UKH

On 24th February Italy had 323 cases of Corona virus, today we have 319 cases. 

Is there any reason to think that in two weeks time we won't be in the same situation Italy is in now?

Quite possibly, quite possibly not.

It seems (clear, at the moment) that different countries are being impacted to different levels of severity, and it may be due to cultural and demographic differences (population age, numbers who smoke, etc) rather than just 'stage of the spread'.

So for now, best not to scaremonger.

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

On January 31st Italy detected their first 2 cases.

On January 31st the UK detected their first 2 cases.

Good enough ? 

(hopefully)

Indeed - and a lot depends on the testing strategy employed so far and the sensitivity/specificity of the test employed.

Italy has been doubling their cases approximately every 3 days. UK the same. Rates of increase in both countries relatively constant over past 10 days. So if nothing changes, we will hit Italy levels - around 10k - in around 2 weeks. Even if we do hit those levels, only 1 in around 6000 people would be infected. Currently we're far lower.

Don't panic....

Paul

A difference between the cases in the UK and Italy is that the Italian ones seem to have developed from a definite 'hotspot' in the north of the country (nobody yet knows how that itself started), whereas the UK ones are more randomly dotted around. So the Italian situation seems closer to the Chinese one.

Edit: ClimberEd's comments above re demographics might also be relevant.

Anecdotal reports of govt advice not being taken very seriously and the daily evening aperitivo going on as usual. Friendly, communal bunch the Italians. Fortunately we all hate each other here so should be better.

Only something like 60% of the Italian population trust what the govt tells them , whereas in Uk it is something like 80%.

Medically things ares structured regionally in Italy, whereas in UK it is centralised.

Older population in Italy.

They have better coffee.

And then 10 days after that?  

I’m wondering if there’s a false sense of security in the U.K. case numbers to be reported over this week.  A drop in rates as we switch from importing cases (increasing travel shutdown) to local infection which is probably much smaller - now - but masked by imported cases.  For the next 10 days or so.  

80% trust what this UK government tell us... I almost choked on my tea there.  We already had the Health Secretary (who should be in crisis sensible mode) lie on Question Time about talking to supermarkets.

On things like this, yes the trust is higher. Something I read somewhere.Are you telling me you do or do not trust what the CMO is telling you?LOL

The Italien PM is credited as referencing Winston Churchill. 80 years ago it was a massively different situation. Did Winston have all of the answers? did he gamble? did he have a Parliamant that was "roughly" singing off the same hymn sheet? Were there other options for the population? Will anyone take Boris's word for what to do next? 

I genuinely believe the CMO is right now pushing back against a foolish desire in government to place too much emphasis on economic mitigation (saving the most lives costs) and being professional will be not showing his concerns to the public. I think he was wrong to emphasise 1% mortality (which I will believe in the early stages but, as Italy has shown, not when the system starts to struggle). If you want a positive I don't think Boris is as bad as Trump. I just hope we are really lucky and seasonal change or mutation rescue our joke cabinet...by far the worst I've ever seen in my lifetime.

https://www.theguardian.com/politics/2020/mar/09/johnsons-coronavirus-press...

The CMO is a medical professional who advises the government, not a politician. So going back to the point of trusting the government, not a hope in hell with this lot of lying shysters. 

To put a less positive spin on things:

The Italian government took this very seriously and implemented quite strict containment measures early on. For weeks, they have been screening people coming in and out of the country and have been restricting movement in certain areas.

So far, our government has done... Erm... Well... Errr... Ok, I have absolutely nothing. Given that Johnson and Hancock have held press conferences where they directly contradict the latest  advice from the chief medical officer and the WHO, how long do you expect people to continue to trust the government on this?

We have no idea how many people may have returned from hotspots in Italy/Iran/China. We don't screen anyone and rely on people self-reporting which is going to be very unreliable given the number of younger people who are unlikely to become seriously ill but who couldn't afford to take 2 weeks off work.

There have been reports of patients of infected health workers who have not been contacted by anyone. There couldn't be a simpler example of people to trace. The only conclusion I can make is that we are not tracing known contacts of infected people.

