idea that human behaviour is key. That's the case whether driven by anxiety, law, weather or something else.

Perfectly calm, just taking the time to be absolutely clear in the face of a very unclear comment, as there’s an awful lot of talking at cross purposes going on lately.

I’m trying (and it seems failing) to suggest that behaviour isn’t proven to be *the* key when it comes to seasonality.

If you put people in a vacuum, there would be no transmission.  The atmosphere is as critical a part of transmission as behaviour.  

There are lots of plausible mechanisms where-by atmospheric properties affect transmission.  For example, the mean lifetime of virus loaded water particles in the air, the rate at which wind drives indoor ventilation through openings, the inactivation of the virus by UV-C irradiation.

The weather factors that influence behaviour also influence the physical mechanisms.  This makes it very difficult to assign causality to specific factors.

That’s my point - it’s far from clear how much of seasonality is behaviour and how much is atmospheric physics. 

I think the demographic weather passband analysis strongly hints towards behaviour, although I haven’t a clue how to turn that in to a testable hypothesis.

I think you both seem to be saying very similar things, but with a different stress.

Wintertree puts things in a rather 'objective' phrasing, whereas Offwidth expresses his obvious (and entirely understandable) rage at the situation.

This was an apparently healthy larch,  I think these are effects of a nodal point for branches a bit further along the axis, but rather than investigate I just hit it with an axe a lot.  I got a 3-way split but there was nobody there to see it.

The last month has been brutal in revealing the scale of the ash dieback problem here.  I'm going to have to have a lot of pollarding and trimming done to prevent a buildup of unmanageable levels of dead wood.   Also got to find out who owns the ones overhanging from the roadside to try and get them to sort those out.  Looking at the amount of work this is going to cause along the roads, railways and power lines got me wondering about a change of career to tree surgeon; they're not going to be short of work for the foreseeable future...

More the discolouration than shape.

The heartwood is, of course, dead. But I suspect it has a fungal growth...

Would you like to remind me that fire is hot whilst you're at it?

Little is provable on the timescale needed for decision making so you use empirical observations that we have such as indoors vs outdoors.

This suggests to me that indoor atmosphere matters and outdoor atmosphere where transmission doesn't occur much doesn't matter much unless it drives people indoors. If I'm wrong we'll see outdoor clusters in countries with good contact tracing.

Would you like to remind me that fire is hot whilst you're at it?

Little is provable on the timescale needed for decision making so you use empirical observations that we have such as indoors vs outdoors.

This suggests to me that indoor atmosphere matters and outdoor atmosphere where transmission doesn't occur much doesn't matter much unless it drives people indoors. If I'm wrong we'll see seasonal growth in clusters of transmission outdoors in countries with good contact tracing. I don't think that's been observed.

No, but I would like you to try and grock the point I am trying to make rather than apparently arguing against something I'm not saying.

It's a point rooted in a lot of scientific literature on seasonality and flu, where people try and find evidence based ways to prove things to a scientific standard.  

This is a broken assumption IMO.

In a country like the UK, the indoor and outdoor atmosphere are far from decoupled.

Almost no houses use dehumidification or air conditioning, and indoor and outdoor temperatures are far from decoupled.  Most of the year many houses are unheated and their temperature is defined by the weather plus  energy load.

The weather affects air temperatures, humidity and air drying capacity indoors just like it does for outdoors.   Wind outdoors changes air turnover times indoors in many buildings, especially when ventilating by opening windows in accordance with CIBSE Covid guidance.  Following CIBSE guidance on both passive and actively ventilated buildings increases the coupling of indoor air and to outdoor air in terms of temperature and humidity.

The only weather related component that can be fully discounted using your logic is UV-C irradiation, because we pretty universally have windows made of glass.

I wasn't aware of talking about proving anything in relation to decision making, but about a potential aspect of the data to support our apparent shared hunch that behaviour is at the core of short term weather effects - and by extension seasonality - and not physical properties of the atmosphere.

I think we both think the same thing is likely here.  We can both posit this, but what I am interested in is how to use the data to prove that, because it's an important question to a lot of people for a variety of reasons.

I think the demographic breakdown is evidence in that direction.

What I don't know how to do is to progress what I've observed to a testable hypothesis.  Any ideas?

No, I don’t think we would, because outdoors the dissipation of virus laden water droplets through unrestricted diffusion and wind driven motion far outstrips all other effects except direct contact between people.  It wouldn't matter if the virus laden particles were dried up more slowly or faster because they'd diffuse away before causing infection, regardless.

This is why I think contact tracing data on indoors vs outdoors can't be used to resolve the unknowns in the literature on seasonality in the way you suggest.

Shows how much I (don't) know about trees!

What is provable in the future that does not inform policy now is not my personal interest. I'm more interested in what is unproven but might plausibly inform policy to reduce deaths now.

I'm sorry, the intent and message of your last five posts is completely opaque to me.  I really don't know where you're coming from or what comment you want to try and put across to the reply I made to AJM.  None what so ever.

