'Herd immunity'?

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 bruxist 23 Sep 2020

Can anyone point me to a serious, informed discussion of the im/possibility of 'herd immunity', please? I haven't seen one yet, but every time I try to run the figures, I simply cannot make them reach anything like the proportion of the population needed.

The best I can do tops out at approx. 15% of the population before we run into a 'Red Queen' situation, with those infected losing their immunity at the same rate as those who are gaining it, assuming immunity lasts 1 year. And in the very unlikely case that immunity is lifelong, I calculate it costing the lives of nearly 5% of the UK population over the next 4 years, dramatically reducing life expectancy of the rest, and still not giving us herd immunity in that period.

I'm not a statistician or epidemiologist, but it seems weird to me that the notion of herd immunity is still part of the conversation. Maybe the herd immunity proponents are thinking over a much longer timescale - something like Jacob Rees-Mogg's "50 years to see the benefits of Brexit" - but if so, I haven't seen any acknowledgement that they're doing so.

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gezebo 23 Sep 2020
In reply to bruxist:

This weeks  life scientific on R4 discussed it briefly yesterday evening. Apparently one or two boroughs in London are possibly close to achieving herd immunity. 
 

It was worth a listen. 

 Neil Williams 23 Sep 2020
In reply to gezebo:

London is probably the live experiment - it had far more cases than elsewhere, so the question is what will happen now?  A delayed kick-off like elsewhere in the country, or something far more subtle?

 MG 23 Sep 2020
In reply to bruxist:

> And in the very unlikely case that immunity is lifelong, I calculate it costing the lives of nearly 5% of the UK population over the next 4 years,

How do you get to 5%?

 MG 23 Sep 2020
In reply to Neil Williams:

Brazil is probably a better place to look. Cases are falling, but slowly.

 skog 23 Sep 2020
In reply to bruxist:

I'm not a statistician or epidemiologist either, but we've been told that we're likely to have herd immunity when about 60% of the population is immune to covid (as far as I can remember).

We could beat that by vaccinating 80% of the population with a vaccine that's 80% effective.

And if we retain some measures that make it harder for it to spread, we can lower that threshold a bit.

It doesn't sound unachievable, but we're not going to have it for Christmas!

gezebo 23 Sep 2020
In reply to Neil Williams:

Maybe. I’ve not followed it all very closely for a while. Maybe other countries would be a better experiment to study? 

 wintertree 23 Sep 2020
In reply to bruxist:

I think that it is too soon to know if the various immune responses that a person develops to Covid are usefully persistent over long time periods, and it is too soon to understand how mutation rates affect immune responses especially with the t-cells which seem to have a much broader response than anti-bodies in terms of what they key to.  It is too soon both because there has not been enough time for the natural processes involved to play out, and because there is not yet widespread testing of t-cell immune responses so we haven't established a baseline level let alone had time to see if individual responses decay from the baseline over time or not.

My hope is that by the time the situation has played out to the point we know with some certainty that infection-induced herd immunity is or is not achievable, both vaccine development and clinical care have come far enough that it's a moot point.

My long standing issue with the more noddy Markov SIRI models is that the infected and immune states likely both relate to the viral load that caused the infection, and a Markov model can't incorporate that; or in other words many of the people only mildly infected don't go on to develop useful immunity and so will undergo periodic re-infection until a response builds up or they get it bad enough to develop immunity, which would significantly shift the rates for long term disability and death.

All just spitballing though and I'm not a statistician or epidemiologist either.

 kaiser 23 Sep 2020
In reply to bruxist:

Best plan is just to  pull the duvet over your head and hibernate for 30 years until it's all over

1
OP bruxist 23 Sep 2020
In reply to skog:

Exactly. I've been working my figures out on 65%. What I'm more concerned about is the proposition of herd immunity without a vaccine. It keeps cropping up on the forums as a possibility, but I don't think those proposing it have a viable argument for such immunity being achievable without a vaccine, and I'd like to see what the argument for such a possibility is.

 Billhook 23 Sep 2020
In reply to skog:

Getting free of the virus isn't  achievable in the medium to long term either at the way we're managing so far.

Far too many 'ifs, 'buts', 'maybes', 'perhaps', 'could', and so on.

By the time we get on top of this virus won't be any month soon.  And the economy will get worse and worse.

I"m all for herd immunity. It won't go away on its own. And I'm one of the crumblies that are "Vulnerable" according to the bean counters who have decided that I need 'protection whether I want it or not.

According to theBBC news this evening there have been more deaths in the last 6 months from common cold, Flu and pneumonia than those caused by Covid..```

And still the population in the UK increases. We are going to have to face up at some time within the next year that the virus is not going to disappear as long as there are reservoirs of Covid elsewhere on this planet and we allow people to travel to and from these countries.

It might also help those bean counters who care only about statistical information, that we can't prevent people from dying from every virus or bacteria on the planet.  We might just have to accept that people die every minute of every day from flu related causes and pneumonia even though they've been around for many  years and we might just have to add this virus to the list.  

We may think we're the top of the food chain but this and many other virus and particularily bacteria will win in the end.  Even if you die of something else, unless you are cremated its the bacteria who'll be having the final meal.  You! 

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 MG 23 Sep 2020
In reply to bruxist:

> Exactly. I've been working my figures out on 65%. What I'm more concerned about is the proposition of herd immunity without a vaccine. It keeps cropping up on the forums as a possibility, but I don't think those proposing it have a viable argument for such immunity being achievable without a vaccine,

I don't think it's a helpful term in that context.  The idea that we accept we can't control the virus without destroying our way of life but will have to live with it (until  a vaccine works) is different.  In this case we accept it is endemic and people will die from it.  Not nice, but arguably better than hiding at home for years. Sweden seems to be trying for this.

1
cb294 23 Sep 2020
In reply to bruxist:

Herd immunity, pah.

The virus will go away because of herd mentality, or so the orange piece of vomit claims.

CB

2
OP bruxist 24 Sep 2020
In reply to MG:

Sorry! My bad - that should read .5% (to be clear, somewhere around 350k, though I know Imperial's model still states 500k+, and I'm not sure how they arrive at that figure).

 Si dH 24 Sep 2020
In reply to bruxist:

So. I agree that herd immunity of the whole population is a pipe dream and trying to achieve it would result in many unnecessary deaths.

However I am beginning to wonder if herd immunity may be reached over the next few months in populations who are at increased risk than most of us of actually catching it, but who are also less vulnerable and not taking as many personal precautions. Primarily school children, students and to some extent others in their age groups.

Is it beyond the realms of possibility that herd immunity is reached in these populations over the next few months given how much the virus is clearly capable of spreading in the right environment? If it happened, it would not protect wider population, but if we then got the peak down again by other means it would make us less vulnerable to a subsequent resurgence through those groups.

I'm not advocating this as policy by the way. Although the current student hall isolation situation almost seems like it might have been designed with this in mind.

Post edited at 19:53
OP bruxist 24 Sep 2020
In reply to Si dH:

Yes, I see what you're getting at. And I can imagine some sort of localized effect - though at a great cost - emerging in subpopulations. With under-18s only accounting for 21% of the whole population, though, it seems impossible to get to proper herd immunity; even if we include everyone under 40, that's still only 50% of the population. As Wintertree points out above, there are still a lot of unknowns about how long immunity lasts, but I don't think these prevent us from modelling the possibility of herd immunity using assumptions based on natural immunity to other coronaviridae.

My hope was that someone was aware of a public model using such assumptions. With so many people saying that they're all for herd immunity in this and other threads, it would be useful to be able to point out what the likely cost of such a policy would be, and whether or not it's even a viable strategy. And if, as I reckon, herd immunity is like you say a pipe dream, it's terribly unfortunate not just for those who buy into it but for everyone.

 DancingOnRock 24 Sep 2020
In reply to bruxist:

They’ve tested SARS patients after 17 years and they still have an immune response. 
 

There’s a city in Brazil with 1.8m people, name escapes me. They reached herd immunity at around 1 in 500 deaths and estimated 44-66% infection. The age distribution of people was much younger than the U.K. and less underlying health issues. Estimates using those figures with our age distribution and underlying illness levels are that 1 in 1000 would die in the U.K. before herd immunity is reached. 
 

Their health system collapsed and they were shovelling bodies into pits. 

Post edited at 21:07
 Neil Williams 24 Sep 2020

Do you mean 1 in 100?  Because 1 in 1000 means 60,000 deaths in the UK, which we have exceeded already, haven't we?

 DancingOnRock 24 Sep 2020
In reply to Neil Williams:

 The U.K. figures are much lower than that. Lots of our figures include people ‘with Covid’. 
 

