UKH

Small sample size, but if not a fluke, epidemiologist says it would mean lockdown strategy is pointless:

https://www.bmj.com/content/369/bmj.m1375

Isn't this what the proposed antibody test is intending to establish?

Yes, the only issue is that we don't know how long the antibodies last, i.e.whether someone could have had it in December/January and no longer have the antibodies by the time they're tested.

If 4/5th are asymptomatic that further validates the lock down to me. If that many people are infectious with no signs showing social distancing is more important than ever. 

Weren't these people just asymptomatic at the time of testing? They could have developed symptoms later. Unless I missed something in the article.

Not pointless at all. The idea is to slow peak infection. If just a couple of percent of the population needed hospital treatment at the same time they'd be pegging out en masse in the queue for A&E

Did you read to the end? One of the epidemiologists is explaining that with that infection rate, lockdown would be little or no help.

I believe it's just at time of testing, but (a) it fits with small scale Italian data on a high proportion being asymptomatic throughout, and (b) with so many people, the likelihood of them all simply being too early in progression to have symptoms is low.

Did you read to the end? One of the epidemiologists is explaining that with that infection rate, lockdown would be little or no help.

I did read to the end but data from multiple countries indicates that lockdown is followed by a slowing in rates of new cases.

Unfortunately, without widespread random testing, we have no idea if that's causal or not. We also have examples of the opposite, too.

Really? I've not come across this in the news. Though the news isn't much of a standard to gauge the veracity of anything these days.

Diamond Princess suggests otherwise too. Sounds like wishful thinking. 

Both Italy and Spain didn't see improvement until well after lockdown should have had an effect on the numbers of new infections, even making very generous assumptions on incubation period. That could be explained by other things of course--we just don't know.

Anecdotal accounts from both Italy and Spain suggested that local populations were widely ignoring lockdown in the initial stages. The state had to get pretty heavy handed to ensure compliance. In any case, most patients seem to be asymptomatic for the first few days so you'd expect something of a lag.

locking down a country where individual domiciles are well separated and populations are cooking their own food in their own kitchens to be served on their own china, is in no way comparable to lockdown on a cruise liner.

No. But if 70+% of infected people are asymptomatic, there wouldn't have been nearly so many unwell on the ship

OK but in the early stages of exponential growth you'd expect a majority of people to be less far along with the development of their infection, because more people catch it every day. Given this uncertainty it seems extreme to say lockdown is pointless. I wonder if that epidemiologist was miss-quoted?

Older demographic and proximity increasing viral load.

Ha, no, definitely not misquoted. You can read him again not mincing his words on his centre's website:

https://www.cebm.net/2020/03/covid-19-the-tipping-point

Seems unlikely to me. Obviously if we have all had it infact we can stop worrying but sounds too good to be true. 

If he can casually write "Lockdown is going to bankrupt all of us and our descendants" Im not sure I can put much weight on his conclusions elsewhere. 

Deaths on average 18.5 days after onset of symptoms (23 days after infection?), that's a very long lag when things are changing 10-30% per day.

Hospital admissions now reflect what was happening 10 days ago (serious cases apparent 5 days after onset of symptoms?).

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/...

I suspect he might have credited his readers with the ability to determine hyperbole.

Another article where an epidemiologist is making political / economics comments.  Funny how many of these are suddenly appearing.

Their thesis is worth considering but until we have actual hard facts on our population, releasing lockdown on a theory is Russian roulette with lives and with the economy they claim to be wanting to save.

Until there is mass, random sampling with an antibody test it really is spitballing.  The prudent choice seems to be to err on the side of caution and get testing to get hard data.

Ah well obviously the lock down was the wrong thing to do then. 

That could be explained by other things of course--we just don't know.

There is a lot we don't know but the world is learning and sharing all the time. 

Let me ask you a question, have you ever been in a pitch black room, that black you can not see anything at all. If the answer is yes did you move about very carefully feeling your way or did you plow forward at full speed and crash in to the wall? 

Complicated stuff - evidence based medicine was from the very outset counter intuitive; when RCT were introduced  any number of 'common sense' interventions were shown to be not just ineffective, they were dangerous.  The way this government and its' advisors (who are as much bureaucrats as they are academics or physicians) have lurched from one magic bullet to another - herd immunity, ventilators, PPE, testing, emergency hospitals, lockdown - hasn't inspired.

