UKH

OK, I confess, I have a contrarian streak, but my thoughts mulling through my brain while on a long walk today were:

The Imperial College report said that a "do little" approach could mean 510,000 dead.  Huge number.   Except that in a normal year 600,000 die in the UK.   Further, the risk profile of COVID19 (elderly, the long-term ill) is pretty much the same as the overall risk profile in normal times.  

What this means is that, for any individual, the effect of a "do little" policy would be that your chances of dying the next year would be roughly doubled from a normal year.  Thus, what would have been your chances of dying in the next two years would now be your chance of dying this year.

Yes, that's bad. But is it so bad that we should shut down large swathes of society for an indefinite period that could be a year or even more (if hopes of an early vaccine are not fulfilled)? 

Most of us don't particularly worry about the probability of dying in the next two years.  And those for which that probability is high (elderly, long-term ill) are usually more interested in quality of life than quantity, having accepted that it is finite.  We just accept the 600,000 as the way things are and get on with life. 

Further, a doubling of risk for "do little" compared to  "lock-down" is likely an over-estimate, since: (1) many of the 510,000 would be among the 600,000 anyhow; (2) at this point we're not going to save all the 510,000 whatever; (3) shutting down swathes of society and the economy will also have consequences for lives.     So perhaps the lock-down reduces the increase in risk, compared to normal, from (maybe) 1.6 or so to (maybe) 1.2 or so. 

So, on my walk, I couldn't help wondering whether maybe the government's initial response was about the right balance, and that everything since the Imperial College report has been an over-reaction.  (I do realise that it would be politically impossible for politicians to have done otherwise.)

[Aside: it seems that it's not actually the virus that kills people, it's the immune system over-reacting to the virus and producing a cytokine storm that then damages the lungs and heart, that kills people.]

So, is it worth it?  Maybe the answer is: yes, it is indeed worth it.  But we should ask the question. 

The dislike button is just below for those looking for it!

If it means that the virus isn't going to spread unchecked, leading to the NHS getting overwhelmed and people dying alone in makeshift hospital tents without access to a ventilator then, yes, it's most certainly worth the inconvenience. 

Three different perspectives:

If we want a health service left that’s staffed by human beings in a years time, we have to do our best.  Doing our best is going to hammer these people.  Letting it happen unabated would I think wreck them.  

I’ve not seen any actual figures giving any basis for what fraction of the “take no action” COVID victims would anyhow die in the next year; I don’t think the overlap has to be that high a fraction.  I read an article on the BBC drawing the same analogy this morning and did wonder if Cummings had slipped a draft to someone at the BBC.  It’s a slight of hand to assert this “because the numbers are similar” when both are a small fraction of a larger demographic.  It proves nothing.

This virus could be a relatively benign precursor for something worse.  The fewer people it infects, the lower the probability of that mutation occurring.

I know you’re a boffin but are you sure about your stats/probability mathematics and your assumptions here ? 

Nail on the head.  While the pontetial for deaths is huge I think the possible overwhelming of the healthcare system and the probable resulting increased death rate is enough justification on its own for current measures.  It's easy to reflect on whether it is all worth it while on a walk... Not so easy while lying hooked up to a respirator or sat at home while a loved one is hooked up to a respirator (or can't get access to one) in a tent or a hospital corridor somewhere.

Twice as many deaths will not be the same as usual.  There won't be the usual dignified funerals and the same medical treatment.  

It's not just the overall numbers being similar, the risk factors (age and serious ill-health) are also similar, with the age profile being similar for covid19 vs normal.

It’s not only the old and frail who die from COVID19.

Younger people also get very sick, in fairly large proportion, and without respiratory assistance and hospital care, they also die.

In France, 50% of those in hospital are below 65yo. These aren’t people who were going to die in a few years.

It’s also about having a functional health system. Without these lockdown measures, what you will get is hospitals totally swamped, and I mean, swamped, by hordes of very sick, desperate people in urgent respiratory distress.

You’ll get hundreds of thousands of people literally dying in agony in their own home, or outside hospitals, and not even any capacity to process their dead bodies.

Any way you look at this, the numbers of people who would need urgent treatment at the same time if we let the virus rip are so big, it just isn’t even an option.

The experience of Italy and Wuhan is genuinely, genuinely horrible.

Basically it isn’t even a political possibility.
When social media is flooded with videos of people left to die in their home and in hospitals, lockdown happens whether you like it or not.

There would be the extra suffering happening, too, involving people with more everyday injuries and illness who'd not be getting adequate treatment because of covid19.

Edit: On rereading this we're saying the same thing, or things which overlap.

Is that taking into account the compounding effect of an overwhelmed health service? Or is it based on continued effective treatment? (Genuine question, not a loaded one. I haven't read the report.)

Yes but a lot more people with those risk factors don’t die in any particular 12-month period.   There’s something like 9,000,000 people over 70 in the UK.  Like I said before I haven’t seen any statistical analysis giving credence to the “dead in a year either way” argument.  

The 510,000 number is from the Imperial College report.

The 600,000 number is well established.

The fact that the age profile is similar (age hugely increases risk of dying in normal times, and under COVID19) is fairly well established.

The fact that serious health conditions is a major risk factor, both for dying in normal times and for dying with COVID19 is also pretty well established.

So, overall, I'm not really making any assumptions (ok, the bit about "from (maybe) 1.6 or so to (maybe) 1.2 or so" was a wild guess, feel free to ignore it).

I think it's an additional point to what I'm saying and it makes sense to me. 

The "dead in a year either way" argument just says that increase in risk is likely less than a doubling of normal.  So, if you don't accept that argument then ok, let's go with a doubling of normal risk.

As I understand it, the 510,000 figure in the IC report is indeed with an overwhelmed health system, so it's the number presuming that there is not effective treatment. 

(I'm open to correction if I've misunderstood this.)

This is my response to another "overreaction" post, a few days ago now. I think it's a bad mistake to think in terms of number of deaths, rather than amount of suffering caused.

A death isn't just a death though. We really don't like getting murdered, but we're not nearly so bothered if we die of cancer having had the best available treatment.Depending on the policy response, we might either be dealing with a steady bunch of deaths of ill, old people who got treatment and who might have died anyway. Or we could be dealing with loads more people dying at the same time who just needed a ventilator, but the hospital system was completely overwhelmed. The preventability of deaths makes an enormous difference to the level of suffering.

All the information I think's reliable I've seen is unanimous that a fast pandemic is f*cking awful because of the limited capacity of the healthcare system. I genuinely don't care about the numbers of deaths in any given year; what I care about is the amount of suffering. If someone I know is told that their partner or parent or child is going to die untreated because they don't qualify as sufficiently important to get a ventilator, then that to me is the end of living in a civilised society. I don't think we can recover from that for a long time.

I think the questions we need to ask are aren't about the numbers of deaths. They're questions like "would I rather lose my job and live on hand-outs, or have my mum die alone in a corridor of an imploding hospital". They're easy to answer - the information is right in front of you. A slow pandemic is just about bearable, a fast one is absolutely f*cking awful.

By the way, my comments on the age profile of the risk being pretty similar (COVID19 versus normal) are based on:

https://medium.com/wintoncentre/how-much-normal-risk-does-covid-represent-4...

But a slow death from cancer, even with the best available treatment, can be (to use your expression) absolutely f*cking awful.

Would it actually be worse? We seem to be choosing between 10x NHS capacity for months, even years, vs. 50x for weeks. Both are horrendous but in terms of effects on staff wouldn't the shorter one be preferable?

I am increasingly wondering whether we are just kidding ourselves there can be a "nice" solution and in the process adding a wrecked economy to many deaths (which as Coel points out, would happen within a year anyway for the most part. 