Edit: Yes. Sorry. One in 100. 

Post edited at 21:11
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OP bruxist 24 Sep 2020
In reply to DancingOnRock:

Manaus? Yes - really interesting situation. But that's an area where dengue is rife, and after the news about prior dengue infection having a protective action against SARS2 I'm loth to draw any comparison. Pleased as punch for them though - anything that's going to help Brazil is good news.

 wintertree 24 Sep 2020
In reply to Si dH:

> I’m not advocating this as policy by the way. Although the current student hall isolation situation almost seems like it might have been designed with this in mind.

It is tempting to speculate, isn’t it...  

mattmurphy 24 Sep 2020
In reply to wintertree:

So I did a little experiment on immunity.

When lockdown hit I moved back home from London and moved back in with my parents.

My mums a nurse practitioner in a midlands hospital and the whole family got covid.

My brother is doing a phd down in Bristol and his housemate tested positive for covid and he had covid symptoms. I drove down to Bristol and took him back to the family home.

We’d all recovered from our covid symptoms but I got my brother to lick his hand and then I licked his hand - a bit gross, but I don’t care. Anyway I didn’t get ill.

tldr - once you get covid you’re immune 

Post edited at 21:35
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 Jon Stewart 24 Sep 2020
In reply to mattmurphy:

> We’d all recovered from our covid symptoms but I got my brother to lick his hand and then I licked his hand - a bit gross, but I don’t care. Anyway I didn’t get ill.

> tldr - once you get covid you’re immune 

Err. Would I be correct in the assumption that you haven't trained in the sciences, or even got a GCSE grade A-C?

1
 elsewhere 24 Sep 2020
In reply to DancingOnRock:

>  The U.K. figures are much lower than that. Lots of our figures include people ‘with Covid’. 

If UK covid figures are much lower than 60,000, what else came along in 2020 but not 2019, 2018, 2017, 2016, 2015 etc to cause the 60,000 excess deaths in spring 2020 and why did it plateau and decline in the way Covid deaths did?

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

<iframe height="1618px" width="100%" src="https://www.ons.gov.uk/visualisations/dvc989/fig1/index.html"></iframe>

Post edited at 22:21
 wbo2 24 Sep 2020
In reply to bruxist: can you show/explain the maths of how you're doing this? 

cb294 24 Sep 2020
In reply to mattmurphy:

You are a biology student? Seriously? Maybe time to look at a career in voodoo or homeopathy.

CB (professor/lecturer in biology)

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cb294 24 Sep 2020
In reply to DancingOnRock:

They also tested other SARS classic patients, and they had no detectable immunity after a couple of months. Correspondingly, there have also been rare cases of SARS2 reinfection that have been confirmed by sequencing the viruses and finding diffent strains.

Coronaviruses generally specialize in suppressing the formation of immune memory, whether they succeed or the body manages to generate immunity probably depends on factors such as which tissues are infected first, with which viral load, etc.. Indeed, there are other coronaviruses causing seasonal cold, which only works if immunity in general does not last until next winter.

The good thing, though, is that immune responses can in principle fight the infection, and vaccine induced immunity (where the viral processes suppressing immune memory formation are absent) is therefore much more likely to work.

I agree that aiming at herd immunity by deliberately letting natural infections spread through the population until the pandemic burns out almost amounts to mass murder. We definitely do not want to recreate the Brazil scenario in our ageing societies!

CB

 tom r 24 Sep 2020
In reply to bruxist:

> Manaus? Yes - really interesting situation. But that's an area where dengue is rife, and after the news about prior dengue infection having a protective action against SARS2 I'm loth to draw any comparison. Pleased as punch for them though - anything that's going to help Brazil is good news.

That's interesting. I heard about the differences in covid infections in the old areas of west and east Germany the other day. One mooted explanation is because of the different vaccination programs for various things, I think in the East it was mandatory. This discusses it in reference to the BCG vaccine.

https://voxeu.org/article/bcg-vaccine-does-not-protect-against-covid-19

Post edited at 23:21
 munkins 24 Sep 2020
In reply to Jon Stewart:

> Err. Would I be correct in the assumption that you haven't trained in the sciences, or even got a GCSE grade A-C?

I think it's a joke. A good one.

 DancingOnRock 24 Sep 2020
In reply to elsewhere:

It’s around 50,000. 

 elsewhere 24 Sep 2020
In reply to DancingOnRock:

> It’s around 50,000. 

53000 excess deaths in England alone.

5000 excess deaths in Scotland.

Close to 60000 in UK.

If UK covid figures are much lower than 60,000, what else came along in 2020 but not 2019, 2018, 2017, 2016, 2015 etc to cause the 60,000 excess deaths in spring 2020 and why did it plateau and decline in the way Covid deaths did?

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 Toerag 25 Sep 2020
In reply to MG:

> How do you get to 5%?


I suspect by looking at what happens to the people that are currently being shielded.  People are currently saying the virus' kill rate is lower than we thought it was ("it's getting weaker, cases are rising but the death rate isn't"), but they're forgetting that a) it's being kept away from the vulnerable and b) the viral loads are way lower now than they were in the spring.  The kill rate should be calculated by looking at the kill rate for each age group and multiplying that up by the percentage of that age group in the demographic.  The classic is the care home scenario - there were regularly news articles about homes with 20%+ of their residents dying from it.

 Toerag 25 Sep 2020
In reply to bruxist:

Is this page of any use?

https://ncase.me/covid-19/?fbclid=IwAR2HZf861gE1FTABtzbeKkKi1Mf4jXTtArEYS_v...

I think you're probably right - herd immunity is impossible without crashing healthcare. I wrote this on another local forum yesterday:-

"To achieve H.I. you need to infect 80% of the population because it's so infective. You need to do this before the virus has had a chance to mutate and render people's immunity void. We already have people who have been re-infected by a different strain to their original infection, so let's say immunity lasts 6 months. This means we'd need to infect 50,000 of our 65,000 population within that time - 8,333 per month or 277 per day on average. Let's say 1% need hospital treatment, that's 3 people per day. People requiring hospital will remain there for a fortnight, so that means 42 beds, which is more than we have. We also need to keep this up for 6 months solid without the rate dropping (or we won't infect fast enough) or rising (or people will die due to lack of beds), and without our finite numbers of hospital staff becoming ill or dying. Do you think we can control the spread that accurately? Then what happens is the virus mutates elsewhere in the world and we import the new strain we're not immune to and it all kicks off again. Oh, that 1% needing hospitalisation? That only refers to the young people currently spreading the virus, the vulnerable are massively more likely to require hospitalisation - an 80yr old is 400 times more likely to need it that a 20 year old. What percentage of our population are vulnerable? 20% are elderly, 40% are obese, ??% have medical conditions like diabetes or heart disease. We would kill plenty of people."

1
 Jon Stewart 25 Sep 2020
In reply to Billhook:

See if you can get your head around this:

The policy makers don't care if you live or you die. They're not trying to save your life.

They care about their own survival. They care about the economy. They can't serve themselves without a functioning society, and that depends on the health service and people going to work. That's what they want to save.

Not you! 

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 summo 25 Sep 2020
In reply to Toerag:

> We already have people who have been re-infected by a different strain to their original infection, so let's say immunity lasts 6 months.

What percentage of people have caught it twice? 

Immunity could be years, look at the numbers of cases and deaths in Vietnam and Thailand, they've likely got lingering T cell immunity from something milder previously. The body doesn't constantly have covid antibodies patrolling(they decrease slowly after initial infection), it only retains the knowledge to generate them if a covid19 strain was encountered again in the future, so you could argue everyone is constantly being reinfected, only the body's response is so fast you don't notice. 

 MG 25 Sep 2020
In reply to Toerag:

It doesn't have a 5% mortality rate, as Bruxist acknowledged. It's just a starter plague really!

 Si dH 25 Sep 2020
In reply to elsewhere:

> 53000 excess deaths in England alone.

> 5000 excess deaths in Scotland.

> Close to 60000 in UK.

> If UK covid figures are much lower than 60,000, what else came along in 2020 but not 2019, 2018, 2017, 2016, 2015 etc to cause the 60,000 excess deaths in spring 2020 and why did it plateau and decline in the way Covid deaths did?

I thought the number naming Covid on the death certificate was something like 50,000 odd though? That should be pretty comprehensive and will no doubt include some suspected Covid cases that weren't, as well as missed cases that were. The total excess deaths is the best way to measure our overall response but not the best way to measure virulence of the disease. It will include the effect on lots of other mortality due to the pandemic. Eg people dying because cancer or strokes are not diagnosed or treated on time, people in care homes dying essentially of loneliness with nothing left to live for - there will be others but I am sure those three alone will be big numbers.