Regardless of what may eventually be proved over the mechanism(s) linking weather, seasonality and the transmission rate of respiratory viruses, I don't see it having much feed through to current policy.  The policy makers have far stronger, far more evidenced and far more accessible levers to pull.  They aren't pulling them.  This discussion over what might be tentatively shown though the weather analysis is completely the wrong place to look for policy to reduce deaths now.  So I really don't know what you're looking for here, other than a chance to repeat that control measures work to reduces deaths.  Which we all know, and which we all agree on.

I’ve not paid attention to vaccination rates by age for different countries. I was assuming it’s similar but if we are indeed ahead in the older and more vulnerable cohorts, that would be a large part of the reason for us being in a relatively better position now. The only thing I recall seeing is that Portugal has been so efficient at vaccinating older people that they managed to vaccinate over 100% of certain age groups 😂

See the link in this post up-thread:

The devil, as they say, is in the details.

Indeed, for better or worse it’s going to be a big test of your theory. I do wonder if it gets cold enough to have the opposite effect, particularly among older people - not socialising as much in the first place, as opposed to socialising indoors. Plus the steady stream of bad news on the NHS front will make some people pause. We shall see… and bank any decay we get in the next few days.

Thanks, that link wasn’t working for me earlier so I wondered what all the fuss is about. That’s very interesting - not as high coverage where it matters but higher for people in their 20s and children. One might say misplaced focus.

Social demographic health and economic inequalities (with other factors no doubt) reflected in covid death stats reaching mainstream media:

https://www.bbc.co.uk/news/uk-scotland-59317484

Still annoyed that at the start of the pandemic the Scot Gov spent so much time shouting about protecting isolated and rural populations, when the populations that were most in need were obviously going to be multigenerational, multi occupancy areas of lower socioeconomic standing in inner city and suburban areas.  Complete deflection to avoid having to address the hard real challenge of covid in these pre-existing poor health areas.

We knew the lessons from previous generations respiratory pandemics that ventilation (picking up their heating bills and telling them to keep their windows open) and taking the infected out of these settings would be good practice, but the politicians North and South didn’t have the guts.  
 

Like you I’m amazed that ventilation has seen so little emphasis throughout.
 

If you look at Aberdeens very low covid prevalence in February it’s hard not to come to the conclusion that due to the city pavements (and most roads) being covered in sheets of ice that people stayed in and didn’t interact resulting in a very low transmission rate.

The downside was AE hard a surge of orthopaedic cases from slips, and the AE consultant on radio was saying if you go out pick somewhere safe ( he almost said ‘and if that means breaking the five mile rule so be it’, but fudged the last part of the sentence he clearly had initiated).

Or one might say <<pass sanitaire>>

https://ourworldindata.org/explorers/coronavirus-data-explorer?&Metric=...

Can you guess when it was announced? And which demographic responded best to needing it to go to the pub?

What surprised me with this are some suggestions that the inequality of outcome has got worse during the pandemic, although I suppose issues around misinformation and vaccine hesitancy can amplify that.  After a promising early start, the inequality angle had largely dropped off the media radar.  

There are some radio adverts now in England about it, both for households and for workplaces.  They're channeling the Spirit of Dark and Lonely Water, but not as terrifying.  But...

... what use is it telling people living close to the breadline to open their windows going in to a winter with exceptional and rising energy prices, if we're not going to pick up their heating bills?  I believe our LA are budgeting for a 50% increase in heating costs in schools this winter, and schools close for some of the coldest period. 

This looks like a massive missed opportunity to me; ventilation is a lever almost as potent as behaviour in many settings.  As well as the possibility for "Covid fuel payments", there's been a missed opportunity over the last 18 months to look at fitting wall mounted and duct-based MVHR systems where appropriate to private households at high risk, and supplying portable HEPA units where that's not possible.  You just have to look at the mould issues in a lot of households (and student accommodation blocks) to understand how insufficient the ventilation is - especially where there's been disjointed efforts to increase energy efficiency without thought for air quality.

In reply to Misha:

Yup, lost in the noise up-thread was a suggestion that Proper Winter would send cases in to decay because people would be stuck at home.  Well, in my case out running in microspikes with a sledge clipped to my harness' haul loop and a small child shouting at me to bark like a doggie.  It worked a treat last winter for exercise...

That and keep the boosters flowing as fast as possible. If my interpretations of recent weeks on D1.c are right, that's where a critical deciding factor lies in how this is going to pan out.

Some pre-emptive messaging targeting the vulnerable to repeat the importance of getting the booster "and until you do, here's how to stay safe during the enhanced risk the cold spell brings..."

Several people did say that here in the face of comments that the UK was failing by taking its time to evaluate the safety data over children, noting that vaccinating the more vulnerable is more important and that vaccinating children may compensate in the top level numbers but doesn't have the same effects...  I don't think they were listened to much, others just wanted to complain about things...  I mean, there's a lot to be unhappy with but it's also important to recognise and appreciate what has gone well, what it means, and to understand that the commitment doesn't just stop there.

Nationally heads have been expecting that 50% increase for over a month, unless there has been  a recent announcement, they haven't been given an additional funding. 