Ironically I've argued for lockdown elsewhere, if only to slow down the progress of the disease, not affect the eventual outcome. Common sense, innit? 

He's making two separate comments.  One, that IF the data is not a fluke, lockdown would be pointless from an infection control point of view.  Two, that if this is true, lockdown would be an economic disaster with no benefit.  Statement one has nothing to do with politics or economics.

Did you just try to say that I said the lockdown was the wrong thing to do immediately before quoting where I said that the failure could be explained by other things?!

Well this is exactly the epidemiologist's point--that it would NOT slow the progress of the disease, if this infection rate is shown to be true in larger samples.

If he thinks it's wise to be casually throwing hyperbole into a BMJ covid article during the greatest health crisis in living memory, then it rather casts the rest of his judgment into doubt too.

Yes, hardly very balanced is it?  

Where’s his point on the other possibility that releasing lockdown will make things worse if point one is wrong?  Why is there so much emotive hyperbole given to his predictions of the effects of our current action if his first point is right?  

When an expert in subject A is making selective, emotive, hyperbole laden comments on subject B, predicated on their assessment of subject A, I come to seriously question their impartiality in subject A.  Twice in one day as it happens.

The hyperbole is not in the BMJ covid article.  It was in the other link that I provided.  Sorry, I probably shouldn't have introduced potential confusion into the discussion.

Given that the article is about the new data, why would you expect it to include a discussion of the unrelated issue of what happens if we lift the lockdown and things get worse?  The article already includes his very clear statement that what he's saying is conditional on the data being repeatable in a larger sample.

In all fairness, I'm very easily confused.

It's hard not to be at a time when just getting through daily life is exhausting!

Given that the article is about a medical hypothesis, why would one expect *any* commentary on the social and economic effect of lockdown?  Discussing the wider effects of both possibilities gives context to the medical discussion.  Giving unsubstantiated (true or not), hyperbole laden discussion of just one possibility is not impartial or appropriate.  It’s as thickly laden as my preferred brand of condensed milk. 

I don't see how the antibody test matters when it comes to deciding which lockdown measures should continue and which to stop. The test will settle the question whether there's (have been) between 0 and 10 times more cases than we have currently measured. It cannot be much more than 10 times, because then the fatality rate would be below that of the common flu and that is inconsistent with the amount of fatalities everywhere. In both extreme cases the large majority of the people (>99%) would not have had the virus. The max 1% who is resistant does not matter in the decision (except for volunteering for medical duties or so.).

What matters in relieving lockdown measures is the effectiveness of the test/trace/isolate procedures. This decides whether you can suppress the virus safely at a certain level of cases. The better a state is at this, the more relaxed the general countermeasures can be.

Now I'm worried, given that my post accrued 2 likes in mere seconds!

Except that's not what he says.

He asks if it's worth it to halt or delay something already "amongst us".

And the answer is yes - because delaying it gives a finite capacity resource the chance to both increase in size and have a smaller peak to handle.

By all means flag up research, but don't seriously misquote them to further your agenda because you want to go climbing/running.  It's becoming pretty distasteful.

Agreed.  I didn’t say it was critical, but that speculation courses of action based on estimates of asymptomatic infected is spitballing.  Potentially dangerously so.

Agreed - and a point missed by some of the wishful thinking such as the article in the OP.  

Agreed.

Agreed.  Unless the UK has lets it get so bad we can’t get test/trace running sufficiently to close Pandora’s box.  Assuming we can do it, random sampling with the antibody test lets us know the scale we need to trace and test to.  It also puts dangerous speculation like the OP’s linked article to bed.  If the UK is going for the apparently insane herd immunity approach modified by cocooning the vulnerable for the next 6 months, understanding the ratio of symptomatic to asymptomatic infected is critical to tuning the gradual release of lockdown.  This route is possibly total lunacy but I do wonder if it’s still the plan, especially after today’s politically and emotively loaded piece in The Times from a member of the advisory board.

Agreed.  Also, the worse, the tighter.

Surely that is a possibility? Particularly among those under ~60.

Wow, you should really re-read the article.  The answer, according to him, would be no, not yes.  If you like, I imagine he's on Twitter or email, you could always get in touch with him to clarify?  

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

Go look at this.  The history in Spain.  The impact of lockdown.

You are part of the problem.

BTW I'm not personally negatively impacted by the lockdown, or at least not to any appreciable degree.  I just hate seeing people die needlessly (you've done the math on deaths that will be caused by lockdown, right?).