 Michael Hood 25 Sep 2020
In reply to Si dH:

Effect of the covid pandemic = excess deaths, pretty definitive

Number of deaths due to covid = ??? difficult to say

Probably more than the government "within 28 days" number. My gut feel is that the ONS "mentions covid" figure is likely to be near since "mentions covid but death mainly from something else" is going to be balanced by "died from covid but not recognised". How good that balance might be is likely to be even more difficult to determine.

As always, "there are lies, damned lies, and statistics" 😁

 neilh 25 Sep 2020
In reply to cb294:

Brilliant reply. best yet

In reply to Toerag:

Excellent link. Should be required reading for everyone. We had tv schedules interrupted across channels to hear Boris chunter on with variants of his usual cliches. How much more useful would it be to show this in a prime slot across major tv channels...

 Neil Williams 25 Sep 2020
In reply to Jon Stewart:

> They care about their own survival. They care about the economy. They can't serve themselves without a functioning society, and that depends on the health service and people going to work. That's what they want to save.

You speak as if that's isolated from your life.

If the economy crashes big style:

 - You lose your job and can't put food on the table

 - The NHS collapses as we can't afford it

 - Crime increases as people steal to feed their families

 - Your pension disappears, as you know that "fat cat" housing developer?  It was invested in them

The economy HAS to be considered - it's a careful balance - because the economy itself means lives as well as the disease.

If you're happy for there not to be a "functioning society" at the end of this, but that's all good as one more life was saved (only to die of a preventable disease because there was no longer free healthcare), then I'm glad you aren't in charge.

Post edited at 09:20
 Offwidth 25 Sep 2020
In reply to DancingOnRock:

You need to do some better research. Manaus was absolute hell with a complete breakdown of the health system and no one has a clue how many actually died there from C19 as most deaths didn't go through anything resembling a system.

Also learn some science, immune response is not the same for every virus: what some outlier scientists like Prof Gupta have claimed about it for C19 is provably wrong and what is known right now is far from being as comforting as you present it.

Unlike flu we have a large percentage of people if those who don't die that end up with long term serious health problems.

 elsewhere 25 Sep 2020
In reply to Si dH:

> I thought the number naming Covid on the death certificate was something like 50,000 odd though? That should be pretty comprehensive and will no doubt include some suspected Covid cases that weren't, as well as missed cases that were. The total excess deaths is the best way to measure our overall response but not the best way to measure virulence of the disease. It will include the effect on lots of other mortality due to the pandemic. Eg people dying because cancer or strokes are not diagnosed or treated on time, people in care homes dying essentially of loneliness with nothing left to live for - there will be others but I am sure those three alone will be big numbers.

You are right, there are multiple measures, none of which is perfect and different websites have slightly different dates/numbers.

Captain Paranoia's link (https://www.bbc.co.uk/news/uk-51768274) gave these figures for UK as a whole. I've rounded to nearest thousand.

  • 42000 deaths within 28 days of +ve Covid test
  • 57000 deaths with Covid on death certificate
  • 65000 excess deaths compared to previous years

There will be excess deaths due to people not getting treatment (stroke, cancer, heart disease etc etc etc) when they should, the stress of Covid bereavement, unemployment or business failure and all sorts of other things.

All of these things have different characteristics and timescales to Covid. For example, business failure would not rise with Covid in early March before individuals, businesses and eventually government started social distancing or lockdown resulting in an economic impact.

Similarly the stress of Covid bereavement for individuals did not stop because the Covid deaths for the nation was falling.

Everything that is not Covid would not start at the same time as Covid and the grow with the same exponential curve as Covid in March. That would be an unexpected coincidence.

Everything that is not Covid would not respond to lockdown at the same time as Covid and plateau in the same way as Covid in March/April. That would be an unexpected coincidence. 

Everything that is not Covid would not decline at the same time as Covid declines with the same shape of decline as Covid. That would be an unexpected coincidence.

The rise, plateau and decline of excess deaths looks the same as the other Covid graphs.

It's possible that all the other causes of death track Covid deaths but this requires an extraordinary level of coincidence between the timing and timescales of medically, socially and economically different issues. 

The simplest explanation is that if excess deaths graph looks like the other Covid graphs that is because the 65000 excess deaths are mostly* Covid infections. Other causes are not enough to change the shape of the graph of excess deaths.

*mostly, NOT exclusively
 

Post edited at 10:30
 wintertree 25 Sep 2020
In reply to Toerag:

> people requiring hospital will remain there for a fortnight, so that means 42 beds, which is more than we have. We also need to keep this up for 6 months solid without the rate dropping (or we won't infect fast enough) or rising (or people will die due to lack of beds), and without our finite numbers of hospital staff becoming ill or dying. Do you think we can control the spread that accurately?

This is the critical point missed by people calling for us to run hospitals at a high occupancy to "process" us towards herd immunity.  I mean they're missing all sorts of other points like speculative ones over viral load effects, but...

This requires holding R at about 1.  The UK clearly lost control of that in mid-August and hasn't regained it since.  We did that when times were good - infection was low, test and trace was working, the weather was nice.  We don't really find out until two weeks later.  If we'd lost control like that when cases were 100x higher as needed to hold hospital occupancy high, there would be no chance of having functioning test and trace and we'd go straight to healthcare and potentially societal collapse.  Given the lag from infection to symptoms and death it's a bit like driving a mounting switchback at 60 mph in the dark with no headlights on [*, **] using instructions from someone driving a car with lights on 4 bends behind you.

[*] Some astronomical observatories have the telescopes significantly higher than the residence building(s), and a total ban on headlights in night driving for obvious reasons.

[**] This one time...

 wintertree 25 Sep 2020
In reply to elsewhere:

> *mostly, NOT exclusively

I hear there was a co-incident plague of healthy people with Covid being run over by busses that the time.  

 DancingOnRock 25 Sep 2020
In reply to Offwidth:

I’m sorry that “Health system collapsed and they were shovelling bodies into pits” doesn’t convey that enough for you. 

 Neil Williams 25 Sep 2020
In reply to Offwidth:

> Unlike flu we have a large percentage of people if those who don't die that end up with long term serious health problems.

What is the percentage?

 DancingOnRock 25 Sep 2020
In reply to elsewhere:

That’s an awful lot of words there. 
 

Not all the excess deaths were directly due to Covid disease. I think that’s pretty well accepted by absolutely everyone. Hence why the excess deaths were less than the original Covid death numbers and the call for an investigation into the numbers and subsequent reclassification of deaths. 
 

The death rate is looking to be around 0.3% of the general population, depending on age and other risk factors. 
 

It’s looking like around 120,000 deaths to herd immunity. Give or take c20k. Preferably the other c50k all don’t die between now and Christmas and we get a vaccine because we can’t realistically keep going like this. 

5
 Jon Stewart 25 Sep 2020
In reply to Neil Williams:

> The economy HAS to be considered - it's a careful balance - because the economy itself means lives as well as the disease.

> If you're happy for there not to be a "functioning society" at the end of this, but that's all good as one more life was saved (only to die of a preventable disease because there was no longer free healthcare), then I'm glad you aren't in charge.

I'm not sure what you think I'm saying but it's not what I'm saying!

I absolutely want a functioning society, I agree with the strategy of imposing restrictions to save us from the economic armageddon of a second lockdown (this would be the result of lifting restrictions now). 

The whole lives-vs-economy narrative is horse shit. We are in the position of having no choice: control the virus to prevent the collapse of society. 

2
 elsewhere 25 Sep 2020
In reply to DancingOnRock:

> That’s an awful lot of words there. 

> Not all the excess deaths were directly due to Covid disease. I think that’s pretty well accepted by absolutely everyone.

I agree entirely and I am sorry if "mostly, NOT exclusively" did not convey that to you.

 DancingOnRock 25 Sep 2020
In reply to elsewhere:

I didn’t get that far to be honest. I thought you’d already missed my point when you replied last night. 

6
 DancingOnRock 25 Sep 2020
In reply to Jon Stewart:

>The whole lives-vs-economy narrative is horse shit. We are in the position of having no choice: control the virus to prevent the collapse of society. 

 

It’s not horse-shit. It’s very important. 
 

The biggest killer in the U.K. is heart disease. Yet we do very little about it. It’s more important to sell crap food to people and let them have ‘freedom of choice’ than to save their lives. Because they all die slowly one by one over the year and we have adapted to cope with that many deaths a year. 

The fact it costs us billions is glossed over.