I worry it could all be academic; using non heat recovery ventilation across Europe as a covid control measure - suddenly much more in focus now it becomes apparent the state is actually worse in much of Europe - is going to dramatically raise the demand for gas.  Meanwhile, Belarus are threatening to cut off the pipelines transiting their border over what looks like an engineered crisis with Poland, Russian troops are massing on the Ukrainian border whilst they distract people with an utterly reprehensible ASAT test (*), and Nord Stream 2 has just today been pushed back to beyond the critical winter period.

Lots of different events that in isolation look like typical back-and-forth posturing but that taken together have me dusting off the winter readiness checklist.

* - seriously, ASAT tests above VLEO should automatically incur immediate and massive international sanction.  The risk they pose to space access is mind boggling, and the importance of space operations to terrestrial quality of life goes way beyond what most people realise.  I’m just staggered at this test beyond words.  Given the rapidly degenerating state of what’s left of the Soviet space program it’s almost as if they’re planning a scorched earth policy over use of space.

We've enough wood for about 4 years, so I think the responsible thing is to put the chainsaw away until spring at the earliest. 

I left mine away and got a professional in this year.  It seemed wise.

It was easy to design restrictions to protect rural areas and very low cost in terms of resources. All they needed was rules about not travelling to the highlands. There's not that many roads and not that many ferries.

They used the tool they had in the areas it could work.  Protecting the rural areas didn't make the response in cities any less effective.

Also, more remote areas do not have the provision of medical services of a city. Not many ICU beds for example. It could have been very nasty if large numbers of people started catching it.

Ah yes. Should have done it here but hey ho.

I do think we have been slow with getting to a view on vaccinating children but we had already jabbed the vulnerable well before thoughts turned to children. 

On international comparisons and hospital occupancy - can anyone explain the vast difference in the proportion of our hospital patients who are in ICU compared to most of Europe? Is this even partially real? In France's case it's also amazing how high the general hospital occupancy data is compared to the UK given their lower case rates, I think that must be down to significant differences in policy for keeping people in who are not very sick?

I cross-checked the owid graph for the UK against dashboard data.

I think it's due to the availabilty of ICU beds, most European countries have vastly more capacity per capita than the UK so use them rather than shunting seriously ill patients off to general wards.

You need to correlate against a third set of data.

Thanks, but I'd say it's more than that. Wintertree is in my view almost completely right about what he says on the covid data but seems to have got it in his head I'm trying to undermine him in some general way and I'm doom obsessed. I'm desperate for genuine good news, as it affects all our lives but I just think covid data is dropping down the list of the most important data to watch. Top of my list is national ambulance response times and local variations. What is most important is where hospital capacity is struggling. There is no indication that covid levels will drop fast, so wobbles, slight increase, flat or even moderate decrease, they will still be at a level where they are significant in bed terms and more so in covid infection control terms.

I feel I was a bit unfair and a bit dumb picking on that initial CFR use (but I'm not a mind-reader and didn't quite get what he was doing with the data until he explained in detail), yet the reaction led to some of the most interesting plots I've seen here. As well as clear evidence of testing system failures, it even gives really useful mortality information in that the comparative mortality risk of pre and post vaccination for age groups contain similar distortions (from actual mortality rate) so the ratio of before and after will be close to correct.

It's also important to watch other virus data.... so far, fortunately not so bad (as a bonus I think I've spotted the reason behind the weird Guardian age banded case plots from today's check of the latest pdf).

https://www.gov.uk/government/statistics/national-flu-and-covid-19-surveill...

I really think he is wrong on the heath politics. He is right that the major system problems were built in a long time ago but the same applied when Trust leadership shifted fast in hospitals to deal with the covid peaks with minimal government interference (even though waiting lists shot up, some of the most urgent non-covid work didn't stop... this was so impressive it was reward territory for me). Government have stopped trusting Trust leadership and are forcing ludicrous targets on them with threats of removing leadership ....the same idiocy that led to the Mid Staffs disaster. Roy Lilley is the best bell-weather on health management I know, as so many managers leak NHS idiocy to him and he publishes it and suggests real solutions. It's the government control freakery, bullying and blocking that is much worse under Javid that is the biggest threat to NHS function in my view (and Lilley's) right now and so there is a very obvious change the government could make to reduce Trust pressures. Let managers get on with difficult vital work without constantly looking over their shoulder.. Stopping attacking the dedicated people from CEO to nurse that we rely on is another. Stop Daily Fail style obsession on unvaccinated staff leading to a mass exodus in crucial understaffed areas is another. Plan B is another thing the government could do.  It's simply not true that there is nothing we can do to help. Battling with senior managers and staff in a public health crisis is just nuts.

*tap tap tap* is this thing on??

https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_52-... 

Also remember cases/infections is a different number for each country.

The definition of ICU level care varies between countries, and the thresholds for admission will vary significantly too, so it is difficult to make direct comparisons of rates. For example some kinds of non-invasive ventilation would be ward-level care for a respiratory unit here, but ICU elsewhere. 

If you have more beds, your threshold for using them will also be lower. 

Although, I noticed an article from over a week ago that said ICU beds in Saxony were already 85% filled by covid patients. So I'm pretty sceptical about that. (Also worth noting that UK covid ICu occupancy is currently only 25% of the January peak, so although general NHS services are under significant pressure, it's nowhere near enough that you would start downgrading where you put people to free up ICU bed space in large numbers.) In fact the bed space shortages are more likely on general wards because they can't discharge people to social care.