That's true. But it doesn't support any argument you're making. Those deaths are going to happen in the slow pandemic, and they're going to happen in the fast pandemic in an imploding hospital.

Are you trying to say that in fact, there are upsides to overwhelming the healthcare system, because it actually does more harm than good? It's not a compelling argument.

Personally, I think that they need to do some studies quickly and ascertain which cohort is surviving by being mechanically ventilated, and then nurse those with poor prognosis off ventilators outside hospitals. 

I take your point – it looks like we will be so overcapacity that “stretching the peak” makes very little difference to the total fatalities, and stretches it out.  But, if we make enough difference to transmission things are wound back to the point we can hopefully wait for a vaccine.

But it’s about much more than just the deaths; giving up is a big step and one that I think would be very difficult for many medical people, politicians, and people in the street. Mountain rescue don’t give up when it’s difficult, nor do the Fire Brigade, nor do our armed forces. Making people give up and watch death unfold goes against defining characteristics of our species and our society.  Once you start giving up...

There are no good solutions yet, but the more we do to stall for time, the higher the chance of a better solution coming along.  The number of vaccines under development is phenomenal – about 50 at last count – and some are already in phase 1 clinical trials. There are also therapeutic treatments being developed around plasma from survivors and things are changing rapidly. Just imagine if we let the virus rip through our population then the next week there is a cure.

I also can’t begin to imagine the logistics of having half a million people die in the next 10 weeks if we just let the virus rip.  I think that would cause public and political turmoil every bit as dangerous as the financial damage of our current approach, and it’s hard to see it ending with anything other than the mass burial pits photographed from space in Iran earlier this week.

No, not at all. What I am saying is that many people have an "absolutely f*cking awful" death anyhow.

(That's partly because we insist on throwing medical care at dying people. We treat people worse than dogs in this country.  When a dog is in terminal suffering we put it down; with people we insist that they suffer on, with teams of doctors trying to prolong things -- but that's another issue for another thread.)

So, given that many people's deaths are not going to be pleasant (as in, the 600,000 who die annually in normal times), saying that many of the 510,000 deaths would also be highly unpleasant doesn't rebut the argument -- whether they lived 1 more year, 2 more or 10 more years, their end could then be just as unpleasant.

This is 1) a denial of the reality on the ground if this virus 2) way too fatalistic

The experience in Wuhan proves two things:

1) letting it rip isn’t even a plausible option, even for an authoritarian state with strong media controls like China.
People simply won’t accept having their loved ones (and not only the old, btw) dying of agonising pneumonia unnecessarily at home, or in the corridors or the outside of the totally swamped, disaster zones of what would be left of our hospitals.

2) It is perfectly possible to control this virus and limit deaths substantially, even to a point that semi-normal life with adjustment can continue. There just is a substantial economic cost to do that.

It’s just a matter of making a collective effort until we get an exit strategy. Actually I am very optimistic that we will find either a cure, a vaccine, or a way to control the epidemic through rapid, repeated mass testing or other means.

It is way too early to give up.

I sense a certain fatalism in some of the posts, and maybe that has been instigated by our uninspiring leadership, but I think it is very dangerous to succumb to that instinct.

You haven't understood my point, sorry if I wasn't clear. I'm saying that the "unpleasant deaths" associated with a fast pandemic are immeasurably worse than the normal "unpleasant deaths" that will happen anyway.

It isn't just about the person who dies, it's about the suffering for everyone. If you are told that your loved one didn't make the grade for the icu place, and their body is in the corridor to be cleaned up later, then I don't think you're going to recover. I don't think the hospital staff will recover. If your mum dies of cancer, and you feel that everything possible was done in her favour, then that's just a sad part of normal life. 

Plus, flattening the curve isn’t only about dealing with the covid19 cases, it’s also about protecting those who would die from other preventable disease and or accidents, because there would be  no functioning hospital left.

My intuition is that the things hospital staff and many many more would have to deal with in the fast pandemic case would be unthinkable.

You would have to very very sure that the best case was still horrendous to give up trying, just to get it over with. I haven't heard anyone with any credibility endorsing anything other than "flatten the peak". 

I’m not being fatalistic Rom.

Neither am I advocating letting the disease run its course unchecked.

Survival rates for ARDS, which is what kills the poor unfortunates are poor for people with underlying health conditions even if ventilated.

Ive worked in ITU and wouldn’t want a parent to experience prolonged suffering with no positive outcome.

No point in ventilating everyone at the expense of those that can survive it.

The approach should be palliative care outside a hospital setting as upsetting as that is.

Personally I don't agree with letting nature take its course with the pandemic, but it is likely to be part of the train of events anyway, since its likely that treatment will not be offered to all older people when the health service is overwhelmed.

 I do think saving individual lives is not worth any cost, for instance if a large number of people were killed in a rail accident a democratic government might think of potential vote loss and spend huge sums on preventing a similar accident, even if there was very little risk of a repeat. However the money spent might have been used to save many more lives with new hospitals etc (or better nuclear bombs for the cynics). There is possibly a parallel with the government's current pandemic response  money  and the future health of the people. I think it is worth it, but the OPs point is certainly worth discussing.

IMHO it now looks as if it would have been better to start the voluntary restrictions earlier and to have strictly enforced restrictions if possible. A large proportion of people are not taking the isolation space seriously eg crowded queues at supermarkets; TV of schoolchildren all together, hugging etc as they end school early with no sign of warnings from teachers present. Even some old people are phlegmatic and careless, but this won't just risk their lives but will lead to more infections and block hospital care for others.
It is very fortunate that younger ages seem much less affected than with many other illnesses, and that deaths will be concentrated among the old who have hopefully had a good life already.

"Let rip" is an extreme but The Economist is asking this week where the best balance between economy and health is. It's the end game that's also  problem. If we all isolate for months (which has its own health implication)  and then stop what happens? Without  a vaccine (far from certain) , we end up with a peak then and with a weakened economy to support us. The Imperial paper predicts this. It's a horrible situation but pretending by locking ourselves away we solve it seems delusional to me. China, for example now have the problem of new imports. SK perhaps offer a solution with fairly intrusive surveillance? 

I'm not convinced.  If it's already got to "their body" stage then at least it was quick(-ish). 

I really am not convinced that dying from cancer after 12 weeks of gradual decline, feeling continually ill, with invasive treatment,  and "everything possible was done" is better. 

In fact, that latter sounds vastly worse to me. 

I’m with you here Coel but the universe is not flat

You don't seem to be reading the whole of my posts.

I think that I am, but am disagreeing with them.

Totally agree with every word you've said.

So, quietly, do many judging by the number of (particularly older) people I've seen out and about.

I think the questions are more like " would I rather lose my job and have 1000 others also lose their jobs or have my mum die alone in a corridor?"

And I don't know the answer.

I've come across a video from a South African expat who lives in China with his Chinese wife and daughter, who pointed out that the Chinese government who has put it on imported cases is the same one which suppressed information about the outbreak at the start, and has a history of stoking up nationalistic sentiment against foreigners, towards maintaining national unity in difficult times essentially. I'll find the video. He's pretty balanced seeming in what he says about China.

edit: Here it is.  youtube.com/watch?v=MR-m2vnpEmM&

Pretty blunt!  But yes fundamentally the type of question. Also whether losing tbe jobs actually protects your mum or not. 

You seem not to have considered the suffering of anyone other than the dying; or made the wrong judgement that loved ones of those who die on hospital floors will react with "at least it was quicker than a prolonged death with good treatment". I think you misunderstand how people feel about preventable and undignified deaths of their loved ones, and of what the effect of a drastically overwhelmed hospital will be on anyone who experiences it.

I agree with you entirely about keeping people alive and causing them unnecessary suffering that way. I just think you've failed to see how bad an imploding hospital system with a lot of bodies in it would be. 