Its just with Covid if we don’t get that balance right there’s a very fine tipping point because it’s a communicable disease rather than something that builds up over years. 

 Offwidth 25 Sep 2020
In reply to Neil Williams:

We don't know the clear numbers yet but the problem is identified as affecting a large number of people (seemingly more than the fatality rate).

https://www.gov.uk/government/publications/covid-19-long-term-health-effect...

 MG 25 Sep 2020
In reply to Offwidth:

Those are unpleasant symptoms for a few weeks clearly, but hardly "long term serious health problems"

I'd imagine not so different to flu either.

Post edited at 11:22
1
 DancingOnRock 25 Sep 2020
In reply to MG:

My friend had flu two years ago. No underlying health issues. She was in her early 40s.

This developed into pneumonia and then into sepsis. She was on a life support system for 3 weeks and expected to die. 

She nearly lost a foot. 

She has now almost 100% recovered after months of intensive physio and now walks with only a slight limp. 

Flu isn’t respected as much as it should be. 

 Neil Williams 25 Sep 2020
In reply to Jon Stewart:

> I'm not sure what you think I'm saying but it's not what I'm saying!

I think you're contradicting yourself or not coming across very clearly, one or the other.

> I absolutely want a functioning society, I agree with the strategy of imposing restrictions to save us from the economic armageddon of a second lockdown (this would be the result of lifting restrictions now). 

> The whole lives-vs-economy narrative is horse shit. We are in the position of having no choice: control the virus to prevent the collapse of society.

Those two paragraphs contradict themselves.  The current restrictions ARE a balance.  The best way to reduce cases would be a full lockdown, but that would be economically disastrous.  So it IS lives vs. economy, though not in a simple way.

 Neil Williams 25 Sep 2020
In reply to DancingOnRock:

> Flu isn’t respected as much as it should be. 

Isn't it?  Do you want to see annual lockdowns in the flu season?  Christmas cancelled every year?

Seriously, I don't want to live in that country against what is a very small risk.  If anyone is concerned about that risk with regard to annual flu, then they can themselves arrange their life to stay at home all winter if they want.

You're missing a big point on risk assessment there.  Risk = impact x LIKELIHOOD.  The likelihood of severe outcomes from annual winter flu is very low unless you are otherwise infirm.  Everyone who posts one of those "horror stories" without pointing out how (un)likely it is is guilty of that - scaremongering.

COVID is different because "likelihood" is a bigger figure, so that quite rightly gets more attention.

Why are climbers so bad at risk assessment when it comes to anything other than climbing at times?  You wouldn't even get on the end of a top-rope if your risk assessment was *that* bad.

Post edited at 12:04
1
 elsewhere 25 Sep 2020
In reply to MG:

Public Health England publish something with "long term" in the title that includes phrases including "more than 4 weeks", " continuing symptoms for 8 or more weeks following discharge" and the list "Persistent health problems" of includes things that to a lay person look serious, long term, life changing (particularly for climbers) or life limiting:  

  • fibrosis and pulmonary vascular disease
  • acute myocarditis and heart failure
  • mental health problems
  • Guillain-Barre syndrome
  • fatigue
  • thrombosis

and you write

> Those are unpleasant symptoms for a few weeks clearly, but hardly "long term serious health problems"

Post edited at 12:07
 Billhook 25 Sep 2020
In reply to Jon Stewart:

> See if you can get your head around this:

> The policy makers don't care if you live or you die. They're not trying to save your life.

> They care about their own survival. They care about the economy. They can't serve themselves without a functioning society, and that depends on the health service and people going to work. That's what they want to save.

> Not you! 

Thats good to know.

So far I'm still alive - not thanks to the government.

Their own survival isn't guaranted.  So thats more good news.

As for the economy and a functioning society;  I'm not sure they appear to be achieving that either.

So good news all around.

 blurty 25 Sep 2020
In reply to DancingOnRock:

Agreed, the Flu can be really nasty, we just confuse the situation by call a common cold 'the flu' in the UK.

By the way, I'm just recovering from Covid now and it's not been a barrel of laughs, but it hasn't been unbearable either.

Post edited at 12:09
 DancingOnRock 25 Sep 2020
In reply to Neil Williams:

>Isn't it?

No it isn’t. 
 

>Do you want to see annual lockdowns in the flu season?

I don’t think that’s necessary and I don’t think anyone has suggested that  

>Why are climbers so bad at risk assessment when it comes to anything other than climbing at times?  You wouldn't even get on the end of a top-rope if your risk assessment was *that* bad.

What do you mean by *that* bad?

All I said was we should respect it a bit more.
 

Maybe if people took a week off work when they had ‘a touch of flu’ rather than soldiering on, infecting loads of other people, dragging it out for several weeks and ending up in intensive care or killing an old person or cancer patient, we’d have fewer deaths, and fewer people with time off work or in the office being unproductive moaning about how shit they feel. 

 Billhook 25 Sep 2020
In reply to elsewhere:

But many other illnesses such a colds & flu (and many more) can, and do sometimes lead to serious complications.  My father died following either a cold or flu and then died due to pneumonia.  

And as you know, had we the same way of reporting as we had of reporting covid deaths (.....anyone having had covid within the last month) his death would have been reported as a flu or cold related death.).

 DancingOnRock 25 Sep 2020
In reply to blurty:

> Agreed, the Flu can be really nasty, we just confuse the situation by call a common cold 'the flu' in the UK.

> By the way, I'm just recovering from Covid now and it's not been a barrel of laughs, but it hasn't been unbearable either.

Like Covid - different people react different to different strains of flu. From ‘common cold’ like symptoms to high temperature, sweats, hallucinations and aches. 
 

I’ve had flu twice in 50 years but I’ve also had something very similar to what I experienced with flu that lasted 3-4 days but wasn’t anywhere as extreme. Maybe I had partial immunity to that strain from one of the other severe encounters. 
 

Glad you’re feeling better. My wife has tested positive for anti-bodies and I’ve been feeling ‘knocked out’ for the majority of the summer, felt much better in the last two weeks. Other than that neither us nor the children have had any ‘classic Covid’ symptoms. 

 DancingOnRock 25 Sep 2020
In reply to Billhook:

>And as you know, had we the same way of reporting as we had of reporting covid deaths (.....anyone having had covid within the last month) his death would have been reported as a flu or cold related death.).

 

We do. And those deaths are about 6th on the list of cause of death. 

 Neil Williams 25 Sep 2020
In reply to DancingOnRock:

> Maybe if people took a week off work when they had ‘a touch of flu’ rather than soldiering on, infecting loads of other people, dragging it out for several weeks and ending up in intensive care or killing an old person or cancer patient, we’d have fewer deaths, and fewer people with time off work or in the office being unproductive moaning about how shit they feel. 

I do agree with that (even for a cold to some extent) - but maybe that would be more likely if sick pay in many companies wasn't as derisory.

 summo 25 Sep 2020
In reply to blurty:

> Agreed, the Flu can be really nasty, we just confuse the situation by call a common cold 'the flu' in the UK.

My mother's definition;

If you see a tenner on the floor and you have cold you'll pick it up, if you've got influenza then it can stay there. 

She's had flu a couple of times, then she had covid in May and it was the toughest or the most ill she's ever felt in her life. She's 73 and still not back to full strength yet, probably never will gain the strength and fitness back at her age. 

 Offwidth 25 Sep 2020
In reply to MG:

I know no one who has died but lots of people with ongoing serious ME type conditions that don't seem to be getting better and are working with support groups who are keen on the research for obvious reasons. The worst examples in the early research seem to have GBS induced by C19 which is often lifelong.

 DancingOnRock 25 Sep 2020
In reply to Neil Williams:

> I do agree with that (even for a cold to some extent) - but maybe that would be more likely if sick pay in many companies wasn't as derisory.

I guess some of us have the luxury of choosing who we work for and choose companies who take the welfare of their employees seriously rather than just a tick box exercise. 
 

Surely having someone at home for a few days is more beneficial to a company than all of the above. There’s some companies operating in the dark ages. 

 neilh 25 Sep 2020
In reply to DancingOnRock:

There are alot of companies who just about survive on a day to day basis becuase of the market they operate in.Paying sick pay can push them easily over the edge.. The hospitality sector is one of them.For the most part it is tiny operating margins

Its easy to cast stones at them when you work for a company that is at the other end of the spectrum.( or are in the public sector).

 Jon Stewart 25 Sep 2020
In reply to Neil Williams:

> I think you're contradicting yourself or not coming across very clearly, one or the other.

Definitely not coming across clearly, sorry! 