The only 3rd dataset I can think to use is weekly deaths per capita. This falls somewhere in between the other two datasets - UK was higher than most European countries through early autumn but already overtaken by several (including Germany) and noting that there is a lag of several weeks from hospitalisation to deaths. So it sort of implies part of the difference is real (a smaller proportion of UK hospitalisations lead to deaths, but not small enough to fully explain the observed differences in ICU occupancy.)

Edited to add more info.

I think that's a good example. 

LSRH - yes I haven't forgotten that. The question is really about whether there is anyone knowledgeable enough about the difference in definitions (as referenced by Mik) to be able to say how much of the difference (or all of it, or even more) they explain.

Latest..AZ decide its time to take profit on their vaccine: 

https://www.bbc.co.uk/news/business-59256223

It's a hardly a good look when it's the poorest countries that still need the most help. I wonder what the Oxford team will say about that.

Surely it's what you'd expect? The other providers have been making (very substantial) profit throughout. At some point, AZ need to justify their decisions on the vaccine to their shareholders. You'd have thought that by giving it away at cost they'd have gained significant reputational capital, but that hasn't happened because of the actions of the EU commission and because of people with political agendas like Tom. Unfortunately what they have got in return for their altruism is largely a slap in the face. It's not surprising they now want to see what profit they can make. If they charge too much then people will buy Pfizer instead... but I think that's likely to still be a lot more expensive.

Once the vaccine is no longer supplied at cost to poorer countries, the rich world needs to get it's act together and provide doses to those who can't afford them - not expect a single company to do it for them.

Perhaps the Oxford team read the article?

The jab will continue to be supplied on a not-for-profit basis to poorer countries.

I think that's because you seem to be brining the same over-interpretation to this that you did to the initial CFR stuff and European comparisons.  

I can't say this much more clearly....

I'm as appalled as you by the current pressures on healthcare and the ways their manifesting.   We seem to be in agreement on both the long term factors behind this, the direct impact of Covid and the indirect impact of more recent policy enacted around Covid.  I can't actually find any actual disagreement in this between us.

However, I am far from convinced that stricter Covid controls are a sustainable solution to this over the timescale of more than a few weeks - and we're not in to the historically busy time of year for healthcare yet.

Trying to hold Covid back in other countries through control measures far short of lockdown is failing in nation by nation with the onset of winter, and winter's barely begun yet.  It's becoming increasingly clear that it's either a choice of face much higher hospitalisation and death rates than the UK or to go basically to lockdown and suppress that potential.  I don't know how many more business or people could take three months of lockdown to suppress Covid over the winter, and this also goes on to undermine progress towards exiting this.

That I disagree over what the right measures are now doesn't mean I disagree over anything else.

• > and I'm doom obsessed.

Not doom obsessed, but if you look back at the various ways you've pushed back against what I've had to say recently - and then turned out to be wrong as the data develops - every time it was a case of my presenting a data driven counter-argument to others claiming the UK was X times worse than somewhere else, with my counter-argument showing why X was a massive over-reach (all-be-it still more than 1 at the time).  

I don't think you're trying to undermine *me*, but you've been giving some pretty strong push back to any analysis that paints the UKs situation as less doom laden than others were claiming.  You've generally acknowledged now that you've been wrong on the data with each of these.  Seems to me like you're being led by something else when this becomes a pattern of responses.  

Let's pick an example:

https://www.ukhillwalking.com/forums/off_belay/friday_night_covid_plotting_49-...

"What wintertree didn't tell you about that graph is it's not quite as startling as it looks"

Going back to your pantomime analogy, "oh yes it was".  Things have actually paned out far more rapidly that I was expecting, with  much less moderation of the exponential growth rate as case rates grow in many nations - almost everywhere on the chart is ploughing on towards record case rates and potentially record death rates.  

There are lots of indications that we're moving more towards decay than growth.  In England:

• Plot D1.c shows older adults being robust against growth in cases during recent cold spells, with increasingly strong decay in cases presumably tied to boosters
• Plot D1.c shows how growth in school ages and "linked" household ages is now only happening in the coldest spells with otherwise strong decay
• English hospital admissions are down ~12% in the first half of November
• English hospital occupancy is down ~15% in the first half of November
• English deaths are down ~25% in the first half of November

It's really interesting that deaths and occupancy are falling faster than admissions.  

Yes, it's too early to say if these recent trends will continue - they've been going on for about 3 weeks now - but the demographic data is I think very promising, as is the gradual downwards drift in the long-term rate constant for cases, as is the ongoing roll out of the boosters meaning the developing improvements to the demographic rate constants are not finished.

My worry is that all these signs of improvements under the top level data could be washed away by the cold spell.  As I've said, if that happens I don't think it can be long before signifiant restrictions come in.  

That's likely going to start mattering for flu if / when it kicks off, too.