We appear to be unique as a country in this lack of action. Hopefully we know something that nobody else does.

Italy has far higher numbers of ICU beds per capita than the UK and started off with far greater spare capacity than we have, yet they have still run out and they are having to prioritise those beds to the LESS severe cases. The elderly and weak are less of a priority because they are a) less likely to recover and b) will probably take up the bed for more time. Whole hospitals have become covid-19 centres. They don't have any capacity  to treat anything else.

They have an older population but we have higher rates of pretty much every aggravating condition. I don't think it is clear yet whether this will be a net positive or a net negative.

Maybe I'm wrong but all I see is complacency and buried heads from our government. Anecdotal evidence from those who are/will be on the front line doesn't suggest that this is part of some great plan, there just appears to be a vacuum from above. And some of the few actions that claim to have been taken have been exposed as lies. Hopefully our lack of a single geographical cluster of cases may lead to it being easier to manage and we will be less affected than Italy. But I'm not holding my breath.

Having said all that, I'm not panicking and making massive changes to my daily routine. But I am concerned for the future impact this will have on vulnerable people in our society.

If you enjoy those dark, over roasted carbonic flavours and don't mind not being able to detect any of the subtle flavours that get obliterated in such a dark roast. Or if you want to salvage something drinkable out of rubbish quality beans. I don't advise airing these opinions in the presence of an Italian, it doesn't tend to go down well...

If nothing changes and the time to double the number of cases stays the same then of course you're looking at 80-100k cases 10 days after that. Once we hit Italian levels (or maybe before) I would expect gov to enter delay phase, and we'll have to see what that does to growth rates. Not helping that apparently infected people are asymptomatic for average 5 days. 

Roy Lilley's take....

Just do it...  News and Comment from Roy Lilley

What did you get for your Birthday?  Socks, flowers, the chance to jump out of an aeroplane, a day at a spa, dinner, a bottle of something... a card. This year, the Director General of the World Health Organisation, Dr Tedros Adhanom Ghebreyesus, for his Birthday, March 3rd, got to make a speech about COVID-19, the scale of the problem and its likely impact.

He said; "Globally, about 3.4% of reported COVID-19 cases have died. By comparison, seasonal flu generally kills far fewer than 1% of those infected..."

That's all we need to know.  As I write, the World-O-Meter website is calculating the death-rate at, guess what, 3.4%. Johns Hopkins rolling calculator gives a global death rate of 3.49% Italy is up to nearly 5%.  Iran, right on the WHO prediction. Different countries have different health systems, spotting milder cases is difficult and it is highly likely most cases will never get counted.  The best guess in the UK, 2% but it depends on how well you are, how old you are, where you live and access to care. It's access to care that is most worrying. Essentially, Corona gives us respiratory problems, pneumonia and pressures will come from the number of patients who will need access to oxygen and mechanical ventilation. Italy say, 10% of people diagnosed need ITU and they are becoming overwhelmed.  Last December the NHS had 4,048 adult critical care beds available and 3,048 occupied.  There are efforts to open more, but you can do the maths... and they must be staffed by experts.  Maximum , one nurse for two patients. On top of that, there are complicating factors such as organ-function damage, including kidney and cardiac injury and liver dysfunction.  All of which need complex and skilled treatment. It is likely the survival time of the non-survivors, is within 1-2 weeks after ICU admission.  Survival might take 28 days.

Bluntly, this means we will need beds with special kit, staff who are specially trained and patients will occupy beds, for no short period. It is easy to see how the NHS could become overwhelmed and why it is important that retired, volunteers and others, with clinical expertise, are recruited, to back-fill for 'normal' patients, whilst regular staff work at the high-end of their registration for Coronavirus patients.

Do we have a crisis?  Who'd argue, the worst is yet to come?  We are starting from the position; there is no headroom, we are choc-a-bloc, there are significant rota-gaps and a worrying dependancy on bank and agency staff. It's the old story; if you're going to have a crisis, I wouldn't start from here. 