What data? There's hardly any in the paper apart from 4/5 is asymptomatic. If you apply this to Wuhan's high fatality rate of 4% you get in the 0.5-1% fatality range on which most strategies are based. That does not imply lockdown is useless. Five times more cases still means almost everybody is susceptible.

I think the chance that Corona has been around for a much longer time than mentioned is negligible. This would imply a much lower fatality rate than 0.5%, because it is impossible to miss/misdiagnose a large number of deaths from a week long respiratory struggle. And if the fatality rate were actually so low that it becomes common to the seasonal flu (0.05%), China would not have had to quarantine a whole province.

China didn't have the benefit of the asymptomatic carrier data when it made the decision to quarantine, though.  

I think everyone, including the epidemiologist interviewed in the article, is clear on the fact that this is still an "if."  But I think we're equally clear on the implications if the "if" turns out to be real.  Probably the best we can do right now is repeat the same thing on a larger group and see what we find.

Sure.  And asking people to stay home, exercise once a day and have a shortage of alcohol and sugar produces some very theoretical conjectures.

Just as the "what happens if we let it rip" is theoretical conjecture, because everyone has been sensible enough not to let that happen.  Go look at New Orleans; or Paris; or Madrid or Northern italy.  That's *with* measures.

Unfortunately the BMJ is not a by-word for quality.  I don't even know what its impact score is.

It's important to read some of the responses to the article for a bit of balance.

https://www.bmj.com/content/369/bmj.m1375/rr-5

"“Four fifths of cases” of coronavirus disease 2019 (Covid-19) are not asymptomatic. The fraction of people testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not the same as the fraction with Covid-19. Also, the numbers cited do not show that “the large majority of coronavirus infections do not result in symptoms.” It is not possible to extrapolate a proportion of people without symptoms at a single time point, to a general statement about the natural history of an infection. "

This is what Red Rover was bringing up above--see up thread.

Indeed! Almost uniformly polite formulations of "why the f*ck did you publish this bullshit!" 

I can't tell if that last line is meant as parody or not, but I'm going to assume it is.

I would imagine many readers are aware of the previous data from Italy that suggested this could be the case, and so would understand the relevance of it.

That would be madness! I don't see how you can get to herd immunity with a decent level of control and protection of the vulnerable at a timescale shorter than the timescale to develop a vaccine.

What a funny take.  You seem to believe that the lockdown is going to kill more people than it will save.  I haven't done the maths, because that level of modelling is utterly beyond me, and I suspect beyond just about everyone.  But If you have some to share with us, please do.  We could potentially pick ourselves up from a month of totally overloaded health services or two months of much reduced economic activity.  I know which I'd choose in a heartbeat.  Especially as the deaths are irreversible, but everyday under lock down we adapt, adjust and learn more about the problems with the virus and can make better plans.  

Totally anecdotally, I went away with 7 others (before lockdown). We all mingled and climbed together, shared lifts, ate at the same table all together etc for almost a week. Plenty of time to spread what is supposed to be a very contagious virus. 4 people got it (2 of these tested) and the 4 others didn't show any definite symptoms. And some of those who didn't show spent long periods traveling in confined spaces with others who had symptoms.

This obviously suggests that there is a high rate of asymptomatic cases. Who knows if this is good or bad. Good that people are staying well (potentially reducing the overall mortality rates) maybe good as the people are most contagious when coughing and showing symptoms. Potentially not good as some spread from asymptomatic cases.

the 0.5-1% I mentioned is an average for a typical population distribution. So for people under 60 it is smaller. But the same holds for the common flu...

No, where did I say it would kill more people than it would save?  I said it would kill *some* people, which I don't think is disputed by anyone with even a modicum of public health knowledge.  That means that if this data does turn out to tell us something on a large scale, we end up in a situation where we're employing a strategy with small or nonexistent benefit and a very serious negative impact.

The only way I'm aware of to quantify that impact is by studying excess mortality for years to come, which is not a particularly exact measure and also would necessarily mean we won't have an answer any time soon.