As I've said before, my worries this winter are far wider than Covid, and that's one of the reasons I don't think short term suppression of Covid cases is going to fix this, and it carries a risk of recharging the pandemic potential to a point it break through the control measures and suddenly we have rapidly rising cases, slow political reaction to that and a situation developing akin to those in our neighbours, except without anything like the absolute per-capita capacity or realisable headroom in our healthcare.

The numbers for Sachsen yesterday at 9.50am were;-

Covid patients in ICU - 364

Patients invasively treated (breathing) - 167 (45.88%).

ICU beds occupied - 1188

Number of free beds -163.

Reserve free ICU beds - 684

So 27% of the ICU patients in Sachsen have Covid. For all of Germany 3400 Covid patients in ICU, (1716 breathing), 19,791 ICU beds occupied, 2439 free. Reserve 9392. Maybe review your news sources?

Nobody apart from poor countries wants it, even the UK isn't using it any more.

The end-user price is determined by competition between the Indian company who makes it and other low cost vaccine suppliers.  Giving the Indian billionaire who owns the manufacturer the vaccine IP for free where China and Russia charge for access to theirs will mean he makes a bigger margin.  The Oxford guys get to feel altruistic, the Tories get to do a favour which will eventually get paid back and the Indian billionaire gets rich.

Thanks for the data. I wasn't putting a huge amount of store by the 85% figure I had seen but it was obviously derived as the number of ICU beds currently occupied as a proportion of the total excluding reserve (now 87% according to your data.)

Interesting data in there - the 167 figure should be directly comparable with the UK figure. So in Germany we need to reduce the ICU numbers by approximately a factor of two to provide a fair comparison with the UK. That still leaves it higher than one would expect from a straight comparison of detected cases, but perhaps more in line with the deaths data. So back to Wintertree's CFR comparisons from a week or so ago (and the discussion over potential causes which LSRH has picked up on.)

I think you are massively overblowing some picky comments I made on specific detail on CFR and European comparison and unfairly linking that with serious NHS system concerns (very different to problems in western Europe). I'm pretty sure we have the same UK political concerns but I do seem to be in a small minority on these threads pointing out the big issues that stem from recent political changes under Javid (that absolutely were not seeded a long time ago) and that are making a bad situation a lot worse. They relate to covid as that is a big drag on NHS capacity and morale and the Javid foot shooting might lead to unnecessary damage to readiness for dealing with covid increase, if it happens with colder weather (especially if flu comes), and the other major NHS non-covid business which is even more certain to be negatively affected.

The existential exasperation based pantomime ploy wasn't really about you (you're one of many on these threads who get it)  it's more about most of the UK seems to be ignoring the massive elephant in the room: the parlous state of our NHS..... and that our politicians who should be trying to help in such an urgent major problem (as even tory ministers would normally do) are too often doing the exact opposite.

As a mixed children's metaphor the clothless emperor looks at a threadbare and shivering NHS and diagnoses they should follow his fashion example.

You'll no doubt have noticed that Sachsen has a third of the number of ICU beds compared to the UK despite only having a population of 4.1m.

I was in ICU ( in Bavaria) for 24hrs post-operative observation a couple of months ago and altogether 5 days in hospital for something which the NHS discharge you the same day for and if there are problems you call an ambulance! Comparing ICU occupation without looking at the availabity is meaningless, if more are available you can improve outcomes all the way down the system.

I'm not linking them to your concerns - which I share - over the NHS.  

I'm illustrating what I perceive as a rather non-evidence driven trend in your comments on the data as the Covid situation in the UK shifts.  Yes, there is a crisis looming, but the answer to that is not in denying what the data has been saying in increasingly clear ways.

Yes, I have clearly noted that I see a range of changes include those pre-dating Covid and those in response to Covid.  We have no disagreement here.  I get the impression you may have over-read a bit of my comment and are struggling to let go of that interpretation.  I can't agree much harder with you here.

I have noted that one change pre-dating Covid- cutting back the above inflation annual funding boost to the NHS - has clearly not helped, but also illustrates an elephant in the room.  Decades of above-inflation funding rise is not sustainable.  At some point we have to face up to this - now, for obvious and pragmatic reasons - is not that time.

Yes, I think we are in total agreement here.

The only area where I can find that we actually disagree - if I don't selective pick what I read - is over how much controlling Covid in to faster decay than we have now is going to fix the problem over the next four months.  If anything, the consequences of this are that I think the problems is worse than you do, because I see one less solution than you.

What's the going daily rate to lease out their fully-staffed services to a foreign nation?

Asking for a friend.

There's a few things I was totally unaware of before Covid that still surprise/shock me - one is the scale of uncertainty over population numbers, and another is how much better the levels of hospital provision are in many comparator nations to the UK.

Comparing hospitalisation and ICU figures is useful because, along with cases and deaths data, it gives insight into the different ways the pandemic is behaving in different countries that have taken different approaches to it. There is a need to interrogate differences between the data rather than blindly trusting it (hence my original post) but it's only meaningless without availability data if your objective is to find out which country has more headroom. That's not my objective.

Fwiw my personal experience of the NHS in the last few years (pre covid) is 'mixed' to say the least, so I'm certainly not in the business of trying to make it look better than its equivalents.

Good.