The plan; to kick the Corona-can down the road, in the hope that better weather produces Coronacide.  It's brave, hopeful and optimistic.  Fingers crossed? National crisis... it's worth remembering there is no such thing...   All 'national-crises' are local and personal for the people involved.  We have a national flood-plan but it still left people with ruined photographs of their Mum and lost memories.  Crises are very personal. The national-plan, to self-isolate is fine, if you are prepared and can use the time to paint the bedroom.  If you're not, it's about who's going to walk the dog, get your med's. National plans only exist in the minds of national planners.  Everything is local, everything is personal.  Everything is; 'what happens to me and mine'. 

BoJo talking of 'beating' and a 'battle' with Corona is bonkers. Evoking the sprit of war says, rationing, shortages, stockpiling and panic.  Everything we don't want. He should be saying; 'If we wash our hands, take sensible precautions and look-out for each other, we are as ready as we can be and together, we will come through this.' Note the words; 'we', 'each other', 'together' and the honesty of 'as ready as we can be'.  Evoking sharing, support and 'I've got you'.  Everything we do want. Yesterday, the Corona-COBR committee delayed decisions on escalation.  Mmmm... As the Corona-flap turns into something more sinister there is only one person, there is only one voice worth listening to. The one who talks like yer favourite uncle; sense, experience, truth, with warmth and believability... the CMO, Chris Whitty.  Here he is at the Health Select Committee.  Peerless. If you could speak to him, he would tell you; never mind buying blog-rolls, Corona-salvation is in our own hands, go and wash them... just do it!

It is at least inconsistent that British people who were repatriated from Wuhan in late January or so were immediately (and very publicly) officially quarantined for two weeks, but, so far as I can see, nothing of the same has been done for people returning to the UK from the Italian 'hotspot.' Are people returning from Northern Italy asked to (or advised to) self-isolate?

Where are you quoting this from? (You could have just posted a link.) Yesterday Chris Whitty appeared publicly to support delaying the decision to escalate.

And that is who people are listening too, Witty is getting rave reviews. He  is Govt, which is what people are listening to.

I appreciate your politcial bias, but if people are washing their hands more ( which is clearly the case unless you are some form of idiot), then clearly the message is being trusted.

I think you are just looking at the trust issue the wrong way round.

as far as I understand it the worst case scenario put forward last week was for Britain to lose more lives than were lost in WW2, though obviously not equivalent in demographic distribution

There was huge complacency over FMD until they belatedly brought the army in.   It was chaotic up till that point here.

Agreed.And it was the same for his deputy on R4 this morning. There appear to be valid reasons- medical, social and economic for not going the whole hog at the moment.

I am sure it will happen, but as they say if they mistime it then alot of needless misery will happen.

Meanwhile keep the handwashing going.

Good grief where on earth did you get that fake news from.

Roy Lilley is probably the most followed health UK commentator in NHS management. If you google him it takes you to his blog (where you need to sign up, with very minimal personal info) this episode was posted earlier today. You can't link to it direct but sometimes someone tweets a copy that you can link.

I'd lay strong odds that the CMO would want us to move to delay right now, irrespective of what he said. Others can call my views on our government political bias: I'd say I'm pro honesty, pro competance and pro democracy. If Thatcher, Major, Cameron or May were leading their cabinets right now I wouldn't be anything like as cynical.

I think it was based on 80% of the population getting it and 1% of those dying.  Being discussed on R4.   In earlier scares I'd calculated worst case of 800,000 based on assumptions that were spoken of on the radio but that was in bed not knowing the UK population so I guessed 80M rather incorrectly

I sincerely hope these figures are not remotely close to the truth.

My own Trump-Hunch is that infection is far more widespread than currently known and that the mortality rate is lower than current calculations.  I have no idea how many of the UKPop will be infected.   

I wonder what the annual flu deaths in UK would be if a proportion of vulnerable people were not immunised.  I understand there are about 17000 pa in England

No further questions, m'lud.

I presume you think I'm wrong... the CMO evidence to the select commitee, before the announcement with Boris, clearly indicated the delay phase was imminent. The decision was not his, he advises, it was for the government.