> Those two paragraphs contradict themselves.  The current restrictions ARE a balance.  The best way to reduce cases would be a full lockdown, but that would be economically disastrous.  So it IS lives vs. economy, though not in a simple way.

True, the best way to reduce covid cases would be another full lockdown but you'd get a load of deaths from other causes. I think selling that as the "saving lives" option is false. 

 On the other side, there is no option of economic recovery, if we're prepared to pay for it in lives. This is the narrative I think is horse shit, but it seems to be a popular view. The option doesn't exist, if we tried it, the hospitals would fill up and we'd just be forced to have another lockdown and economic armageddon. 

2
In reply to Neil Williams:

> You speak as if that's isolated from your life.

> If the economy crashes big style:

>  - You lose your job and can't put food on the table

>  - The NHS collapses as we can't afford it

>  - Crime increases as people steal to feed their families

>  - Your pension disappears, as you know that "fat cat" housing developer?  It was invested in them

> The economy HAS to be considered - it's a careful balance - because the economy itself means lives as well as the disease.

> If you're happy for there not to be a "functioning society" at the end of this, but that's all good as one more life was saved (only to die of a preventable disease because there was no longer free healthcare), then I'm glad you aren't in charge.

that's what he was saying to the op

 Neil Williams 25 Sep 2020
In reply to neilh:

> There are alot of companies who just about survive on a day to day basis becuase of the market they operate in.Paying sick pay can push them easily over the edge.. The hospitality sector is one of them.For the most part it is tiny operating margins

Then perhaps we need a mandatory State sickness insurance scheme that pays it, say on the "furlough terms" (80% with a cap increased by inflation each year), with companies able to top up to 100% if they wish.

Post edited at 13:06
 MG 25 Sep 2020
In reply to elsewhere:

4-8 weeks of unpleasant illness isn't life changing like say losing a leg. Obviously unpleasant and not to be ignored but keep things in perspective. I think it's reasonable to suppose those are worst case examples too, like the side effects.listed on medicines.

1
cb294 25 Sep 2020
In reply to Neil Williams:

... as in civilized countries on the continent....

 DancingOnRock 25 Sep 2020
In reply to Jon Stewart:

I think anyone think it is black and white needs to sit and have a think about what they’re missing. 

Like every thing in life, it’s a balance. Where that balance lies often depends on your personal situation, but it shouldn’t because we live in a very complex society where upsetting the balance in one area affects another in unexpected ways. 
 

I think what a lot of people are missing is you don’t join a motorway and set your accelerator at a certain point for your whole journey. You have to lift off, apply brakes, change gear, do a bit of steering, accelerate a bit, stop at the services etc. The problem is some people seem to want to floor it down the outside lane and others want to stop at the services for a couple of hours.

1
 DancingOnRock 25 Sep 2020
In reply to Neil Williams:

There is SSP plus you can get health insurance that just covers sickness for a relatively small amount.

 malk 25 Sep 2020
In reply to cb294:

> there have also been rare cases of SARS2 reinfection that have been confirmed by sequencing the viruses and finding diffent strains.

this study suggests reinfection for coronaviruses is most frequent at 12 months so only at start of reinfection curve: https://www.nature.com/articles/s41591-020-1083-1

 

> The good thing, though, is that immune responses can in principle fight the infection, and vaccine induced immunity (where the viral processes suppressing immune memory formation are absent) is therefore much more likely to work.

how would that relate to possible 'antibody-dependent enhancement'?

https://www.nature.com/articles/s41586-020-2538-8

https://science.thewire.in/the-sciences/covid-19-reinfection-reactivation-r...

a friend sent me this vid from what appears to be an evidence-based scientist:

youtube.com/watch?v=8UvFhIFzaac&

what do you think?

 neilh 25 Sep 2020
In reply to Neil Williams:

Unfortunatley the employer tends to pay the cost of this via employers ni, and yet again it can tip those companies over the top.

The problem is alot of people look at it through the lens of a big company or public sector mentality. They do not look at it from a micro/small business perspective ( where something like 50% of the workfore is employed). If you are running  a small cafe for example, these costs are significant.

There is no easy solution.

Sunaks/Hancocks  of a £ 500 payment to low paid  for isolating is possibly the best compromise.

cb294 25 Sep 2020
In reply to malk:

No time to watch the video, but the fact that CV reinfection occur after the time when antibody titers drop suggests (not proves) that the humoral immune response does play a role. However, this only works if the virus somehow manages to prevent the formation of immune memory. The mechanism of this partial immune suppression is reasonably well understood for other coronaviruses, essentially they screw up communication between various immune cells.

Evolutionary, that the first infection is at some point cleared does not bother the virus, it will have passed on to further hosts and is happy when the first host is available again come the next cold season. If it reinfects that host, in the absence of immune memory, the whole game can start again, with infection, immune response, suppression of memory formation, clearance....

Now with a vaccine, things would be different, because the other viral proteins involved in suppressing immune memory would be absent, so memory can be triggered, which is the entire point of vaccination. If this works as hoped, in the first real infection the immune system should have a head start.

Antibody mediated enhancement can happen in various infections, in particular when certain pathogens have evolved using antibodies as adaptors to infect immune cells. Also, in various diseases the damage of the infection is actually caused by the immune response rather than the virus itself. This is e.g. the case for Yellow fever and Dengue hemorrhagic complications, which are typically associated with reinfections where the first infection ony triggered low antibody levels (or a poor response to vaccination). High AB levels are ususally protective.

A trigger happy immune system, whether AB or T-cell mediated, also seems to be involved in SARS2 pneumonia, which is why dexamethasone or other steroids are used to prevent lung damage in ICZ patients.

Any viral infection is a dynamic game played out in our body, where loads of highly nonlinear parameters determine the eventual outcome. It is very hard to predict beforehand whether a generally good thing (formation of ABs) will also have negative effects, and if so, how often, in which patients, etc. . This is why there are staged trials for any candidate vaccine.

CB

 Billhook 25 Sep 2020
In reply to malk:

Thanks for posting that Video.  It is very enlightening and really supports the notion that many other people have been pointing out all along.

Of interest to me, were the graphs from the USA showing that since their lockdown and compulsory mask wearing that the infection rate for both illnesses was in no way reduced or altered whether you were locked up or wearing a mask.  You still got and still people died.

There were some even more enlightening graphs and analysis showing the reasons for 'excess' deaths - basically a lot of it was caused by a lower death rate in the preceding years - so Covid simply took out those who had lived longer than they would normally have done.

I don't suppose it'll get many views though.

1
 Michael Hood 25 Sep 2020
In reply to cb294:

Since you're knowledgeable in this area...

I've had Covid mildly (unless I had something else and my ab test was a false +ve), so I'm assuming that I've got some immunity for some period of time but obviously I don't know how much and for how long.

Information wise we're being told that re-infection is a big unknown and so immunity can't be relied on. But at the moment I've only heard of one or two possible case of re-infection worldwide. I'm assuming that if & when re-infection occurs in a significant number of people, then it's going to be HUGE news, everyone will hear about it and the information will become "You can get it twice".

So if I decide to take more "infection risks" (e.g. maybe not being worried about being so strict about distancing) knowing that I've had Covid, then I'm actually just "gambling" that it's very unlikely I'll be in the first cohort of people to get re-infected (because I would be less likely to take those risks once the news is out).

Is that a reasonable approach?

cb294 25 Sep 2020
In reply to Michael Hood:

I am no medic (even though I started my career in virology), but work on the signalling pathways involved in immunity that are being manipulated by coronaviruses. My information therefore a bit second hand, as skim read the literature rather than diving in fully. So, you should take my comments with a large grain of salt.

Anyway, here goes: Having recovered from a mild but confirmed infection is probably the best state you can be in.  Presumably you are indeed protected for the moment, it would need some really bad luck to get reinfected in the next few weeks. How that will look in half a year or a year, though, is anyone's guess.

IMO you should nevertheless diligently stick to the standard hygiene measures (masks, distancing...). These measures are effective only with high uptake rates, anyone showing slack gives a bad example, even if they personally can assume to be at lower risk of infection.

What I would do, though, in your position, is to attend concerts or football matches (which are starting to be partially open for fans here in Germany, but not all tickets are sold because people are still reluctant to expose themselves to such a risk), pretty much following your logic.

CB

1
 Neil Williams 25 Sep 2020
In reply to DancingOnRock:

> There is SSP

SSP is derisory.  You can't live on it.  It's below the minimum wage and you can barely live on that.

> plus you can get health insurance that just covers sickness for a relatively small amount.

Most people won't even think of that.  It's similar to pensions, which is why those are now "opt in by default" - it needs to be the same.