I still disagree on the last point. Despite all the detailed slushing around that adds up to a UK case rate looking broadly static, something that reduces R by a small amount is useful in improving a most likely (but not guaranteed) downward trend and I am pretty confident most of the population would have no issue with it. It would also help keep flu etc at bay until any growth is when the weather and NHS winter pressure is improving. It's something that is cheap and easy to do and is not a political U turn. Implementation now might look very good for them politically (an opportunity to claim success based on misunderstood  cause and effect) and if overall case decline does happen into December it might be a lot harder.

We can't undo the Care staff vaccine mandate idiocy. That will hit us hard this winter, as decline in care quality due to understaffing will increase admissions and decline in care capacity due to understaffing will increase bed blocking. Medium term (six months to a year) there is a real risk many care providers will go bust or pull out as meeting quality requirements in a staffing crisis is just too hard.

The February NHS staff vaccination mandate has too many front line staff looking to leave or retire already .... those who believe in such concerns are not so stupid they will wait to look for new work so long as to risk unemployment (some will be forced to jab but those will be the ones least able to find work elsewhere).

The dangers of government press control and target based threats to Trust leaders and GPs need to be much more widely known. The government could be forced to U Turn if the establishment checks and balances still have any remaining embers of hope. The best chance we have for temporary system fixes is in leaving Trust management to get on with implementing as much good practice locally as possible (this can't all be done top down from the state as each Trust, and GP provider, has different issues).... as per what Roy Lilley points out in the copied post above, and in other areas too. This worked very well before at the 2nd covid peak and it could now if they were allowed to get on with it.

If health care spending was increased by 50%, to bring it in line with Germany (per person), I would expect to see significant improvements.

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

I am not sure the NHS staff vaccination is as much of an issue as you make out.They did the same in France with their nurses etc  and despite similar concerns along your lines( ie its going to be disastorous and lots will leave.), there were very few who remain unvaccinated.Its probably why the UK Gov has made it compulsory, experience elsewhere suggests its not going to be a that much of an issue.I believe it was the same in the USA for example.In effect when push came to shove they get vaccinated.

Social care is a different kettle of fish.

Only if there are considerably more Drs and Nurses.Does not matter which way you spin it.You are alreay 100,000 or so short of nurses a on existing funding so the funding is already there but there is nobody to spend it on so to speak.

I agree, I have been part of ineffectively throwing money at a problem in education, without the staff to implement it. Although perhaps throwing money at the care sector now might have more immediate benefits. 

It was more that presumably those levels of funding have roughly been in place for years if not decades, which is why they have more doctors, nurses and ICU beds now. 

France didn't have a massive staffing gap and have more replacement sources for vaccinated staff (ditto for the US) and their workers are generally treated better. 

I am not sure that is the case in France I recall reading articles about recent ( this summer) medical staff  strikes in Paris etc.

Workforce planning is the weak point. Listened to Hunt about his battles with Treasury trying to get them to up their funding for training Drs. And now the price is being paid for decisions made a good few years bac.

I'm not surprised that it might be harder to make a case for additional control measures against Covid if Covid cases, admissions, occupancy and deaths continue to decline.

I'm hesitant to appeal to common sense here because that's rarely an honest tactic, but I am otherwise out of ideas.

If the cold weather brings sustained growth in ages susceptible to hospitalisations, that could all change remarkably quickly.

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

Might be of interest. Only goes to end of September but the cumulative mortality comparisons further down the page show some very interesting patterns in terms of how different countries or clusters of countries have fared. The different shape of Cyprus and the Nordics excl Sweden is quite striking.

Thanks for that; I really like figure 6.  Striking contrasts.  Will be very interesting to see a version in a couple of months time.

In reply to thread:

Almost back to decay in English cases by a week-on-week measure with today's data update.  Looks like cases in 60+ will have remained in decay throughout this wobble - big development that the most vulnerable part of the demographic remained in decay.  I haven't yet seen any longitudinal analysis showing that the boosters are behind this shift but it seems likely... 

Not shown but English hospital occupancy has seen a week-on-week decrease at a level only seen at one other point (about a week ago) in the last 45 days.  Not unrelated to hospital admissions having fallen week-on-week at a similar standout level with today's update.  In both cases they look like there's better to come tomorrow.  Will be very interesting to see how the weather wobble now closing out translates in to hospital admissions.  

Feels like we're within a gnat's whiskey of holding off against persistently rising cases when the cold front lands less than a week from now.  I was wondering what that cranking down of the temperature is going to do to the various European nations who've already seen a persistent return to rapid exponential growth.  Palpable tensions over what's coming.   

Yes, me too in terms of figure 6.

Yes, the news from across Europe today makes for dispiriting reading - more "lockdowns of the unvaccinated" in Germany and other places, Austria moving towards full lockdown - feels very much like ominous dark clouds are gathering...

I hadn't read the news today - just catching up.

Indeed.  

What's really interesting for me is that these nations are coming towards the point of lockdowns.  That this was coming should have been very clear to their scientific advisors over a month ago now when the exponential rise signal started to emerge from European cases data, and yet none of the governments for the "leaders" in this process are acting with enough urgency to keep things away from their healthcare redlines it seems.  None of the "followers" seem to be trying to swerve from this course.  