Realistic worst case infection rate 80% once it's fully established in a population with no immunity, currently rather low-ball looking estimate of mortality at 1% = ~500k of 66M dead. Comparable to UK losses in WWII https://en.wikipedia.org/wiki/United_Kingdom_casualties_of_war

We should know more about the mortality rate over time and when some of the better contained clusters (eg Diamond Princess) are over and analysed, the mortality rate there seems low given the older cohort but it's also a wealthy, well cohort and many are still ongoing and those may yet prove to be the most serious. Harsh measures we may or may not tolerate may or may not contain the infection long enough for it to die out as appears could be the case in Wuhan but reservoirs will likely still exist here for months and abroad beyond good public health services for years so ultimately unless we close the borders and workplaces at an appalling cost (by almost any measure) we'll have to learn to live with it coming back in sporadic flare-ups until the UK population develops sufficient immunity that transmission within the population becomes unlikely.

jk

are you ready to reconsider your accusations about "fake news"?

I thought he (or similar) made the point pretty clearly that requiring everyone to restrict movement etc too early will result in "fatigue" and less adherence in due course.  It is as much a social/human problem as a maths problem.  It is also a balance of economic loss now if restrictions are too strong vs economic loss later if they are too lax.  All round not an easy judgement no a purely medical one.

More than happy to say I consider it fake news. UK soldier death were 384,000 excluding civilian deaths,( think there were about 70, 000 civilians on top of that)

the worst case scenario is 200,000 for coronavirus. So if you were comparing civilian deaths the answer is yes it will be worse in the worse case scenario.But the overall death total in WW2 far exceeded that number. Never mind those seiously injured etc etc.

St the moment to be honest I think it is a useless comparison.

I can assure you there was not huge complacency over FMD.

There was a massive overstretch of the available workforce.

I'm talking about the Blair government's response, not those on the ground.  As for the chaos - we nearly had a burning pit lit over a gas pipeline here despite the contractors (pre Brigadier Birtwistle) being told about it by someone who'd seen it installed!

That was their second attempt to build the pit - the first was beside the road within reach of trees on the other side, not to mention the hazard caused by ground clinging smoke to motorists that was totally obvious.  (By then we had the smoke coming into the village at 0 feet every day from other pyres, what a taste inside the house.)

Third time lucky, with army guidance.   The government got into gear far too late (I'm remembering previous responses in the 60s and 70s over animal disease)

not the figure that was being discussed on at least 2 occasions on the radio.   Work it out, 80 percent of 66M, 1% mortality.  Does not come to 200000.  That figure might be current now and I hope that is hugely pessimistic  but was not what was discussed then.

btw I was including both military and civilian casualties

To say that I am making up fake news is a lie.

Oh to be sure plenty of Chaos, the starting position was dreadful and some aspects

of that variant of FMD unhelpful.

Bear in mind 'those on the ground' include a lot of government, the MAFF/DEFRA staff showed very little complacency.

The good thing from  UK persepctive is that the recentish experience of FMD has informed some aspects of government response to COVID-19.

I'm not sure anything you are saying that is very helpful. It just seems to be a lot of moaning about the potential scale of the problem and how the government aren't dealing with it in a way that you think is best (or stops you complaining about it on the internet at least)

A few days old now, (26th feb) but interesting:

”UK: 7,132 concluded tests, of which 13 positive (0.2% positivity rate)

Italy: 9,462 tests, of which 470 positive, awaiting results: unknown (at least 5.0% positivity rate)

Italy announced on Feb. 26 that it would relax its testing criteria to the point that contacts linked to confirmed cases or recent travelers to outbreak areas would not be tested anymore, unless they show symptoms.“

https://www.worldometers.info/coronavirus/covid-19-testing/

The Italian policy means they will miss lots of people with mild or no symptoms, pushing up their reported mortality rate. It’s also interesting to see given the relative scales of the outbreak at this point, how much testing the U.K. was doing.

Thank you for your opinion. On the information front, Greece has just closed all its schools and Universities for 14 days (no deaths there as yet).

that is good to hear

Well it could mean giving me a stash of form A’s and the reformation of my little team - so might not be good news for everyone  

“Slaughter Team Six - trying to meet Tony’s two day target”

perhaps the mafia run the testing service?