 Michael Hood 25 Sep 2020
In reply to cb294:

Pretty much am sticking to all the standard stuff, just not being so concerned if people do come to close, things like that.

 wintertree 25 Sep 2020
In reply to malk:

> a friend sent me this vid from what appears to be an evidence-based scientist: what do you think?

You didn't ask me, but when does that stop me sharing my opinion with the world?

I think Ivor is full of crap.

This video has come up at least twice recently, once from a pop-up account on another thread that I think was created by a social media consultant paid to disseminate misinformation.  

Here are my comments from skim viewing of it a couple of weeks ago.  

https://www.ukhillwalking.com/forums/off_belay/is_this_the_covid_equivalent_of...

Post edited at 18:45
 DancingOnRock 25 Sep 2020
In reply to Neil Williams:

I think this is heading to deja vu. I’m sure I’ve  had similar discussions here before. 
 

I have a feeling that this whole mess will lead to similar stress tests for large businesses and individuals that the banks do. 
 

No loans for expansion or mortgages unless you have significant cash reserves. 

OP bruxist 25 Sep 2020
In reply to wbo2:

Sure (though I think the link Toerag posted further down the thread is a much better way of doing it than I've got. My calcs are very crude in comparison.)

I took the starting point as March 2020. If about 5 million had already been infected after six months of the virus (by the end of August 2020), it would take another 3.5 or 4 years at exactly the same level of infection to reach 65% of the population.

(I did a few calcs to work out how many deaths such an approach would cost, and factored them into how excess deaths reduce the absolute population).

By August 2021 we would have had 15 million infections in total. But if immunity lasts for 1 year, approximately 5 million of those would have lost their immunity in stages between March and August 2021. So as of August 2021 we'd still have only 10 million who have viable immunity - well short of the 43.5 million we need at 65%.

I then carried on doing these calcs for subsequent years, and despite a yearly reduction in absolute population, could never manage to get anywhere near the magic 65%, mainly because of the 'Red Queen' phenomenon (the idea from Alice in Wonderland that of running to stand still) - we'd keep getting infected and losing our immunity but never to such a level that the virus became controllable.

 wintertree 25 Sep 2020
In reply to bruxist:

> I then carried on doing these calcs for subsequent years, and despite a yearly reduction in absolute population, could never manage to get anywhere near the magic 65%, mainly because of the 'Red Queen' phenomenon

If immunity does fade on that sort of timescale, the only way to beat the red queen is to slam the whole population through the process in the space of about 3 months with a peak infection at 1.5 months and a death rate peak a bit later.  You'd probably need to raise R significantly above it's "wild type" level to get that process started.

Of course, one of the reasons immunity may fade is because of the virus making some key mutation.  The irony here is that this is way, way more likely to happen in a "solution" (I use that term loosely) based in herd immunity than in containment and control.  At which point we have a bigger problem, presumably called the Red King.

OP bruxist 25 Sep 2020
In reply to Toerag:

That's a really good and useful link. Thank you! I think I'd seen an older version of it a few months ago, and had forgotten all about it. The final simulation - no vaccine and no intervention - seems to me to model exactly what people are talking about when they propose natural herd immunity, and I'm quite certain they don't realize just how brutal it would be. A Britain retreating to a smallpox or polio era would be a very poor place indeed.

 DundeeDave 26 Sep 2020
In reply to bruxist:

Through the Looking Glass

 paul birch 26 Sep 2020
In reply to bruxist:

https

//www.bmj.com/content/370/bmj.m3563

This article seems pretty well informed and a lot more optimistic than some I've read.

 girlymonkey 26 Sep 2020
In reply to MG:

> Those are unpleasant symptoms for a few weeks clearly, but hardly "long term serious health problems"

> I'd imagine not so different to flu either.

6 months and counting for my friend so far. In her 30s, healthy weight, white, no underlying health conditions etc. She still can't work full time. 

 SouthernSteve 26 Sep 2020
In reply to paul birch:

> from the article: The immunologists I spoke to agreed that T cells could be a key factor that explains why places like New York, London, and Stockholm seem to have experienced a wave of infections and no subsequent resurgence. 

However, London is rapidly approaching greater numbers according to the BBC this week. 

I would take this as an opinion piece, deliberately taking a different view. Immunology can rarely be divided into cellular and humoral, innate and specific when it comes to the response to a pathogen or foreign protein which is why it is so complicated.

In the context of the issue

https://www.bmj.com/bmj/section-pdf/1034203?path=/bmj/370/8260/This_Week.fu...

I remain cautiously pessimistic

A consensus document can be found here

https://www.immunology.org/sites/default/files/BSI_Briefing_Note_August_202...

But in this rapidly changing area this is already a month out of date. 

Post edited at 08:53
 MG 26 Sep 2020
In reply to girlymonkey:

That does sound serious, but isn't what the link higher was highlighting.

 girlymonkey 26 Sep 2020
In reply to MG:

No, but I think as yet the data is still emerging. People "recover" from it, still feel rough but just think they are still getting over it, it then takes a while before they finally say they had better go to the dr. Those infected at the start of the pandemic have been ill for 6 months, those infected later haven't yet!!

At this stage, there is no data on how many people and how long on average etc as it's just too early. I certainly don't want to find out by personal experience though!!

 malk 26 Sep 2020
In reply to wintertree:

> You didn't ask me, but when does that stop me sharing my opinion with the world?

thanks, i'm always interested in your opinion

> I think Ivor is full of crap.

he's certainly full of himself with an agenda but you'll have to to better than that

here he patronises a junior doctor who dares to criticise him:  youtube.com/watch?v=eKKIr425b40&

 jethro kiernan 26 Sep 2020
In reply to girlymonkey:

I think for a forum of relatively fit people we should be concerned, I think the long term damage are probably slow in coming forth in a generally sedentary population, a friend who I've spoken to recently who had covid says he would appear to be recovered, however  he is unable to get up a few flights of stairs without struggling. He isn’t overcoming this either. 
How many people on here run, cycle, climb mountains, I’ve a lot of things I’d like to do in life that require full lung function, running races I want to do, cols  I want to do on the bike, mountains I want to stand on.

There isn’t enough data coming through for people of above average fitness to say it’s nothing, for myself personally losing the above aspirations would be a life changing medical condition.

Post edited at 14:54
 Neil Williams 26 Sep 2020
In reply to girlymonkey:

> 6 months and counting for my friend so far. In her 30s, healthy weight, white, no underlying health conditions etc. She still can't work full time.

And a virus gave me asthma in my late 30s.  It happens, and it's not exclusive to COVID.  ME/CFS is a common post-viral outcome.

While it's a shame your friend is suffering in this way, what is more important is how many people are suffering in this way, and if it is more people than from other viruses.

Post edited at 20:45
1
 Neil Williams 26 Sep 2020
In reply to jethro kiernan:

Given that it prats with blood clotting, I wonder if any of these people have (as yet) undiagnosed pulmonary embolism?

I can speak from experience about what it's like if your fitness suddenly gets whacked when something mucks about with it, as it happened to me, and it isn't fun.  It's not the absolute worst thing that could happen, though.  That said, I would want to know the likelihood of it rather than fearing it based on consequence alone.  If you do the latter, you'd best not consider any trad climbing, because a bad fall might mean you in a wheelchair.

2
 Michael Hood 26 Sep 2020
In reply to jethro kiernan:

Simply because this is viral, a lot of the medium to long term effects are going to be of the "post viral fatigue" type; with many ending up with CFS/ME (or something which is effectively indistinguishable from). However that has a wide range of symptoms, longevity and seriousness and many will never fully recover to their previous state (wife had for 18 years - but has never regained former capacity, daughter had for 7 years - fully recovered except that her "battery" capacity is smaller than normal).

Post viral fatigue is not generally life threatening, but it's certainly lifestyle threatening and can greatly affect all aspects of life.

Of course there may be other medium to long term effects specific to Covid-19. We are only finding out about these as time moves on.

1
 jethro kiernan 26 Sep 2020
In reply to Michael Hood:

His fatigue is exercise related due to lung capacity and breathlessness (he was on oxygen for 3 days), this type of damage is coming to light in studies, bad enough to affect your fitness quite dramatically, not bad enough to immediately register as a big concern yet for a generally sedentary population. Obviously there are possibilities of other post viral complications, I don’t believe it’s just another flu though.

@Neil Williams not sure trad climbing and COVID are a comparison worth making

https://nltimes.nl/2020/05/28/thousands-dutch-covid-19-patients-likely-perm...