No, my point is that although China currently have minimal cases, it only takes a couple of incoming cases to trigger another outbreak. Do they repeatedly shut down cities? 

I think that there is a right answer to the question of the best balance, as in, that which results in the least suffering. It isn't possible however to calculate that, so the policy has to be justified on some assumptions. My intuition is that counting number of deaths simply isn't relevant. What is relevant is avoiding the breakdown of society. Harsh isolation with draconian enforcement would be its own type of breakdown if it went on too long. The economic annihilation has to be considered, because that's going to bring plenty of suffering too. But I think that the horror of too many deaths at the same time for us to deal with would be bad enough to justify the strategy "let's try as best we can to avoid that, and deal with the consequences that brings".

No matter what the final strategy the first step should be to lock it down to the point where it is nearly stopped.   So many reasons:

a. The Chinese seem to have had success in Wuhan.   That is a hell of a strong reason to follow their path.

b. If you get it in control and have a few months breathing space with small numbers of cases you can learn a hell of a lot more about it.  It takes the time pressure off.  Maybe we will get lucky and find a drug.  Maybe just a better treatment protocol.  Maybe we will get a far more accurate model of who is likely to get it bad so it will be possible to say to some people 'OK it is safe enough for you to catch it'.  We will have time to build up equipment and supplies instead of a headlong rush to produce jury-rigged crap nobody is trained on and has none of the learning that went into commercial products. 

c. Other technologies will improve.  There will be new hygiene products and new technologies for monitoring and contact tracing so it won't be necessary to have a complete lockdown.   Things like computer controlled UV-C lighting which notice when rooms are empty and flood them with UV light to zap virus.

d. If we start from lockdown and low levels of infection then if we decide we are going to have to release it we can do it in a controlled manner.   You could have a national mobile fever-hospital resource with a ton of equipment that was moved to a city and set up before raising the lockdown in just that one place.

e. It isn't just the immediate deaths.  There's also the people who will have long term consequences such as lung problems, kidney problems, apparently even testicle problems.  That needs to be quantified, as does the degree to which catching it gives immunity and whether there are multiple strains before making a decision.

Why is the suffering of loved one when their parent dies alone in a makeshift ward without intervention worse than watching the slow decline of someone with cancer? Personally I don't think it is.

If it is for most people, it's only cos we're not used to it (unlike say in part of Africa and South Asia), and we've developed a mawkish sentimentality around death.

I've been telling people for weeks (since Italy happened) this is coming and they look at me like they either don't believe me or would rather I wasn't being so indelicate.

I agree that an imploding hospital system is going to 'look bad', and it's hard to tell how the populace is going to react politically (I have my suspicions) once it becomes a reality; but that doesn't mean I don't think that isn't at least potentially preferable to have a rapid build up and the build up of a reasonable degree of herd immunity, rather than lots of smaller waves which, as you know from the modelling, could lead to more deaths overall and a lot more economic dislocation.

edit just to add: as others have said, politically and ethically it isn't going to be allowed to just let rip. 

We aren't ants

We must be scrupulously fair in your idea.  That means all medical treatment has to stop as it is, otherwise, unfair to choose or prefer anyone for medical treatment, children included,.  Let all the medics apart perhaps from midwives and obstetricians who prevent maternal deaths in childbirth have a holiday until the illness passes.    Then we can all be equal ants and let nature take its course in harmony. 

We could also let dentists have a holiday as so many people might be ill that it would be unfair to ration dental treatment during the epidemic.  No one can really complain about having to wait a few months for toothache suffering to be attended to.  You'll surely recognize that what does not kill you makes you stronger and more rational, rejoicing in the fairness of things.

FFS if you don't know the answer to that one, then I'd advise you not to bring the subject up on Mother's Day tomorrow.

and all the young people dying of injuries survivable in normal circumstances and appendictomies left too long etc etc etc

Which is why I'd favour them staying at home, in the company of their loved ones, and an end hastened by GPs with big bottles of morphine.  

''I've come across a video from a South African expat who lives in China with his Chinese wife and daughter, who pointed out that the Chinese government who has put it on imported cases is the same one which suppressed information about the outbreak at the start, and has a history of stoking up nationalistic sentiment against foreigners, towards maintaining national unity in difficult times essentially''

The veracity of the information on it being imported/incoming cases causing issues (now) is what I was talking about. It puts a different spin on the recurring outbreaks happening in China, depending on what the truth of things turns out to be.

I watched my dad die of ARDS / septic shock four years ago. It is indeed a horrible way to die, and took about sixteen hours from onset of severe symptoms. He was 86 with co-morbidities; I can't remember if we had an advance decision or not, but clearly the doctors had made their decision, and he wasn't ventilated. About one hour before he died they gave him an injection to calm him down, I'm guessing opiates.

In contrast my mum's partner died of bowel cancer in his seventies, and they were able to manage his condition without much medical intervention until the very end. Mum and he 'accumulated' enough morphine for a fatal dose if that's what he felt like, but it ended up that they didn't need to use it, and he was reasonably comfortable.

One is short and painful, the other is slow. I'm not sure which to choose.

With respect to Coel's OP, I have had similar thoughts, however I now think the chances of doing nothing are zero point zero, for any number of reasons. Therefore the task that remains is to look after everyone while we get through this, however it happens. Principally, once we're out the other side we need a functioning health service, not a PTSD wreck. I'd personally like to see more decisive leadership - "your country needs you", really on a wartime footing, because that's where I believe we are. Boris and company need to forget Churchill and start thinking Kitchener!

This is really happening folks, and there are no shortcuts.

we could certainly have saved a lot of expense by not having barrage balloons and blackout  restrictions suring the war.

Come to think of it, vaccination programmes cost money.

I'm really pleased that you have raised this post, as I had asked several times whether people had looked objectively at whether the measures being suggested and undertaken were actually likely to help the overall situation.

I have not got round to reading the Imperial College paper, but intend to. Is it the case that if no actions are taken to reduce the effects of the natural flow of the viral infection through the populace, then there will be more people with more severe infections and signs of disease, as well as more deaths? What I mean is that the viral challenge to any one person would be greater, than if isolation and social distancing were/are practiced. So we can probably all withstand 5-10 viral particles, and younger people will better withstand 2,000 viral particles, but few if any would withstand 100,000. (The figures are notional for illustration.)

Rob

I think that we are culturally accustomed to slow declines by cancer, and that we are horrified by preventable, undignified deaths, and of the feeling that we as a society have lost control. Slow declines are a mark of our ability to control death; hospitals full of bodies will chill us to the bone.

You can call it "mawkish sentimentality" if you like, but all I'm bothered about is the degree of suffering. I don't think many NHS staff suffer PTSD when they've been caring for cancer patients, but I think they will when they're clearing up bodies without sufficient resources.

I don't think it's about whether it 'looks bad'. I think it's about whether experiencing it is a trauma from which you don't recover.

As I said, I don't think that the number of deaths is crucial, it's the suffering that's caused all told. I agree that there is a balance to be struck (too much isolation and enforcement for too long could be awful as well), and I think that balance will involve avoiding the imploding hospitals scenario.

I don't think that if the demand on the healthcare system far exceeds capacity, then a solution is for GPs to decide who gets care and who doesn't, with the outcome that the hospitals remain OK for those who get the places. That's just not how people work.

In an alternative reality, people would weigh up the value of their lives, and say, "sod it, I've lived 70-odd years and it wasn't that great anyway, hand me the morphine". But not in this one. GPs deciding that people are going to die when they don't want to really goes against the most basic values we have a society. It's not an option.

I was replying to MG, never said you are !

I was replying to MG, never said you are !