Well that is the worse worse case being predicted as at the news the other day.100,000, tops 200,000. for the UK These are worse worse, and considering the current death toll globally has not reached 5,000 ( although close), it is pretty extreme.

To compare it with WW2 at the moment is ridiculous and why I call it fake.

I tell you what I will buy you a beer if you are right.

I wouldn't be right as I regard the figures as pessimistic by at least one order of magnitude.   I am with the school of thought that there are far more infections than are currently counted, everywhere - including China and Italy.

I was quoting estimate rates I heard quoted on R4 a week or so ago from what appeared to be reputable sources, not Sun journalists,  hence not fake news.  Possibly and hopefully improbable outcome though.

Main difference will be most Itslians will stay at home and eat good food whilst the UK will gross-out on lard. 

I see Merkel is preparing Germany for a 70% infection rate, which is apparently about 58M.

The thing is people saying this are also complaining when races and events get canceled.. (not saying you are).

We are canceling races left right and center. Boston will almost certainly get canned. Its looking like we will close schools and colleges down imminently.

This all slows the spread and gives hospitals a chance. Italy and China didn't react that fast. So hopefully not, but in the US we were slow to start testing.

But I also think we are more aware, hand washing, avoiding common areas etc all helps flatten that curve.

Did you read the links I posted in WildScallion's panic buying thread? What's your opinion on the propensity of Americans to go to work come what may?

This guy has a graph of the number of infections per day in different countries.  TLDR - UK and everyone apart from Japan is on the exact same track as Italy just not as far along.

https://twitter.com/MarkJHandley/status/1237119688578138112

yeah its bad, but sadly we have no sick pay for many of us, especially hourly workers. I have 10 days sick leave, that includes personal time with twins due (I'm a teacher). After that I'm unpaid. My wife is taking 4 months off for the twins, that's $20,000 lost income.

It's easy to say stay home, but the reality is we have to pay bills, come what may.

If we, as a young professional couple (she's an oncology fellow (so a low paid MD), I teach), are taking a massive financial strain having kids, god knows how the other 50% + below us cope. 

I’m hoping that they realise that the cases double every 4 days and that they’ll continue to let that happen until it meets their alarm limit at which point they’ll bring in the next phase. There’s no point in bringing in the next phase if for some miracle reason it suddenly slows. I would hope that by publishing a doubling of figures will make members of the public sit up and take notice and realise it’s a bit more serious than the flu. 
Flu has an R0 of 1.3, Coronavirus 2.2. 
it’s not the absolute numbers of people who will die, it’s the speed that they become ill that will overcome the NHS.
 

Once that happens, anyone needing emergency treatment for a car accident or routine illness like appendicitis will also be at very high risk of dying. I think that’s what’s happening in Italy. People with relatively minor ailments that could be cured by a simple operation can’t have anything done. And that’s horrible for the doctors to witness. 

We agree! 

It's seems the news is one or two footie matches are cancelled, instead of just axing the entire league. Hope the well paid footballer gives generously when many of their loyal fans start falling ill.

It's a joke. The health minister has been feeling unwell for 6 days and just kept working.

Idiots. If it's not careful the UK will suffer more than Italy currently is.

I think it’s more like travelling down a motorway. There’s no way off and you know that its blocked up ahead, apply the brakes as you approach the blockage. After all, it may have cleared by the time you get there. You know the blockage is there so you’re not going to suddenly crash into it. Unlike the Chinese and Italians. 
 

Unless you’re driving an Audi or a BMW...

We haven’t really applied the brakes though, as shown in the chart Tom posted.

Most of Europe has talked strongly about how it may implement a multitude of measures, but overall has done very very little beyond talk. Limited travel restrictions, endless large gatherings, sports events and so on. Head in sand, trump style. 

Even if we are careful being like Italy today isn't going to be the worst of it!

Jk

Italy’s cases have just jumped up by 2313 cases today and 196 deaths in 24 hours despite their lockdown.

I’d be surprised if our government doesn’t see that as leaving it too late and implement Delay phase starting Monday.

It's probably rife already. Just need to wait 7 days for the cases to incubate and show. There are loads of people in public facing roles already testing positive. 

Of course, while we've been busy telling ourselves we're not like them it has almost certainly been busy multiplying and spreading.