Very harsh. The OP had introduced a reputable BMJ article as a counter to the prevailing narrative (always welcome). I've got as much reason to be railing against lock down, or lack of, as any today. I'm currently getting quietly drunk and contemplating that I should be landing in Florida about now and will no doubt be attending some of the consequences of a late lockdown come Monday

We have 4k infections per day detected amongst the hospital admissions and many times more known to be self isolating but not measured (and so not detected).  Say that there are 10:1 undetected to detected cases and we have 40k per day getting infected.  This isn't a crazy assumption as it's less than your 10x bound as it includes symptomatic people who are not basically dying, that being the current criteria for hospital admission and therefore testing and detection.   The government have assembled a corps of 250,000 volunteers to supply food and medicine to "cocooned" vulnerable people etc.   At the moment many of the deaths in the UK will be vulnerable people who were in normal social contact from before lockdown began.  As that fades away the massive hospital capacity they're building out will be able to cope with a population infection level ~8x the current one, as the most vulnerable and therefore most likely to end up in intensive care are isolated.  That gets us to 320k infected per day without overwhelming services.  Relax lockdown accordingly to get the infection rate up, and it can continue to raise day on day as the immune/recovered fraction rises.  After about 30 more days you can cancel lockdown and the "second peak" is sufficiently moderated by the recovered/immune that it doesn't overwhelm the new capacity.  After about 90 days more you have 70% infected/recovered and 30% susceptible in a population mix that by-default moderates outbreaks.  Then you release the vulnerable from their cocoons.  Perhaps we learn more about what makes younger people vulnerable (genotyping, BCG states or taking ACE inhibiting medication?) and tweak the cocooning as we go to speed things up more (the more vulnerable people cocooned, the lower fraction of infected that require intensive care.)

To be clear I think this is a batshit insane way to go but I wonder if it's doing the rounds from certain members of SAGE and currying favour with Cummings.  I don't know if I'm getting overly paranoid but things like the article in the Times today made me wonder.

That data is not required, actually. It only matters for when the breakout will be naturally contained because the entire population has had it. But whether it is 4 asymptomatics to1 symptomatic as in the link above or 100 asymptomatics to 1, you can base the response on the timeline of people needing hospital support, those needing ICU support, and those dying. That tells enough about how fast the breakout will go out of control.

It is a shame, btw, that most countries don't publish the timeline of the hospital cases.

I've seen more than one case made by people with public health knowledge that the reduction in urban area pollution will save more lives than the costs of coronavirus.

You said "I just hate seeing people die needlessly (you've done the math on deaths that will be caused by lockdown, right?)."  That's a pretty loaded statement.

If and when that data appears, for example through widespread antibody testing, I think things will change very quickly.  As it stands, we're having hospitals close to everything except coronavirus patients and births, and that's after almost two weeks of lockdown.  It's going to get worse before it gets better, and it's astoundingly clear what would happen if lockdown was released.  Until lockdown there was an exponential rise - if we had been approaching the point the large number of asymptomatic cases was a limiting factor, it would not still have been rising exponentially.  Unless we spend an awful long time in lockdown, the moment it's released - kapow.  Different countries implemented lockdown at different points in their exponential phase and not one of them ran in to a tailing off that would indicate a large number of asymptomatic cases.  The analogy from another poster about running in the dark seems very apt.

So you haven't "done the math"?

Is that because the numbers are so uncertain and therefore the likelihood of losing control, or from a philosophical standpoint? 

If you think actual epidemiologists are going to convince the UKC resident experts that they might just be wrong about something, then good luck.  You'll need it.

I'm learning from my mistakes

I would love the majority of infections to be asymptomatic and the declining exponential increases in Spain and Italy to simply be due to there being tens of millions of cases in each country

I appreciate that the plural of anecdote is not data, but I have probably spoken to at least 10 people with presumed covid-19 over the past 2 weeks. Many of these have had someone in the house, or close contact with someone, with a positive test. In each household the majority of people have had some kind of symptoms, even the children. If I see a large scale study showing the majority are asymptomatic then I'll believe it, but until then I'm remaining extremely sceptical.

• The number of younger people ending up in intensive care for a period (but not dying).  This is not good for long term health at all.
• The current lack of testing capability to actually understand the bush fire that would have to be controlled.
• The incredibly difficulty of "threading the needle" with constant fine tuning of R0 during the exponential phase of something with a large lag between making societal changes and detectible then catastrophic effect, against a pressure of having to do this as fast as possible.
• Sour grapes that we let it get so far that this might be considered a viable fix.
• Philosophical - I don't like the idea of being (statistically) used as an infectious agent that will result in others dying.

Given epidemiologists are saying wildly contradictory things only some of them will convince. 