Experience in Italy and Wuhan suggest that you won’t be able to give life saving treatment to the majority of those who actually have very good chance to recover either. 

Maybe, we're going to find out aren't we? The evidence of my own eyes is that there is little adherence to social distancing, so it stands to reason it's already ripping through the population.

(Also, by the way, I don't think these deaths can be regarded as 'preventable'. In my view they're not preventable because we would not, and could not, have reacted in the way China or S. Korea did). 

It's precisely part of my point that people aren't prepared mentally for what is about to happen, and that a major unknown is how the general population is going to react to it. 

I'm fairly willing to bet that they will be absolutely horrified once social media starts seeping out from doctors and relatives, and will turn on the government. (On the other hand it might, just, be a bit more like WW1, depending on whether people generally have been really thinking this through in advance). Personally I'm fully expecting scenes akin to Italy, so that is a kind of preparedness.

Source ? Everything model I’ve seen suggests that not overwhelming the health system would save lives, many, many lives.

It would be more, "I've lived 70-plus years, and it was utterly great, and I really enjoyed it and take pride in my children ans grandchildren.  But, nowadays, my eyesight is failing, my hearing is failing, it hurts when I walk and I am losing my mobility. My list of ailments is growing,. This is just going to get worse, and life is slowly but surely becoming less enjoyable and more of a trial. I may last a few more years, but I don't look forward to a messy, painful and prolonged end ... and now I've got the virus, and the symptoms are quickly getting bad ... I could try fighting it by going to an over-crowded and near-collapse hospital, but that would be hideous at best, and the prospects are not good ... sod it, hand me the morphine".  

Rom, calm down son. By the powers of misconstrued posts I was never insinuating that you were

My commiserations.     My thought on reading that is that the calming injection of opiates was about 14 or 15 hours later than it should have been.  

It is wrong to suggest that this impacts only the old and the frail already very close to the end.

In France and Italy, about 50% of those being treated in hospital are younger than 65yo.

Besides, many people in their 70s nowadays have plenty of good life left in them.

Neil Ferguson's early comments (I think). I'm not going to check, I've read reams of stuff over the last few weeks.

I think it's critical to aim not to overload the health system but I also think it's going to happen anyway.

The other point is if you keep squashing the sombrero (sorry!) *too much* for too long more people move into the at risk group. Plus, if you fail to generate herd immunity what will the people who are cocooned going to do (eg especially diabetics). Never come out?

I'd be very interested to see evidence to the contrary. But a lot of what's raised here isn't being discussed because it's become taboo.

Hum I was perfectly calm.

That's a bleaker reality at 70 + than some family members experience, letting it run it's course could snip 10 years of life ranging from middling to decent in quality from many people's lives, which would be awful.

I know Wasn’t having a pop at you is what I’m saying

Well yes, agreed. As I said in the OP, it amounts to -- for people of all ages -- their probability of dying in the next year being approx double what it would otherwise be. 

The question is whether preventing that is worth a lockdown to the extent that we can't leave our homes other than for medical reasons for to buy food, for an indefinite period of time that will be several months at least. 

I think I can see your point. If the assumption that many of the covid deaths will look like the above is correct, then there is a good case for keeping the economy going rather than lock down. However, if a large proportion of the deaths would be people who really want to carry on living because they don't feel that they're close enough to the end anyway, then the suffering will be tremendous. My assumption is that the deaths will be perceived as tragic and preventable, human nature will send everyone running into the hospitals and the consequences will be utterly dire: as such, flattening the curve with harsh economic costs is paramount.

This is the mainstream thinking, because we know from experience that dying people in our society tend to seek help from the NHS, and the NHS staff feel duty-bound to help them. I think you are wishing people were different to how they are, and that isn't helpful. We've got to deal with the world as it is, and make the best of that.

Edit: have you tried morphine? Not actually that reliable at relieving suffering.

Did that study take into account crashes in the health system and subsequent deaths from that?

I think this is way too fatalistic. Wuhan shows you can actually control this, and that if you don’t, it’s really really bad, and way too much for people to accept.

You are right the health system will be overloaded, initially anyway, because we did too little too late, but there is a big difference between being at 2x capacity and being at 20 times capacity.

And it may be that in the end, that is true and there is nothing we can do, and you are right to prepare to this possible outcome, however I think given the current position, it is simply way, waaaay too early to start giving up the fight before the battle even started.

There is plenty of indication that it can be controlled with existing means, and there is plenty of hope for new treatments and new solutions as well. 

I’m actually pretty confident we could get through this relatively unscathed, provided we don’t succumb to despair and fatalism. 
 

I'll regret getting drawn into this but you've reduced your argument to one about euthanasia / assisted suicide, at least in this post.

It is a fundamental tenet of most societies in the world, at the present time, to protect and treat the ill and suffering. Indeed, it is a virtue that we hold up as a signifier of our civilized society, despite all its inherent inequalities. 

In the same way as the question of euthanasia can not easily be reduced to a matter of degree, neither can that central tenet. So, just as doctors pledge in the Hippocratic Oath, we as a society undertake to protect life, where possible. If we cannot hold on to that principle we are in a very dangerous place. Inevitably people die for want of good medical facilities, especially in other parts of the world, but that is quite different to explicitly weighing the possibility of preserving life against other factors.

On the question of euthanasia, having once seen it as generally a good thing, I have been much more ambivalent for many years. In the current crisis, my main contention with it comes immediately to the fore - patients having to weigh their right (to life and therefore to treatment) against the greater good (of their nearest and dearest, or simply the rest of society). Patients who know they are frail and elderly and don't have long left and don't want to be a nuisance. If we accept that their choice is made under both pressure and duress, then it hardly becomes a choice at all. I hope you understand my point.

Without straying into evolutionary theory, a viral epidemic is an exquisitely acute demonstration of survival of the fittest in action in any population. Indeed, as a human pandemic, able to be transmitted rapidly through the WHOLE human population it could be spectacularly effective. However, as beings cognisant of our place in the world, we undertake to protect the weak and vulnerable (to repeat myself). 

No doubt, the pandemic raises many, many interesting ethical questions but it seems pretty clear to me that, since the UK government used the phrases 'many will die before their time' and 'herd immunity' in the same press conference a fortnight ago, they've been moving, belatedly, towards a position more acceptable to most of society. That being, protect life first.

So the question of numbers will always be secondary, although I do entirely understand your point about the numbers and have read and thought quite a bit about it myself in the last few days. The arguments about approach have all been played out in this thread and many others but in the end, doing nothing is simply not an option because that requires individual medical staff to do nothing. Once you do something, you have to keep doing something, with the resources available. Maybe in five years' time we'll all think differently. Maybe we'll build greater resilience in to healthcare systems.

I need to stop.

In essence this says what I meant to say much more succinctly. My main change in view about euthanasia came about when my Dad was dying with dementia and Parkinson's. The time came to sign a DNR. I thought about the question 'if he could answer the question, 'do you want to die', what would he say?'. He couldn't answer the question because of his advanced dementia - he couldn't understand anything. But I was unconvinced that he would have said, 'I want to die'. Of course, that's quite different to a DNR, so I wasn't too challenged. But I think there are very few people who, when they were OK and are being treated, if given a completely free choice, would say with full insight 'I want to die'. Call it human spirit, survival instinct, some pseudo-religious concept from centuries past, but most people have an understandable fear of death and don't want to go there willingly. Most people in favour of euthanasia are either experience severe and chronic pain, or some other major life limitation, of they aren't about to have it done to them...

Unfortunately there is a strand of nihilism and lack of humanity that seem to have infected our political system and society before coronavirus did. I sense that this transpire in some of the fatalistic attitudes we are seeing.