Jk

Fuel  90%, Altitude 700 ft, Descent Rate 8900 ft/sec!

Oh No, too late!

And it will keep growing for a while because of delay between onset and diagnosis.

However in terms of true new cases data from Wuhan indicates that lockdown is an extremely effective tactic.

The problem is getting out of it.

At the end of the day we cannot lock down everybody for ever, even though it’s valid tactic to stop exponential rise in its track. Medium term what we must do is create human societies which work sufficiently well for humans but in which corona cannot spread.

No not yet. We can cope with the projected numbers. There’s no way you can stop everyone from being exposed to it. All you can do is try and control how many get it at any one time so you can treat them. So you deal with those who are infected and lock down everyone else. Then you open it up again and wait for it to grow and treat the next batch and so on until everyone has been exposed or recovered. You can’t save everyone. 

This is what I am suggesting on the other thread about iWatches and getting savaged for.

The new tech which was never available before is personal medical monitoring and automated contact tracing.  If everyone, or even a substantial fraction of people, wear something like an iWatch which takes temp, ECG maybe O2 sat continuously and using the contactless near field RF keeps a list of every other watch wearer than has been within a meter or so from it in the last week then we could

a. detect infections very early, maybe before they become contagious

b. get an immediate list of all contacts.

c. have a system like the Chinese one where the device has an app which shows your status.  If it is Green you get to enter workplaces/public buildings/public transport, if it is red you need to stay at home.

d. monitor large numbers of patients with mild or no symptoms who are self isolating without sending out trained people and get those who are deteriorating into hospital.

Seems to me smarter way it to lower R0 permanently by changing the way we interact, create a slightly different society in which corona has a lower R0.

This is pretty much what we are seeing being done in other countries now with great effect.

Either way, you’re not heading for a car crash with no seat belts are you? 

We can? It looks to me that within a 2-3 weeks we're where Italy is today with the health service on the cusp of failure facing many weeks of case load growth and staff losses still ahead.

I'm just very glad I got to see my ageing family all together for my wedding recently, I suspect it'll be a long time before I can safely travel to see them again if they live which isn't at all certain given their age and health issues. I'm also more than a little concerned my child is due to arrive, all being otherwise well which again isn't a given, early summer when the health service will be severely overburdened, understaffed and rationing care. Realistically I have to now assume the worst and hope for the best by preparing for that to occur at home with no medical intervention available in the event of problems. That or she's whipped out early as seems to have been the approach elsewhere should my wife fall ill while the hospital still has surgical and neo-natal capacity.

jk

I'd been assuming that we were following the same basic plan as Italy but the noises from the government suggest that, initially at least, our "delay" phase isn't going for a full scale lock-down.

My guess now is that is the UK experts are thinking full scale Italian style lock-down just puts off the big peak rather flattens it while limited social distancing will allow us all to be exposed but at the least worst infection rate.

https://www.theguardian.com/world/2020/mar/11/research-finds-huge-impact-of...

Are you in the camp that are thinking we should be more agressive with a lock-down here? I.e. Sooner, firmer, longer.

Presumably the economy goes down the pan either way so that isn't a consideration...

As soon as possible... before yesterday.  Governments facing a risk of economic loss now will always be nervous of making that decision early but the deaths and costs both increase with delay... they are just hoping to be lucky with no science indicating they will be. Those claiming this is really only like flu were always grossly ignorant; the experts were always saying the opposite. Now we have Italy as well as Wuhan to show what happens to hospitals if the virus spread gets out of control.  It's why I think the CMO will be pushing against Boris. I'd add the economy won't 'go down the pan' with a lockdown of just over a month... most of the hit on shares is already priced in (in an ideal world all the major western economies should suspend/lock  share and commodity trading worldwide for a month as these wild fluctuations just allow hedgefunds to suck wealth out of fundamentally sound business)... the big hit will be on small business which likely need urgent cash help, and on the gig economy.

The unconvinced need to read more articles like this

https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d...

Right, that's it.  I'm off to find all the loo roll I can get my hands on.

......or read this

https://www.theguardian.com/commentisfree/2020/mar/12/us-cities-wuhan-coron...