When I talked about a timescale, I meant while having some level of control... You're scenario would get the job done faster, obviously. But it is so dangerous... how can you cocoon 1/4 of the population? Send them to Scotland???

It would certainly be some coincidence that each country activated lockdown measures at the exact right time to be masked by the asymptomatic effect.   I wonder which country is going to blink and release lockdown first to find out?

Jeez Blanche, is Saturday night lockdown getting to everybody? No one's claiming any particular expertise, we're all just shooting the shit here

I get all that. I just see other options as similarly problematic. I also  think long term lockdown is impossible sociologically (after a few weeks in a 1 bed flat people will rebel on way or the other) so we have to choose a route that at least softens it. 

That's where identifying recovered/immune through antibody tests comes in.   The fraction of that 1/4th who are in care homes are apparently being written off - a few stories recently of GPs surgeries and NHS trusts writing to care homes to suggest that they get all the residents to sign DNRs, in one case with some helpful "suggested scripts" to follow.

Let's just hope my thoughts are the ravings of a paranoid lunatic.

Have a like.

Harsh?  Perhaps.  Frustrated, for sure.  Unfortunateky BMJ is not a by-word for quality as I said; the peer review is very weak or often absent I understand.

The empirical experience of what happens once places lock down is fact - it works.  Of course, the ultimate death toll with inaction is unknown.  But the direction is clear - people dying in droves daily and health services being over-run.

The MD replies to the BMJ thread are all, politely, aghast.  Isn't that obvious?  So promulgating an article that runs contrary to the actual real-world evidence to date, is pretty irresponsible.  I'm all for academic debate, and it's certainly happening, but people pouncing on things like this as an argument against prudence, when prudence is having a hard enough time already?  Well, jeepers.

It's Saturday?!?!?!

Yup.  The approach I like the most is where lockdown is relaxed within small island groups, with hard boundaries between the islands. It looks like this achieves a big effect on R0 whilst restoring a lot of normality.  

Sigh.  You too huh?

You may have noticed that there's a fair amount of lively argument amongst epidemiologists about this. Also, until not so very long ago, amongst climate change scientists.

But, the very significant majority see that the distancing and containment measures are necessary and effective - which is probably why every single major country in the world has moved that way.  They're not smashing up their economy for fun, right?  They see that without the drastic measures a highly infectious agent, with a long stealth phase and high mortality rate is an absolute nightmare.

But if you want to follow a poorly executed and worse-reviewed article in a self-publish press, fill your boots.  Just don't promote it elsewhere please.

I get that, but the OP's tone and content in no way justified "you are part of the problem".

As publications go, it's pretty much gold standard.

I agree

All of which validates the BMJ's decision to publish the article in the first place. Personally, I'd always welcome a reputable counter to a commonly accepted narrative, especially if I found myself agreeing with the herd. It provokes debate and acts as a guard against complacency and intellectual laziness.

All fair.  Thanks

We have a positive test in the household. 

Good luck to all

Agree. Chatting with a mate in Oz last night. Hadn't realised they'd instituted hard state borders. Seems eminently sensible given population spread and geography.

The article is odd. It's under a "news" heading, has a DOI, and is written as a discussion article. I think the BMJ needs to be clearer about the purpose. As a provocative discussion point, fine. But the danger is it is interpreted as credible research, which it clearly isnt. 

The modeling by the Ferguson/Imperial College group suggests that in the UK (and similar European countries) about 5% of the population now have it or have had it, with Italy being 10% and Spain 15%. 

Really sorry to hear that. Keep us all updated and the best of luck.

We may be a fractious bunch of f*cktards and we don't know each other (mostly), but UKC certainly feels like a community to me.

It's not "research."  It's a report of a data point, with limitations clearly expressed. In fact they couldn't really be more clearly expressed.  

all the best

OK, well, there are serious reports that a "decade of austerity" cost 130,000 lives in the UK compared to a no-austerity alternative history. 

E.g. https://www.theguardian.com/politics/2019/jun/01/perfect-storm-austerity-be...

I don't know how far to trust this, since I've not looked into it, and a think tank could well have an incentive to come up with a large number to make headlines.  

But, also realise that "austerity" consisted of a drop in GDP of only a percent or so, followed by increases at a slightly slower-than-normal rate. 