Absolutely. 70+ and being asked if you're ready for the morphine because there's a shortage of ventilators. Not an equation I think we should be considering under any circumstances.

I think you misunderstand him.  I don't believe Coel is advocating euthanasia here, but effective targeted palliative care.

Which is very different. 

The rest of your post was excellent, btw, but I think belongs to a different thread (like so many good posts)

In reply to elliott92:

Yep. Obviously none of us know the answer, but my intuition is that being confronted by a lot of grizzly death will be worse than relative economic hardship. I think we would be wise to consider that many of us have a lot more than we need to be happy, and that stuff is of absolutely no use when your loved ones are dying in a pandemic.

Well actually, since you put it like that, does you and everyone else having to stay in your home for ages look that bad, against dying? I realise that you want to offer people a 'stick or twist' on having a hypothesised extra year or two of life against generalised global recession but that's an equation that we we're still moving away from even if we don't still hold to the sanctity of life as Christian ideal alone.

It probably will be for the vulnerable who get to stay alive, and the people who have them in their lives.  At the nub of this thread seems to be the question of how much is a person worth to society, a person who is possibly retired, and older/elderly?

In reply to elliott92:

I think this is way too fatalistic too. Sure there will be a severe hit but, but, especially in the west, we are tremendously rich and sitting on tons of wealth. Provided we help each other, we have more than enough to live through it pretty comfortably.

Plus the good news is a large part of our economy is digital now, and manufacturing the things we need require minimal staffing thank to automation. We have never been better placed to face such a situation, technologically speaking.

Moreover, our economic systems are very good at adapting to different needs. That one of the advantages of market capitalism.
 

But it is based in the misunderstanding that only the old and frail already at the top of te grim reaper’s list are impacted. The argument would be somewhat defensible then. But this isn’t true.

Thanks but my post was far from thought through; it turned into a complete ramble because I scanned the thread desperately wanting to avoid being drawn in and then bit on Coel's specific point about the morphine.

On the specific point though, palliative care (as chosen by the patient) and euthanasia are relatively indistinguishable when weighed against treatment, recovery and life. And this is the crux - either the doctor says honestly 'I'm sorry, there's nothing more we can do for you', or the patient agrees that it would be best for everyone (the whole world!) if they didn't take the ventilator and ICU bed because they'll probably die in the next few years anyway. I don't think I'll ever be ready to say 'I've thought about it and now I have definitely had enough...', without being in severe pain, or otherwise hugely incapacitated. Especially if I've only had a few weeks to seriously think about it because this poxy virus has suddenly blown across the planet like a sandstorm. If I am diabetic at 70 I'll be wanting to give it a while yet.

Eh?

No, it's based in the idea we should palliate those who will most likely die, not that the young and fit won't need treating either. I know many of those will need ventilating. 

In reply to elliott92:

Everything you say may well turn out to be true. But the problem is the world as the way it is, as Jon points out. Which government can refuse to countenance any travel bans / social distancing etc.?

But this isn’t the situation we are facing. What we are facing isn’t an ethical dilemma on the artificial prolonging of life, even if, on an individual basis, these situations will come up.

Instead we are facing war against an enemy that has the potential to kill many hundreds of thousands of people well before their time.

Seems to me that not only the cause for fighting this war instead is most definitely worth fighting for, but there are a lot of good reasons to be quite optimistic about our ability to win this one.
 

It will just take some grit, some effort, and some time. What is really counterproductive at this stage is to engage in fatalism, defeatism and nihilism. It is unfortunate that the Prime minister initially sent this signal, which I think was a grave failure of leadership.

You've totally confused me now.

It started with the "misunderstanding" that only the old and frail will be impacted (I haven't seen that opinion here, or anything based in it), and I'm not sure what your arguing about after that .

I agree having thought about this quite hard as a business owner with numerous employees and as an individual with family both very young and old (at risk).  At what point do we find an exit to save the economy and everyone from a very serious 20’s style depression leading to even greater harm (and deaths potentially) than the virus itself.  I think we have roughly one month to decide.  

I am aware of a very recent wedding at which close to 50% of the attendees were medical professionals,  mostly front line doctors and paramedics, some of whom specialise in respiratory illnesses.  Double standards clearly but leading to what conclusions?

In reply to elliott92:

I don’t think that is true about economic hardship really. Even if our GDP was to be halved (that’s about 3 times worse than the current worst case scenarios) this would bring us back to where we were, in economic terms, in the 1990s.

Life wasn’t that bad then, was it ? 

Possible. We can cross this bridge when we come to it.
But if I was a betting man, I’ll bet that even if this lasted more than a year, our economy would simply adapt, and in fact, would come up with lots of new products and services to help us live better with this situation.

We are already seeing it, actually.

Guess what, I bet there are plenty of things construction workers can do that we will need to get though this.

Well it is the premise of Coel’s argument. Simplifying, he is saying that these people are going to die soon anyway, don’t really have great lives now, so in fact, this isn’t a fight worth fighting.

That is simply, however, not the reality of the situation we are facing. It is based on false assumptions.

I don’t think this is like a 20s style depression.

Unlike in a regular depression, there is no reason to think the productive capacity of the country is being too much permanently damaged, destroyed, or that it is misallocated, or inadequate.

Instead, it’s more like a pause on production. So it will cause very big, sharp drop in GDP, but as soon as we restart, you will see equally sharp spikes in production up.

Now is the time to worry about our health. The economy is there to serve our needs, and I am sure it will, but it’s not an end it itself.

Whilst I agree it’s not the same, I disagree re impact.  Most businesses will be unable to withstand 3 months plus of disruption of cash flow.  Simple as that.  Of course, things can eventually regenerate but it’ll take a decade or two to do so.  

I agree many businesses could collapse but it’s not beyond the wit of man to keep most businesses alive or mothballed through state aid and loans, so that they are able to restart quickly when needed.

Say you have a factory that makes cars. If your factory is blown up by a missile, or is completely geared to produce cars that nobody wants, then you have a deep problem.

This isn’t the same as simply having to pause production for a while. Yes, it will look bad as your production will be zero, but there hasn’t been destruction or misallocation of capital. As such you can get really quick restart, and almost go back to normal very quickly.

Basically I think we will see the deepest recession ever seen, followed by the quickest recovery ever seen.

I doubt many people in Lombardy are having the above conversation.

It seems that roughly 40% of those hospitalised (as far as the data currently shows) are under 55.

https://www.healthline.com/health-news/covid-19-isnt-just-dangerous-for-old...

Exactly.

« In a group of 500 patients hospitalized, about « 20.8 percent were between the ages of 20 and 44, and 18 percent were between 45 and 54. 

Of patients in the ICU, about 12 percent were below the age of 45. Few died. »

Contrary to what is being peddled, a lot of young people end of with a severe disease that requires hospitalisation, but the good news is that they respond well to treatment, and do survive, provided they are given the medical help they need.

Hence the utmost importance to protect our healthcare system.

At least I have tidying and gardening and driving theory and other things to occupy myself with...

The problem is that the U.K, Switzerland and the US are currently following a mitigation rather than a « hammer it down » strategy.

This seems to be the worst choice to me. Because it will still overwhelm the health system many folds, but for a longer period of time, and it provides the perfect environment for mutations to occur.

Very interesting read there: https://link.medium.com/UKnsFR0e34

Without a lower range and some context, this figure is completely meaningless.

It could be that 99% of the 50% are 64yo and 11 months, and have severe underlying health issues. 

Italy, France, 50%, 65yo and in hospital is not meaningless. If you cannot derive some  partial meaning from five simple facts that's down to you. Unknown countries, unknown percentage, unknown ages and unknown situation - now that's meaningless.

It could be if you did not understand that human health does not have a 64yr 11month cut off.