Post edited at 22:19
 DaveHK 26 Sep 2020
In reply to jethro kiernan:

> I think for a forum of relatively fit people we should be concerned,

There's a really rather worrying thread about Long Covid over on the Singletrackworld forum. Quite a few very fit people still absolutely floored with it 6 months on.

 Neil Williams 26 Sep 2020
In reply to jethro kiernan:

> @Neil Williams not sure trad climbing and COVID are a comparison worth making

The point was that there is no value in explaining consequence without explaining likelihood when doing a risk assessment.  If you only consider consequence, you wouldn't trad climb.

 jethro kiernan 26 Sep 2020
In reply to Neil Williams:

I understand risk assessment both the informal and formal kind, the information is coming to light that it isn’t binary, death or recovery, long term damage also has to be considered, this increase the risk beyond what  people are assuming by just looking at the stats for fatalities . So  y risk assessment would include reducing exposure to high viral loads, maintaining  a reasonably healthy immune system, staying out of the pub, maintaining reasonable physical distancing, doing most of my socialising outdoors. The numbers are going up because people have made the classic risk assessment mistake of because something doesn’t appear to be happening they don’t need to take precautions anymore, even though it was the initial precaution that reduced the frequency.

 Neil Williams 26 Sep 2020
In reply to jethro kiernan:

> I understand risk assessment both the informal and formal kind, the information is coming to light that it isn’t binary, death or recovery, long term damage also has to be considered, this increase the risk beyond what  people are assuming by just looking at the stats for fatalities

I don't disagree.  My point is that "my mate got long COVID" says nothing about the prevalence of "long COVID".  If it's one in 10, it's something to be very afraid of.  If it's one in 1,000,000, it might as well be disregarded.  It's most probably somewhere in between, which will mean some people will find the risk acceptable and some won't.

This has happened before - the "think of the children" thing that came up when it was found that some (a very, very small number of) children got a very serious Kawasaki-syndrome-like set of symptoms.  But when you know how few do, a rational decision is to disregard that aspect.  You don't even hear of it now, so rare it is.

> So  y risk assessment would include reducing exposure to high viral loads, maintaining  a reasonably healthy immune system, staying out of the pub, maintaining reasonable physical distancing, doing most of my socialising outdoors.

Those are mitigations - the outcome of a risk assessment, which you determine based on assessing whether likelihood x severity is acceptable or not, and if not you put into place mitigations so the reduced value is acceptable.

Post edited at 22:43
 DancingOnRock 26 Sep 2020
In reply to Neil Williams:

Look. It’s not about assessing your risk. It’s about assessing the risk you present to other people. 
 

Think of it as follows:

Go soloing at a crag miles away from civilisation - fine. 
Go soloing on a sea cliff above a beach full of public sunbathing - not fine. Especially when the public start joining you. 

Post edited at 23:05
 jethro kiernan 26 Sep 2020
In reply to Neil Williams:

I wasn’t basing my thoughts on “my mate had a bad case” though from a personal point of view it was sobering, there is limited information  long term lung damage could be high as 10% of cases and higher in my age bracket 50 ( this puts lung damage in Russian roulette territory 1 in 6 not the very low 1 in 500000 you mentioned) the point being we don’t know the full likelihood yet because the damage is in a Goldilocks place if your sedentary so the information isn’t being registered in overstretched health systems. Initial information would suggest caution if you value your fitness.

Initially No big deal if your physical aspirations stretch to occasionally jogging to catch the No 12 bus, pretty devastating if the col du calibier is on your tick list. 

Because impact is also factor in risk assessments (professional pianist view the dangers and impact of band saws differently to joe blogs)

https://www.nature.com/articles/d41586-020-02598-6

Post edited at 23:50
 Offwidth 27 Sep 2020
In reply to Neil Williams:

I'd normaly agree but with a new virus I see it as a reason for sensible caution, given a balance of probability. If I know no-one who has died and quite a few people with post viral like symptoms lasting months with no sign of stopping, that's a worrying sign for when the research details of the collection and analysis of this information can be published (it will take months).

The information from the Dutch article on long term lung damage from nearly all of those hospitalised is a different but equally serious long term problem and has been known from the beginning (the commonality of lung scar xray images)

https://nltimes.nl/2020/05/28/thousands-dutch-covid-19-patients-likely-perm...

Post edited at 05:07
 Offwidth 27 Sep 2020
In reply to Neil Williams:

A new opinion piece on the subject of long term post viral illness, from the Guardian:

https://www.theguardian.com/commentisfree/2020/sep/26/i-used-to-be-ms-covid...

And the BMJ letter it links:

https://www.bmj.com/content/370/bmj.m3565

 neilh 27 Sep 2020
In reply to bruxist:

This is an excellent simple and short overview of herd immunity from the world renowned Mayo Clinic  

https://newsnetwork.mayoclinic.org/discussion/herd-immunity-and-covid-19-wh...

 Neil Williams 27 Sep 2020
In reply to DancingOnRock:

> Look. It’s not about assessing your risk. It’s about assessing the risk you present to other people. 

Yes.  And that includes how much of a risk "long COVID" poses to them as well.  People who are pushing a "zero risk" approach to COVID are going well over the top when they do not push a "zero risk" approach to other things.

The one exception to this would be if we agreed as a society to push a NZ-style elimination approach (i.e. an aim to get cases to effective zero so we can reopen near-fully), but that is not what we are presently doing.

 jethro kiernan 27 Sep 2020
In reply to Neil Williams:

No one has advocated zero risk, just risk mitigation. 

 wintertree 27 Sep 2020
In reply to Neil Williams:

> People who are pushing a "zero risk" approach to COVID are going well over the top when they do not push a "zero risk" approach to other things.

I don’t think I’ve seen anyone, ever, advocating zero risk.

 Neil Williams 27 Sep 2020
In reply to wintertree:

> I don’t think I’ve seen anyone, ever, advocating zero risk.

I don't think anyone was rationally advocating it, but if you consider a consequence (e.g. the child Kawasaki syndrome issue) without considering the likelihood (did cases ever get past low two figures?) then that's what you effectively do, because that's what the brain does naturally.

Every single person that's afraid of flying is doing that.

 wintertree 27 Sep 2020
In reply to Neil Williams:

I’m not convinced, because this is a new disease and not enough is know to know the long term consequences, and in the mean time it’s setting off an increasing number of alarm bells with very varied long term effects - so any risk assessment for covid includes big unknowns, the only control measures for which is moving slowly and methodically and not rushing in to wide spread infection by quote “waiting for the right time to lock down”.

There are reasons for caution behind the - already quite severe - known risk.  As well as the unknown unknowns around long term effects,  for an individual at low personal/immediate risk, thinking it through suggests their role as a link in a multiplying chain of infection means a complete analysis of the risk of them becoming infected ends with vulnerable people dying and economic damage.  They can’t control who gets infected more than one link along the chain from themselves.  As the recent data shows, the idea of protecting eg care homes against rising community transmission was a fantasy.  You can’t do it with tests only 70% accurate - at best - at detecting infection.

The key risk control measures are about balancing economic damage (from too much restriction) against economic damage (from a major public health crisis).  This somehow has to be sold as motivation to the people who stopped following the relatively light rules and guidance around mid August, because until then it was working, with most of the economy back to running well.  

Post edited at 10:35
 jethro kiernan 27 Sep 2020
In reply to Neil Williams:

> Every single person that's afraid of flying is doing that.

Fear of flying and not getting on a plane to achieve zero risk are two separate things.

many people who fly don’t like it but try and rationalise their Fear. The same with climbers we get the fear but we mitigate it.

in a complex world it is hard to navigate your fears rationally , for instance in the 18 months after 9/11 the increase in RTA deaths in the USA far exceeded the number of deaths in the twin towers because people stopped flying and went on long car journeys instead.

But the the info that flying was safer than driving was readily available to most people even accounting for the blip of 9/11.

It would be possible to think that covid is only effecting the unfit overweight demographic and that as as a generally fit demographic UKC doesn’t have much to fear, my point is that our fitness makes our demographic more vulnerable to the “impact“ of non fatal covid in the short to medium term. Counter intuitive I know but worth considering. 