It's enough to make one pause and wonder exactly what the plan is...

Not entirely unrelated - an updated CFR plot using the most recent OWiD dataset; "reasonable bounds" mean those encompassing values computed on 7-, 14-, 21- and 28-day lags.  The role of this is contextualising the difference in case rates between countries is fading as the situation escalates to the point it's headline news. 

Up to a point - you can certainly be kept in hospital too long and exposed to noscomial infection etc.

You've been squinting at your own charts too long. Step back and look at the raw data not the analysed to f*ck wintertree data. If anything the UK story since the trend changed in July is a slowly rising trajectory with a lot of bouncing about.  It is reaching to call a line that is going up slowly descending.  The number of people who are catching Covid in the UK without any sign of restrictions is absolutely f*cking mental, it's like they were trying to get everyone infected.

https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelect...

You are being a really unpleasant prat here Tom.  I try to be patient, I really do.  

I look at the raw data.  It literally headlines every thread I do, and when I do analyses every notebook with the plots starts with the raw data.  I never post an analysis without looking at the raw data.  That's how I avoid looking like a totally incompetent fool by, I don't know, doing as you did and cherry picking two different days of data subject to a false low (for the foreign nation) and a false high (for the UK, surprise surprise) caused by day-of-week effects leading to an accidental bias painting the UK as 5x worse than it is.  Because that would be a monumentally embarrassing thing to do if I wanted to retain any shred of credibility.

Every single plot I do on anything starts with raw data, and I take my interpretation back to test against the raw data.

This thread started with it - the very first plot, 6e, is raw data and a basic trendline.

I was talking about the rate constant over the last two months, not cases since July, but ho-hum.  Let's mix completely different things and hope nobody else notices.

The rate constant has been positive but slowly descending.  That means cases are going up most of the time.  The wobbles are linked to the weather - a robust scientific method shows that.   The baseline under the wobbles looks to be descending towards decay; it's got there now.  It's about looking at where we're going as well as where we are.  That decay held for the oldest and most vulnerable during the latest weather wobble.  We're seeing the most rapid decay in admissions, occupancy and deaths in 45 days.  Not over-analysed, just the most basic week-on-week comparisons.

That is what is happening now.

I have said quite clearly I'm worried it won't hold when the cold spell comes.

I can't help you if you just want to point at a very limited measure of the situation and make a lot of noise without seeking any sort of understanding.  I've tried to be as clear and methodical as I can in showing what I can.  You don't want to know, end of. 

You keep on coming back to the top level case rate in the UK - an almost totally meaningless number for comparisons.  It captures little of the massive change going on within the UK over that time, and it is entirely flawed for international comparison.  Look at the CFR plot a few posts above - the relationship between cases and deaths varies by a factor of ten across Europe right now, with the UK having a stand-out low CFR across basically the entirety of Europe. 

What do you see in Plot D1.c Tom?  I'm not after your input because I need it (you had this bizarre suggestion I pay you a low consultancy rate to analyse it for me, if you recall) but because I want you to engage your smarts, look at it and tell me what you see - because I want you to think about it, for yourself.

Have you seen what's happening in the rest of Europe at the moment?  Lots of people are catching Covid despite more restrictions, and going off the CFR analyses and death rates - because case rates alone are almost meaningless - a lot more people are now catching Covid elsewhere and that number is rising exponentially by the day.

It looks like more restrictions over the last few months weren't a solution but a deferral, and winter is coming to collect. 

If I take the OWiD link you posted on case rates, it shows the UK has having ~4.5 times as many cases at the Germany 3 weeks ago, about when deaths happening now were being locked in.  If you switch that page you linked to death rates, it shows that today those locked in deaths passed the UKs yesterday.  If this doesn't explain to you the utter naive foolishness of comparing the case rates, you are beyond any interested in understanding.   Case rates have almost tripled in Germany since then - what do you think is about to happen to their death rate?  I've been cautioning you for weeks about cherry picking one moment in time to compare nations, and now that this is - awfully - playing out in the data you can't bring yourself to acknowledge it, nor the likely reasons why the UK is not (or, worrying, not yet) seeing a loss of control of cases unlike much of Europe.  

Do you know, I've had a lot of grief over the last year for these posts.  It started with people accusing me of fear mongering, demanding a single life be saved at all costs, having no understanding of the cost of lockdown, all sorts.   As the times change, different broken clocks come in to and out of their time and, upon reflection, I think you have been the stand out worst of the whole lot, by a long way.   I say that despite agreeing with you on a lot of core points.

I predict any minute now someone will excitedly post a link to an article that draws a conclusion without attribution from a paper that contains the following words, that have somehow got past an editor without them spitting out their coffee:

"Overall pooled analysis showed a 53% reduction in covid-19 incidence (0.47, 0.29 to 0.75), although heterogeneity between studies was substantial (I2=84%). Risk of bias across the six studies ranged from moderate to serious or critical"

It says there will be tiered pricing and it will continue to be supplied on a not-for-profit basis to poorer countries. Not really a big deal.