That's only one part of the argument, in that it's true for a lot of those who would/will die from COVID19.  

But yes, younger people with potentially years of good life are also at risk.  But the risk for them is not that great.  It's a doubling of their current -- often low -- risk of dying in the next year. 

Suppose, six months ago, you'd rubbed a lamp and a genie appeared, who offered you a choice:

Either: months of total disruption, being locked down to your house, at the end of which you've lost your job, and you are financially in difficulties, with consequences that could persist, affecting your quality of life, for years. 

Or: You accept that, whatever your chances of dying in the next year were, they are now doubled. 

Which would you have chosen?

I read your initial post and actually can't face reading the rest of this thread.

'Doing little', which is what too many people like you are doing and promoting is going to get a lot of people killed - and not only killed but with their health severely damanged, and with lots of people traumatised. Everyone with any expertise at all is screaming about the need to do what we can to limit this. And people like you, based on your half-baked calculations try to undermine it. Medical and care staff do not have enough PPE and some of them are getting seriously ill and some are dying: my wife, who I expect will be on front line NHS service shortly, could be one of them. My daughter is on permananent rotation for looking after the young children of essential workers, is at risk. My brother and Dad and mother in law are all immunocompromised and at serious risk. Do little, in the face of all medical expertise to the contrary? You are sick.

My friends and colleagues in Somalia are looking on in mounting horror at what is heading their way in a situation where most have limited access to water and soap, almost no means of self-isolation, very limited opportunity for social distancing, no financial safety net and effectively no medical services. They are scrambling to mobilise their networks and mobilise resources while minimising spread. Once I post this message I will go back to doing what I can to help them.

I am permanently done with you, and anyone else dumb and dangerous enough to like your post, which I see is 31 so far. If UKC had the ability to block someone I would block you. In the wake of this global disaster, I and many others will remember who the dangerous idiots were and who stepped up. Same with organisations - those who undermined responsible behaviour and those who did the right thing.  

The spread needs to be slowed as much as possible to buy us time. But people like you are undermining our efforts.

If you, or someone else like you, due to your stupid and dangerous attitude ends up being in front of my wife to be cared for she will not hesitate to do her absolute best for you no matter the risk to her. Shame on you.

I suggest you do read the thread. No one is callously suggesting people die for no reason. Rather recognising a complex situation with great uncertainty and many factors to balance. 

Actually I'm not.  I'm pretty much socially isolating, perhaps much more so than the average person.   But the question is one we should ask.

The calculations and numbers are not mine, I'm merely reflecting on their implications. 

I'm actually not advocating "do little", that was merely taking the "worst case" number from the IC report. But I do think we need a balance here.  Shutting down society and the economy is not consequence-free either.

It's a nice question, well posed but there are a few ways to answer.

1. I'm a human being not a computer so it's almost impossible for me to properly or accurately comprehend the question with full understanding of the facts and detail.

2. I don't have to make the decision, unless we go back to your euthanasia on a trolley scenarios. Governments make those decisions. And the whole reason we have governments is to enact the collective will of societies / states, or in many countries to otherwise control them generally for the good of the people. Governments take on the responsibility of caring for their citizens to varying degrees. Some governments are (or at the moment maybe just think they are), well able to do it, hence trillion dollar bailout packages etc., some aren't, hence the anxieties about many African countries and refugee camps full on ungoverned people. In this country the plan is to prevent long term economic depression AND save life. We'll see.

3. Separate to point 1, but linked, the abstract nature of your question is such that at some point, somewhere, a medic will have to take a decision about my welfare not me. Unless you want me to sign a waiver when I speak to the genie saying yes I'm up for being left to die if it comes to it and (more to the point), so should EVERYONE ELSE in the world who gets the virus, which is EVERYONE ELSE, because we're not doing anything to mitigate.

Really your original question boils down to a sanctity of life argument. And in many ways I struggle with that as a concept in a broadly post-religious worldview. But this is a global issue that can't be settled by individuals. I'll stop there.

Respectfully, you are wrong about this Coel.
Both qualitatively and quantitatively.

You are basing your analysis on death rates if people get treatment.

Currently about 0.2% of 29 to 44 year old die, but of those, roughly 21% are admitted to hospitals and 2% to 4% to ICUs. It’s a lot.

The problem is that without hammering the virus early, hospital and ICU capacity gets overwhelmed many times over.

Then your death rate of 0.2% for those goes to 2, 4% or more, because people can’t get the critical life-saving treatment they need.

In that situation the risk of someone of that age dying isn’t just doubling (which is already pretty bad) it’s multiplied by a factor of circa 20.

Obviously for anybody older, this gets very much worse.

There is a reason all these countries that have experienced it have gone into lockdown and taken such unimaginable, extraordinary steps.

It’s easy to fool yourself with massaging and cherry picking the data, but the reality on the ground doesn’t lie.

Besides, letting people die isn’t remotely the strategic thing to do now. It’s essentially way too early to give up a fight we have actually very good chances of wining.

It will take some effort for sure, but if we make the sacrifices needed to save all those people, I’m sure we’ll come out of this stronger and wiser.

However if we let 100,000s of people die without a fight, I think we’ll just have succeeded in making our society more nihilist, less respectful of human life. It’ll be a huge step back.

I'm taking the 510,000 figure from the Imperial College report, which is for a "do nothing" scenario in which the NHS would be totally overwhelmed. 

If I've misinterpreted that then I'm open to correction. (Of course the IC report may be underestimating things, or the virus might mutate to worse ...)

It really hit home to me the implications of this. I have read that 43 % of over 70 years will be hospitalised in the worse case scenario. 
 

that is a stunning number . 

If I were you I wouldn’t pay so much attention to fragile models with shaky assumptions and instead look at practical experience on the ground.

In any case, as I’ve said, I don’t see any good reason to give up the fight at this stage. It’s way too early to give up when we have such good hopes for treatment and for keeping the virus at bay through other means.

Absolutely - know loads of people like that final bit, you can hear them making the most of their lives despite desperate ill health on 80 and 40 metres every day.  Heard of the RAIBC?

fuck this give up attitude - we might as well call it a day on astronomy too

Yep, basically those who say we have to give up the fight from the start will reverse their position very quickly, because as soon as this hit, social media will be flooded with people crying for help for their loved ones, dying in their homes or outside hospitals amongst dead bodies.

The strategy of the ostrich just won’t work for long anyway, but it’s very dangerous to spread a defeatist message at this crucial stage in this fight.

I'm sure this has been said already but it's as much about other people needing treatment as those suffering from the virus.

The currently healthy better hope they don't develop any sort of condition during this and those with existing conditions of any sort are likely to see their treatment compromised either due to a lack of resources or fear of spreading the virus.

That isn't the choice. A huge spike in deaths by respiratory failure that overwhelms the capacity of the NHS is *not* having your chance of death in the next year doubled. You are determined to ignore the difference no matter how many times its pointed out.

I wouldn't mind being twice as likely to drop dead in the course of a normal day. But I absolutely do not want to endure living through a fast pandemic. It isn't about the f*cking death rate for crying out loud, it's about what we have to experience in the case of the fast pandemic. Jesus. 

I'm basing my arguments largely on this piece, which derives from the Imperial College report: https://medium.com/wintoncentre/how-much-normal-risk-does-covid-represent-4...

No, each time that that has been put to me I've replied that the figure of 510,000 that I'm quoting *IS* for a "do nothing" scenario in which the NHS is utterly overwhelmed.

And each time I've given that reply I've stated that I'm open to correction if I've misunderstood that. So far, no-one has disputed that the 510,000 numbers is indeed for an overwhelmed NHS.    If that is wrong, I really am open to correction. 