The opposite viewpoint in the US looks bat shit crazy to me but I believe in experts and I'm not a Trump fan.

https://www.bbc.co.uk/news/world-us-canada-51840227

Currently, yes, we’ve barely done anything in terms of social distancing.

That article is interesting but portrays a worst-case scenario *and* does not consider economic effects.  Medium isn't a journal, it's a place where individuals can publish.

I'm sticking with PHE.

One further salient point: with the modelling in Tomas Pueyo's article the US response is in way more trouble than the UK and, as I said above, the UK should already be in lockdown (on the same modelling). Stopping flights to the US won't help deal with the urgent US issues as the numbers indicate several areas of major local infection exponential growths that needed lockdown days ago; but it suits Trump's anti-foreigner politics.

You're in denial.  The article just assumes we follow the math based on the different responses to the virus to different country government actions... it also looks back on the lessons from SARS and on how different responses impacted on the Spanish flu.  If we don't lockdown very soon (when I expect things still to be pretty bad) the only thing that will stop this being a major disaster is luck.... mutation or a seasonal change (the latter seems unlikely given its spreading just as fast in warmer and more humid countries). If it's coming anyway the economic loss due to the lockdown now will be equal to that of delay but the added economic loss due to extra deaths, much greater number in imposed isolation and the collapse of the hospital systems will mean economic impacts increase greatly with delay. The article says compare the situation Singapore, Japan, Taiwan and Hong Kong (wwhere SARS hit)  with Italy. The known data says early response will lead to a mortality rate between 0.5 and 1%... delay and an overwhelmed hoptital system pushes this to 3% to 5% plus all the deaths from unrelated conditions, like strokes, that would have been stopped by a functioning hospital. Doctors in Italy are right now choosing who will have to die.

Why do you think you (and a random mathematician writing on a public platform) know better than Public Health England and their medical professionals?

BTW we will not *stop* it.  Even if we locked down to the extent of eradicating it from the UK it would be back.  Everything is about managing the spread so it's not *too* disastrous for the NHS.

Anyone who thinks it can be *stopped* is deluded.  The Government have also openly stated as much.

It's not a random mathematician its what most other epidemilogists are saying and what other countries have done and what WHO advise. I suspect the CMO is trying to convince Boris on this right now. It's not about stopping the virus, it's about slowing it and  minmising its impact, in particular stopping it from overwhelming hospitals.

report yesterday of how well the S Koreans are doing as they are providing testing for everybody who wants it and thus people can have more certainty about their own health and also know that other people are better informed.   I think we have been really slow to do mass screening as there is no argument against a firm diagnosis.

Could this be ecause they have a strong Civil Defence ethos because of being ready for war with the N?

imagine 80% infection at 5% mortality

the indirect mortality resulting from that is incalculable perhaps

The South Koreans were also unlucky as they had an early superspreader in a closed community.  

Imagine 10% at 5% mortality plus all the extra deaths because hospitals can't function.

Why do you think Public Health England know better than their counterparts in almost every other country?

We are almost unique in our lack of action.

US hand goes up..

We had the great strategy of not testing, therefore we don't have it.

We should be closing down everything now, taking a massive financial hit now. The US just does not have the redundancy in its healthcare system to cope.

The head of our local HemOnc department, MD of 30 years, one of the most qualified experienced Docs in central mass just told our school to close and the school said we will wait 2 days because it is break anyway..

It is not about stopping it, it is about flattening the curve. We have 100k ICU beds in the US, moderate forecasts are we need 200,000 if not contained. Almost all those 100,000 are being used now. We need t buy time and let hospitals cope. People will die because the hospital cannot cope, and they would survive if we slow it down. That is happening now in Italy.

Many other countries' Governments follow a "something must be done, finger in air, let's do that" model.  The UK typically does not.

Or they follow scientific advice..

What have we got to lose apart from money?

Shut things down, the virus slows down a lot. 

Maybe if we don't it still slows down a lot. The evidence suggests it won't.

If experts are right, many don't die. If they are wrong we lose money.

I know someone relatively senior in PHE and have heard nothing to suggest that the Government is not doing so.