I’m with Offwidth that plan B type measures would be sensible and not burdensome. Any reduction in pressure on the NHS would be a good thing. Not just from Covid but from all respiratory diseases. With our current levels of immunity, I’d be surprised if pushing down cases now would create significant problems later. In any case, the NHS should be in a better position to deal with it in spring. 

Politically, a lockdown would be very difficult now anywhere with decent vaccine uptake - until it gets so bad that there is no choice (even then, compliance would be poor I suspect). On the other hand, a lockdown of the unvaccinated (or a quasi lockdown through extensive use of Covid passports) could shave broad support. So it’s perhaps surprising that these measures weren’t brought in earlier. Just goes to show that it’s not just our government which hasn’t learned its lesson…

No, actually, you don't. You tend to lecture and you never concede anything no matter how convoluted your argument has to get.  I started out trying to play nice, but I got fed up with it and now I'm not. If you don't like it don't post star trek memes and consider that sometimes you might be wrong.

You are talking about the rate constant over the last two months, I'm talking about the shape of the raw data and that curve changes in July.  I get to choose what I talk about.

I find the cases per million data more interesting than the rate constant because I don't think it is behaving exponentially in the UK any more due to vaccination and previous infection.  Always looking at the rate constant means you lose sight of the absolute value.

'It isn't growing as fast in the UK' needs to be put in the context of 'because the level of cases we are running is already so high it has pretty much limited out'.

The key feature of the UK graph isn't the rate of growth it is just how long we've been running such high case levels.  Germany is going up really fast but they already announced restrictions, it is probably going to fall again where in the UK we just leave it high and let it burn through the whole population without worrying too much.

Given that the death rate per million over the whole pandemic for the UK is just a little less than 2x that in Germany one of the reasons the UK will have a low death rate  / case now relative to other countries which did not screw up so badly in the earlier part of the pandemic is that many of the really vulnerable people have already died.

Germany clearly has some problems of its own particularly in the east where vaccine resistance is associated with the same right wing views as in the US and the UK.

Also, it is not just about death rate.  IIRC there's 900k long covid cases from about 11 million Covid infections. If we keep going at 40,000 new cases per day we will be adding 3,272 new long covid cases every day.

As an engineer, you should be able to understand the data. Yes, cases are relatively high. They’ve been oscillating within a range since the end of the August peak. The demographic composition has shifted over time and the headline numbers are mostly impacted by cases in children. Significantly, there hasn’t been much change in the case numbers for over 80s - so it’s not surprising that admissions and occupancy are reducing. As of today, headline cases are still growing but the growth is slowing, which is what the rate constants show. If it wasn’t for the cold spell coming up, we might have seen some reduction in cases. The reality is that cases will continue to oscillate until March or so. Not good but could be worse.

Macron has said he doesn’t think extra measures are required because the countries now seeing an outbreak are those which didn’t implement a Covid pass (which France has had since the summer I think). He has a point. Italy also adopted Covid passports a while back and a few weeks ago extended this requirement for all jobs. I’ve not heard much about France or Italy in terms of healthcare pressures (appreciate that this doesn’t mean they aren’t having problems).

As an engineer I understand the data fine. 

The high level summary of the UK data is that the absolute value of cases is way too high compared to comparable countries and the trend is slow growth.  Not only are the absolute numbers extremely high this week but they've been allowed to stay that way for months and government is making clear no attempt is going to be made to reduce them.

The UK government likes to gamble and this is another gamble.  They are assuming that infection will provide long term immunity and they are assuming that the millions of people who will get long covid and other Covid related and ICU treatment related syndromes if this policy of letting everyone catch it continues is not going to result in a huge loss of labour and an ongoing drain on the NHS.  

Germany had passes though, and were pretty strict about checking them, plus high compliance with (medical) mask wearing. 

According to a brief Google Italy is heading towards a lockdown of/extra restrictions for the unvaccinated, which implies it isn't plain sailing over there.

Edit: looking at WTs case rates graph above, France looks to be about a doubling time away from the back of the pack that Germany is in now, maybe a doubling time and a half from the rates the UK and Germany are currently on - which on current doubling time is about 2.5 weeks, something like that? Maybe their system is more robust to high cases than Germany's or ours, or something.

I don’t think that you do.  

I try and explain, you either make a point of replying whilst telling me you don’t read what I write, or you make bizarre demands for consultancy pay to look at the path to understanding, or you call me a corporate fanboy, or write me off for being English, or you start forthing at the mouth about tories, occasionally you descend in to full in racism against the Indians, I could go on.

Tell me what the CFR plots above mean.  The one that has so much variation in it that it works best on a log-x axis.  Tell me what it means for comparisons that the UK has the stand out best (lowest) value of all of Europe.
 

Wintertree says pride cometh before a fall.

France has held out for longer against exponential growth but it’s clearly yielded over the last 10 days or so of data.

Another good reason not to be proud of where we are in the UK, just hopeful…

Edit: France is starting from a good place compared to the UK in terms of all key values, they’ve got a lot more headroom for growth before they hit problems.  Italy, not so much.

*tap tap.... tappy tap* 

All but one: vaccinated pensioners (if we pretend denominator issues cancel out. We'll find out soon whether they do). There's a bit of time to fix that but not much and it's not looking like there's the will.