Post edited at 11:19
OP bruxist 27 Sep 2020
In reply to neilh:

Thanks Neilh. That's not bad as an example of public-facing science communications - nice and brief and written in layman's terms - but it conspicuously avoids any discussion of whether or not herd immunity is actually possible, all the while leaving the idea floating that it might be. I have the impression from discussion here and elsewhere that people still think natural herd immunity is a possibility, and what I'd like to see is some reasoned discussion of whether or not that assumption is true. .

 neilh 27 Sep 2020
In reply to bruxist:

Well i thought because they do not know if you are immune after being infected with Covid  then the jury is out.

so at the moment there is no scientific view point until this is proven or not.

well that is my reading anyway.

i likes the fact that they clearly state that vaccination is the best way to herd immunity 

OP bruxist 27 Sep 2020
In reply to neilh:

Yes, absolutely. It is good that they say that. What I'm puzzled about has more to do with modelling: we can model what will happen in lots of different scenarios, including what would happen if the UK took no action and tried its hardest to infect as many people as possible, so as to achieve herd immunity. When I try to model it myself, I can't produce any scenario under which the UK can hit the threshold, ever. The most optimistic I've seen is in Toerag's link above, where we have to increase ICU capacity by 1000% and manage to achieve a sort of rolling seasonal immunity for 2 or 3 months a year.

 elsewhere 27 Sep 2020
In reply to bruxist:

To me the issue with herd immunity is that it requires infecting five or ten times more people so we can expect* five or ten times more deaths.

Not something to rush into when there may be a vaccine.

*not proven but reasonable to assume there are vulnerable people amongst the majority who have not been infected.

 Toerag 27 Sep 2020
In reply to bruxist:

Oh look, it would appear that it's been impossible to protect the elderly:-

"The spread of the virus has almost tripled among those in their 60s since the start of the month, official data analysed by Duncan Robertson, a policy and strategy analytics expert at Loughborough University, shows. There are 23 cases per 100,000 people in their 60s, up from eight per 100,000 at the end of August; and 22 cases per 100,000 people over 80 – up from nine cases at the end of August."

From https://www.theguardian.com/world/2020/sep/27/regular-uk-lockdowns-could-he...

 summo 27 Sep 2020
In reply to neilh:

The herd immunity research in sweden coming out of KTH suggests there isn't any, they say there are folk with T cells giving them some protection. But it is not possible to know if they had these from previous exposure to older corona type viruses or covid19. So they can't draw a conclusion in either direction.  

cb294 27 Sep 2020
In reply to neilh:

This is not the first coronavirus we are dealing with, we do know quite a bit about this virus family in general, we have experience with a close relative (SARS classic) and a slightly more distant relative (MERS), so it is not as if we are fumbling in the dark (which is what people prattling on about a new pandemic seem to claim).

The situation is not Marburg virus in 1967, where no one had an idea about the virus (we were quite lucky that this did not spread far beyond the initial contacts!)

CB

OP bruxist 28 Sep 2020
In reply to Toerag:

Yes. Dismal but predictable, I think. And on the herd immunity discussion we having (with DancingOnRock, Offwidth, tom r, and a few others) there is news out of Manaus: the city went back into lockdown on Friday. I suspect that the Buss, Prete Jr., et al preprint on 'COVID-19 herd immunity in the Brazilian Amazon' will either be retracted or have some sort of emendation added to it pretty quickly.

https://www.reuters.com/article/us-health-coronavirus-brazil-manaus/in-braz....

 wintertree 28 Sep 2020
In reply to Toerag:

> Oh look, it would appear that it's been impossible to protect the elderly:-

As also visible in the latest PHE Surveillance Report


 Billhook 28 Sep 2020
In reply to wintertree:

>

> The key risk control measures are about balancing economic damage (from too much restriction) against economic damage (from a major public health crisis).  This somehow has to be sold as motivation to the people who stopped following the relatively light rules and guidance around mid August, because until then it was working, with most of the economy back to running well.  

The 'light rules', weren't exactly light in many people's eyes.  No schooling, no visiting grandma, or anyone else in the care homes, keeping to your own bubble, no social mixing, wearing of face masks and so on.  

I live in a place where following the relaxing of the rules in mid August meant we were overwhelmed with visitors, holiday makers and so on.  We had more visitors each day, than we'd ever had on the busiest bank holiday weekends in the summer.  And these people were on holiday from the virus restrictions they had put up with since March.  They'd escaped their towns and cities for the first time in months.  Like many people, the virus was something they didn't encounter back home, the only people they met who'd come into contact with the virus was someone who lived near them or they'd been told second hand.  People weren't dying on the streets, The hospitals were not full of their dying relatives, the death rate from Covid was down to relatively few and the infection rate was also going down.  Our restaurants were fully booked as were the pubs.  Of course all that came with a risk.  The numbers of cases of of employees, in local businesses who have had to self isolate because they've displayed Covid like symptoms has meant these businesses have had to shut again.  

Yes, lets blame all those people who followed government advice and resumed their restricted lives for the renewed spike.

Yes, the government do need to motivate  people to better adhere to the new tighter restrictions, but given  the fact that for most people Covid is something the majority of their friends, relatives and work colleagues do not catch and die from.  

Its going to be difficult I think.

Post edited at 20:44
 Blunderbuss 28 Sep 2020
In reply to bruxist:

> Yes. Dismal but predictable, I think. And on the herd immunity discussion we having (with DancingOnRock, Offwidth, tom r, and a few others) there is news out of Manaus: the city went back into lockdown on Friday. I suspect that the Buss, Prete Jr., et al preprint on 'COVID-19 herd immunity in the Brazilian Amazon' will either be retracted or have some sort of emendation added to it pretty quickly.

If true that puts a nail in the 'let it rip merchants' coffin (for want of a better phrase).... 

OP bruxist 28 Sep 2020
In reply to Blunderbuss:

Gove's “I've come to the view that we need to run this hot”, perhaps?

 wintertree 28 Sep 2020
In reply to Billhook:

> The 'light rules', weren't exactly light in many people's eyes.  No schooling, no visiting grandma, or anyone else in the care homes, keeping to your own bubble, no social mixing, wearing of face masks and so on.  

To be clear, I'm saying the the rules by mid-august were "light" compared to late March/April.  By then, compared to March, you could leave home as often as you liked, you could have household visits with anyone (not just your own bubble), many care homes were running visits, you could mix socially in the pub and the restaurant and outdoors.   You had to wear masks in shops etc but that really isn't an imposition on most people compared to lockdown now is it?

> Yes, lets blame all those people who followed government advice and resumed their restricted lives for the renewed spike.

I think you are missing my point.  I do not think people following the government advice caused the situation to blow back up and I do not blame them.

The measures were relaxed for some time before the situation blew up - even accounting for the lag from infection to detection/hospitalisation/death.  What I said quite clearly is that by mid-August I think that many people had stopped following the light-touch rules (by which I mean they were massively relaxed from those of the early lockdown period.)  By mid august the rules were much closer to "normal" than to "lockdown".  And they were working.  This was great.  We had R ~ 1 and most of our freedom back.  

Then, people stopped following them perhaps because even the relatively lite touch rules were to arduous and perhaps because they either didn't understand that the lack of people dying in the streets was because we were all following these relatively relaxed rules, or because they didn't care.  There has been no shortage of malicious individuals deliberately misrepresenting the situation and the risk either.  

> Yes, the government do need to motivate  people to better adhere to the new tighter restrictions, but given  the fact that for most people Covid is something the majority of their friends, relatives and work colleagues do not catch and die from.  Its going to be difficult I think.

I agree that it is going to be difficult, and what frustrates the hell out of me is that even after the government dropped the biggest peace time bullock in a generation in march/April ,we were getting there by mid-august, and if we'd had clear, consistent guidance from government instead of what almost look like deliberate attempts to undermine their own messaging, we'd be getting better still, not staring down the barrel of more disaster.

Post edited at 21:04
OP bruxist 28 Sep 2020
In reply to Billhook:

I agree - it will be very difficult now. I'm in the West Riding, where it's hard for anyone not to know someone who's died, but that hasn't been the experience all around the country, and some are rightly bemused. I don't want what we have here to become widespread.

That's why I started this thread. If natural herd immunity is as it now seems a pig in a poke, better that people be aware of it so that we can plan for no herd immunity. 

 Billhook 28 Sep 2020
In reply to bruxist:

Wow!, .  I only know one person  in our village, a nurse in a local hospital whose had covid and so far as I'm aware no one I know has had someone they know die or even caught Covid.   As far as I'm aware there have been no deaths from Covid, even in our two nearest towns.

 Michael Hood 29 Sep 2020
In reply to Billhook:

I know several who have died, some who were seriously ill (2 months in ICU) and others who've had it less seriously (me, wife, son).

Not surprisingly, people's attitude towards any restrictions can be greatly influenced by their "local" experience of Covid.

Unfortunately there are still plenty of covidiots in places that have been badly hit by Covid even where these people know others who've died from it.

The important thing to remember is that your locality's "escape" so far from Covid is because of the restrictions (not in spite of them). Hopefully it will stay that way for you.


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