Let's just see, so far this government has a horrific record with scientific advice.

His more recent post has revisited the graphs to normalise the start dates and guess what? Pretty much everywhere is following the same curve.  The none-log scaled graphs tell us the poo is going to hit the fan...     https://twitter.com/MarkJHandley/status/1237781162153717760

British exceptionalism is so weird.

jk

I'm not blaming the CMO (or PHE). This is a government decision and unless they decide something stupid the CMO (and PHE) will agree it, despite wanting to move faster. If you want independent public advice you won't get it from the CMO, as it's his job to present and defend the decision, or if he can't, to resign. 

My wife worked in a senior position in Public Health (PH) for over a decade and they always wanted more on their key areas of concern but they didn't go around embarrassing the government because they usually didn't get it. Of all the key areas of health, PH has been the most gutted by austerity as it moved to cash strapped Councils. It's a national scandal given the importance of PH in keeping the NHS budget under control, by preventative action; and yet, where is all the mass public concern?

Here is some independent news from a UK PH expert.

https://www.theguardian.com/world/2020/mar/12/health-expert-brands-uks-coro...

It seems to me that this is an absolutely vital point which is not being made with sufficient vigour. Flattening the curve, or spreading the load, will be essential if health care systems (here or elsewhere) are not to be utterly swamped. 

A conservative friend just said "all we are doing is delaying people getting the disease"..

She just didn't grasp that that is exactly what the aim is. Hopefully less get it but slow the spread. 

I think a lot of the actual fear is stemming from that misunderstanding - a lot of people think that Governments are taking these measures because if they catch it they will likely die, not simply to control the demand for health services.

The government today just said we are 4 weeks behind Italy... this seems crazy to me. Look at Feb 12th on this Italian graph.... we seem to be at the same position as Italy on cases and deaths as around Feb 26th. Where is the extra two weeks coming from?

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

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

I thought most British city dwellers had been enforcing 1m distance for years?

I think it's because we have been testing more extensively than Italy at the same position.  Italy likely had a lot more cases than that on Feb 12th, they just didn't know about it yet.  Just a theory.

Except it roughly matches Italian deaths for the week before 2 weeks ago. Most experts previously said 2 to 3 weeks behind ... 4 weeks is new.

One positive perspective on this is that the UK situation is different from the Italy situation in some notable respects:

https://www.bbc.co.uk/news/uk-51858987

None of that makes enough sense to say we are 4 weeks behind Italy when UK numbers are doubling every 4 days and our deaths are at the same level as Italy 2 weeks ago. Sure we have a wider geographic spread but it still has hot spots and we have proportionally fewer ITU beds and serious staff shortages and reported problems with protective equipment. You also forgot this new science of the British boredom with pandemic control that was a key reason to delay the measures other countries (with similar infection levels and spreads and better ITU facilities) felt were necessary (lucky they don't suffer from British boredom I guess). The big eastern nations have had significant success slowing the virus by strict national measures.

The editor of the Lancet says the UK government is complacent and points to this paper. 

https://mobile.twitter.com/richardhorton1/status/1238145139840778241

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30627-9/...

Yes, I'm aware of all that - I was just presenting the BBC article as one counterpoint. Let's face it, there's nothing any of us can do to fix any national-scale issues at this point, so you might as well look for the positive.

For what it's worth, I do think there's some logic in not closing the schools (which may or may not be included in what you mean by the strict national measures). Doing that will deplete the adult workforce due to childcare requirements, and will also result in a lot of grandparents (who are the very group that need insulating from the virus) being brought in to cover so that parents can continue to work.

Italy was doubling every 2 days back then...

In the US we are screwed.

My wife is an MD at UMass, a huge regional hospital. They are rationed to 30 tests a day. It's a 1000 bed hospital, two emergency rooms. They cant even request tests directly and the US tests are very slow.

And they were testing.. people saying 'well we are n't seeing the doubling of cases"...

We are having it even if we aren't trying to detect it.

On the positive side: https://twitter.com/leonardocarella/status/1238511612270690305

The full thread of clips makes for uplifting viewing.  Though their weather looks better than here too.