The figure in the IC report is that for people aged 70 to 79, 24.3% of those with symptoms would need to be hospitalised (so less than that, as a proportion of the whole population, after factoring in those who get the virus but no symptoms, and those who don't get it at all).  

Obviously it's still a very large number. 

Sorry, I wasn't clear. I'm not disputing the numbers. Everything you didn't quote is my point - have you read it? Have you got a response? 

So basically you do not want to be hospitalised. Whatever age group. 

If your point is that a fast pandemic in which 100,000 die is vastly worse than a slow pandemic in which 100,000 die, and that dying in a day or two untreated is vastly worse than a prolonged death over several months with the best treatment expended on you, then yes I do have a reply -- I disagree, as I've said.  If it were me I'd prefer the former. 

This comes down to how individuals feel about things, of course, so it's something on which we can legitimately disagree. 

The death rates on which his whole analysis are based on what you get with treatment.

Take the 30 to 39 age group, 5% of infected  require critical care, but the death rate is only 0.08%

What happens when those 5% don’t get critical care ? Well, the vast majority of them start dying.

Note that these numbers in the first place have a large uncertainty around them.

I don’t think it’s a good thing to make such naive assessments based on such bad data and so little understanding. Instead we should look at the reality on the ground.

And the reality Italy suggests is that you get lots of deaths, very fast, very early in the epidemic, and they aren’t only people who were already close to the end.

100,000 wouldn't die in a slow pandemic, it would be quite significantly less. I thought that was part of the point of this approach.

The problem is that it is a gross misrepresentation of the situation we are facing. This is a problem that extends way beyond those  people who already suffering and at the end of their life.

Granted, but in saying that I was trying to isolate Jon Stewart's point (which he says is not about numbers dying, but about the manner of the deaths).

I was thinking about this, with the duration being 14 days and no hospital visit for the luckier people, a 2 week 'pause in society' rather than the more ongoing situation we currently have, one where all but essential services are maintained, would be comparatively easier for businesses to deal with, and for self employed people, and for people in general.

Unless we take definite steps as individuals, it'll possibly keep going for as long as we all keep zigzagging about in our individualistic way... 

The point, which I've made several times, and which you confirm above you don't get, is that the level of suffering associated with a fast pandemic is of a different order of magnitude than that of a slow pandemic.

For the nth time: it's not just the suffering of those who die. One more time for good luck: the impact is not measured by the death rate. To illustrate this:

I wouldn't mind having double the risk of dropping dead, all other things being equal - your genie choice gives this option, but it is false. If we don't take the strong measures to slow the infection rate, then even if I don't get infected, then I'll have to live through a catastrophe in which people around me are dropping dead and losing loved ones in pain and without treatment. Assuming the best case for me, that me and my family aren't hospitalised, then I don't want to face that suffering. The NHS workers should not be made to face the horror of the fast pandemic. It is the worst option *not because of the number of people who will die* but because of the amount of trauma and suffering it will entail. It will of course entail more deaths as well.

No. The way people at large feel is a fact about the world, not an opinion of an individual. Either they don't mind living through the horror of a hundreds of thousands of deaths in a few weeks if it means they can get back to work quickly, as you are arguing, or they will mind an awful lot, as I am. One of us is closer to the truth here. 

This.

Horrific consequences but right now no ones currently getting on top of this,  except for the Chinese if you believe their own reports.

Please take on board what Jon Stewert is saying. I've noticed that you can (occasionally) adopt a contrarian point of view, and then find ways of supporting it which make intellectual sense, but which possibly don't always have an equal grounding in reality. Though you're undoubtedly very clever. 

If left unchecked, a pandemic will be drawn out suffering, because people below 70 (and 55) will be needing hospital treatment who wouldn't have died from old age related infirmity, as well as the older people who will be dying from old age related infirmity 'as well as' (quite probably) the older people who happen to catch it and need hospital treatment too. Which is before one considers the people falling off their motorbikes and getting burnt, and everything else which people need hospital treatment for throughout the year by our poor old NHS which is stretched anyway. It's about the total load on the NHS and our ability to cope, as well as the extra people dying which one would rather avoid.

Edit: I hope you take this in the polite tone which is intended. 

and as services collapse you can expect higher infant mortality and women dying in childbirth.  Let's not forget that this was a major killer before modern medicine intervened.   Denial of that medical service during a rapid epidemic would set us back to a time before the modern NHS gave us now routine life saving treatment without too much rationing.

Coel and Dominic seem to share a common blindness, apart from the inhumanity of the idea.  After all, what use is astronomy during this epidemic, just a waste of money.

Certainly it will be emotive on social media.  But I'm watching someone die from late stage cancer at the ripe old age of 78, being shuttled from home to a ward....and they and us would rather they were simply left to die than wired up to all manner of machinery for weeks on end, when the prognosis is already clear.

Currently they have pneumonia but are also being tested for covid19 during which time family cannot visit.  The situation seems to be descending into a farce.  Everyone would accept that, in their current state, flu/TB/pneumonia would likely have done them in anyway.  But if its coronavirus the reaction seems to be different.  

Is there anything wrong with accepting your time has come as age and illness have taken their toll?  That it's perfectly natural for a secondary illness to take you out some weeks or months ahead of when your primary illness would have killed you anyway?  And all that happening at home may be better than consuming a hospital or hospice bed?

I'm sorry that you're experiencing that right now, it's probably the contagious nature of covid19 which is meaning they're being tested for it?

There's nothing wrong with accepting that one's time has come, but the crux is that covid19 may claim people who'd otherwise have X number of decent years ahead, somewhat different (I think) to the person you know of at 78.

I thought to myself.

I'm over 60 but reasonably fit. But my wife has asthma and has been hospitallised with pneumonia before plus my dad is 87 so for me personally I am hoping that people help to stop it spreading until the government wakes up and decides to test all cases and track them.

currently in regard to closed cases in the UK the death rate is around 73% according to World Meters. There are plenty of ongoing cases but then again only recorded ones. In reality we don't know how many have got it because only people entering hospital with severe symptoms are currently tested. People with mild symptoms are told to stay home but not tested.

Also deathrate doesn't include those who don't die but end up with severely damaged lungs. Pneumonia is a secondary infection and so is organ failure from immune system over drive, but the virus also damages the cilia of the lungs. The long incubation period, when one is infectious but not showing symptoms also make it particularly difficult to avoid.

Again, to be clear, these are all valid questions, I am rather of the side of being quite liberal with euthanasia and choice when it comes to end of life. But this is not at all the question we are facing.

We are looking at 100,000s of people with plenty of life left in them, many middle aged, and some quite young, dying in large numbers, and uncessarily. This isn’t the same as pondering whether we should extend the life of those who  are suffering and already on top of Grim reaper’s list.

I think these are important questions and ones we should have put more thought into at the outset of this.  I'm also leaning towards the conclusion that the government's initial response was about the right balance.  I have a lot of frustration at the people who either intentionally or unintentionally mischaracterized that approach ("they're trying to kill off the elderly!!"); it was that reaction which dragged the government into taking a horrible middle ground that probably combined the worst of both approaches...

Ask the health professionals responsible about this. They are required to take relatives' views into account, especially if the family have a health LPA, and DNR or advance decision set up for the patient; however the medics do have the final say.

For example, my mum's care home have agreed not to try to send her to hospital any more, although they are worried about her situation, details beyond the scope of this post.

In general, now is a really good time to be thinking about these things and discussing with your family and GP (if you can get their attention).

The thing I'm not convinced about is that being a factor 12 over capacity for 6 weeks is worse than being a factor 2 over capacity for 36 weeks.   Both would be horrific. 

If your suggestion is that by locking down we can avoid being over-capacity, and thus that the NHS can run "at capacity" for those 36 weeks, and never has to deny appropriate care (ventilators/ICU beds) to people, then yes, I see your argument.  I'd been presuming that that is an over-optimistic hope.

But this isn’t only about preserving NHS, ultimately this is about saving lives.

A strategy of suppression would save several hundreds of thousands of lives within the year. Confinement does seem to work.

The problem is of course the exit strategy but there is no reason to think there isn’t one, from new treatment to mass testing and other adaptations, and ultimately, a vaccine if we are lucky.

And it may be that at some point there is nothing we can do, but this is just way too early to engage in defeatism and fatalism. The evidence simply doesn’t support this approach.

What we have to do is pretty clear, suppress the virus, and then go after it.

Note that acting early and hard is paramount for this to work.

This approach could keep us at around 20,000/30,000 deaths, instead of half a million if not much, much more.

Interesting tool to play with for those interested: https://gabgoh.github.io/COVID/index.html

Totally uncalled for.  You are panicking.  Get a grip.

We're all in this together.  I have latent TB and lungs just recovering from pneumonia a few months back.  Everyone is exposed in some way.  The question in the OP is entirely justified and lashing out at someone is completely OTT.

Have you ever considered that NHS capacity can increase, the more time we have to increase it and develop workarounds?

This is an excellent point and, I’d like to think, a white hot priority for the authorities. Trained staff would seem to be the bottleneck.

Indeed, but I'm sure that a few months of training would see some aspects of roles being able to be delegated to trainees (for example ventilator supervision).

There’s quite a few people who could convert to this - if the alternative is leaving someone to die - anaesthesiologists from veterinary, animal research and dental fields for example.   Vets and research are trained to a high standard across a range of animals; humans are just one more species...  There are also military specialists.  You then start moving to one anaesthesiologist supervising multiple junior staff; again normal practice doesn’t usefully apply when the alternative is lots more death.  

Also, there is actually a very good chance we won’t overwhelm the NHS is we practice social distancing well.
That’s what the modelling suggests anyway.

We might be a bit too late, and there seems to be still low levels of compliance with social distancing, but provided we get our arse in gear we could manage this.

It all seems like an unsurmountable mountain now, but everything in the data suggests to me that there is nothing about this virus that is unmanageable provided there is a will to change radically the way we live for some time.

I didn't see panic in ericinbristol's reply, I saw disgust

That makes it any better?  Disgust, panic...at someone putting forward an entirely worthwhile question?

The entire OP could be read as saying “should we give up?”.  Sure it’s phrased with lots of silky, thoughtful framing devices and some rather wonton abuse of numbers many won’t question (several did here);  I can see why that’s entirely disgusting to a medical professional, or to many other people.  Once we start giving up because something is hard we reach a societal dead end.

4000 people die a day of TB. I'm wondering what the difference is that causes us to insist on minimising suffering for covid patients, yet most of us will have done literally nothing to help those suffering from the TB pandemic. Presumably all the same arguments apply.

That's good, we're at least talking about the same thing now. I'm convinced that being 12 x over capacity for 6 weeks would be far and away the worst bet, because that sounds like a bodies-piling-up scenario. Many more of the NHS staff would become infected and capacity would reduce further.

The points have been made by others: the slower the better, as that gives more preparation time, more capacity building, more time to learn about how to treat the disease and how to stop it spreading - and possibly eventually a vaccine. It is very clear that slowing down the infection rate is the best strategy, and it doesn't rely on any unrealistic assumptions about keeping within current NHS capacity.

I think the question is worth asking, but don't think there's much controversy about the answer.

https://www.youtube.com/watch?v=lWOYj8hjjjM&t=5005s

It seems from the above video, is that even after a lock down, there can be enough of the virus in the population still so that when people re-interact again, new outbreaks occur, making my post above seem like I am talking through my a hat a little bit in thinking no interacting for the duration of the virus might sort it. Which I probably was. 

You’re interpretation of the paper is incorrect. The predicted  peak mortality in an uncontrolled outbreak does not account for the healthcare system being overwhelmed.

We can see from Italy that even a highly developed healthcare system with many more ICU beds than our own per head of population will become overwhelmed even with a significantly reduce surge.

I also think you should look again at the significant proportion of patients who will require critical care who are in their 20s, 30s ,40s, 50s.  These are not people “who would die anyway” and be under no illusion that there would be enough ICU beds to manage all the young. There would not...-and there may not be even with the measure that have already been taken. 

Wrong. 

Your right to be considering the impact on staff managing these patients.

What I’m not sure you appreciate is that at both 10x and 50x overcapacity a huge number of patients will not receive optimal or any care...and will die.  

OK, if that's true, and the risk involved would be far higher than a doubling of the risk of dying, then that changes my argument.

I've been clear from the outset that the increase in risk applies at all age groups, and is not just about "people who would die anyway".

It is true. I’m sorry. We are facing a truly awful scenario. 

"The Imperial College report said that a "do little" approach could mean 510,000 dead.  Huge number.   Except that in a normal year 600,000 die in the UK.   Further, the risk profile of COVID19 (elderly, the long-term ill) is pretty much the same as the overall risk profile in normal times. "

I am just curious how they arrived at these numbers. Given that this is a new disease with no pre-existing immunity (unlike the flu virus - which mutates but has rarely been as fatal as the Spanish flu epidemic).

How do you model something you have not come across before? Where do you draw your comparisons from?

Have a read

https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fel...

Whenever people quote this study they forget that the 510,000 number doesn’t take into account the negative effect on mortality of overwhelmed health system.

Methodology is explained in paper, but basically they have looked at the data that has come out from Wuhan and Italy. 

Very interesting. Though I feel that some of the assumptions may have to be revised up a bit.

Latest studies

https://www.cebm.net/global-covid-19-case-fatality-rates/

Also this is pretty good.

http://gabgoh.github.io/COVID/index.html

For a bit of light relief from Coronavirus I've been rewatching the original Star Trek.  I'm amazed how familiar it is, despite only ever having seen most of it once before, decades ago. Also influential to me... especially the exchanges between McCoy and Spock on logical versus human responses. On the negative side it's incredibly sexist (despite being ground breaking in the other direction at the time) and quite a few episodes involve epidemics. 

I never expected I'd be reading posts on UKC that in comparison make Spock look like Kirk. I guess Dom might be pleased... more weirdos to replace the ones who had to resign already.

A lot of the fatality-rate data is pretty much meaningless, since, often, only those with severe symptoms are being tested.

Suppose, hypothetically, that 10% of cases need hospitalisation and 1% die.  The true death rate is then 1%.

But, if you tested only those that get hospitalised (current UK policy) then you'd get a 10% death rate. 

I agree that at the moment we have very little idea of the spread of the virus given that we are not testing for it and we are still in the relatively early stages

There is selected community testing going on also.

Interesting -- do you know what the results are? What fraction of the UK is currently infected?

And how on earth are they selecting those they test ?

Sorry I’ve no idea about the specifics, just heard through the grapevine it’s ongoing. There is a lot  of info on the HPE site.

One thing bothers me in the imperial college study.The doubling time they use (5 days) doesn’t seem to fit even naive observation.

Maybe I’m missing something, but trivial analysis on the death data in nearly all countries including China, Italy, France, Spain gives me a doubling time of 2-2.5 days. Given the incubation time, it corresponds to R0 4 to 5.

Seems to me they could be wrong by a factor of two. Can anybody tell me where this 5 days in IC study comes from ?

Studies such as

https://www.sciencedaily.com/releases/2020/03/200317175438.htm

It doesn’t say anything at all about doubling time. I think you misread.

Yes, I thought it was the 5 day incubation time you were after.

Some leading risk academics on the subject.

https://www.theguardian.com/commentisfree/2020/mar/25/uk-coronavirus-policy...