This crisis could be ten times worse than austerity in economic terms.  (It could also be 20 or 30 times worse, if it goes on for many months.)   Multiply the above number of deaths by 10 or 20 or 30 and you get a big number.  Even if you divide by ten to account for rampant exaggeration by the think tank you still end up with a number similar to that for projections from Covid19.  

I have little idea how sensible that above number is, but this question really does need asking and answering. 

Edit to add: here's a Channel 4 "fact check" on that 130,000 figure: https://www.channel4.com/news/factcheck/factcheck-did-austerity-kill-120000...

No one is suggesting a "do nothing at all" strategy.  Everyone wants some distancing and containment measures. The issue is of degree, and of balance with other factors such as the survival of the economy. 

And not all countries have gone for shutting down large swathes of things; Sweden, for example, have not. (Their strategy is being led by epidemiologists.)

It'll be interesting to compare outcomes in Sweden with those in countries with harsher lock downs.

Well they very much could, as pointed out repeatedly in the responses

At the forefront of the minds of most of those in power will be one simple fact. Mistakes are much easier to forgive if they don't have a huge bodycount attached.

And then Taiwan, with early infection, no lockdown, and currently only 0.2 deaths per million people! Compare to Spain at 216...

I hope they get well soon and others are not infected, or if they are it's mild and only brings immunity!

do you have a link?

I found this one, where he mentions 0.9% fatality and 20000 estimated deaths total, which would give something like max 1 million.

https://www.nature.com/articles/d41586-020-01003-6

On March 22nd in the thread “is it worth it”, you wrote “I'm also leaning towards the conclusion that the government's initial response was about the right balance.”

Our governments preparation and response is why we have 64 deaths per million.  Taiwan’s preparation and response is why they have 0.2 deaths per million.

We are where we are, and it’s an awful place where every possible direction is riddled with unknowns and deaths.

If it was true though and let's pretend most of us either have it or have had it, wouldn't one expect at least someone in the household, of more than one person, to have shown symptoms?

Keeping families together surely is better than not doing so, even if most people are asymptomatic, what are the other options?

If nothing else how would the NHS cope with the extra influx?

You'll have to compare with similar countries though - over 50% of Swedish people live alone and cluster spreading within households is a significant cause of infection. It may be that their epidemiological modelling has suggested that they can get away with less tight social restrictions. Our lockdown was also informed by epidemiologists.

Taiwan had previous experience with SARS. They implemented very aggressive quarantine, testing and tracing immediately as soon as the reports of a SARS-like illness appeared. People with confirmed Covid-19 were tracked with GPS to enforce quarantine. They stopped exports of PPE and ramped up production.

There was no need to lockdown, as they contained it, which is what we and other Western countries failed to do.

Best wishes to all.  

There’s a lot of discussion over “viral load” - nothing is definitive but erring on the side of caution is possible.  The more you can spread out others in the house getting infected (symptomatic or not) the safer everyone may be.  Keep in mind that a surfactant based soap may be more effective at inactivating this virus on surfaces than bleach  etc.  

I'm not sure where I first read it, but here is a link to some numbers from a few days ago: 

https://www.dailymail.co.uk/news/article-8175263/UK-coronavirus-cases-numbe...

But what is the average age of cruise liner versus the general population, I presume the majority of asymptomatic cases will be those under 50, and data from Germany is already showing that majority of people diagnosed with cornavirus are those under 50.

Probably this report.  The Mail, typically, reporting the upper error bound nkt the best estimate

https://www.google.com/url?sa=t&source=web&rct=j&url=https://ww...

Their Germany model seems to me to be very far off. Exponential growth of the infections up to the last day in the graph (March 30). Whereas the measurements show a peak in the infections around March 16 (probably, needs another week of data to be sure). So they would predict the amount of fatalities to be continually increasing exponentially in the next weeks due to the 3 week lag between infection and death. It has been constant for the last 4 days and hopefully will go down next week.

So I'd rather take the lower limit.

BTW, they predict for all countries that even with complete lockdown the virus will spread through the whole population unless a vaccine is introduced. Amazing...

What will be interesting is data showing what proportion of Covid-19 deaths were amongst people who were about to die anyway. Some data suggests that 50-70% of those dying with (not of) Covid-19 would be projected to die in 2020 anyway from other conditions.

I suspect measures will be in place for a lot longer than 2 months...this idea that all we have to do is sit at home for a bit and it’ll all be fine is probably wishful thinking.

But of course as others have stated, who knows until we see more widespread testing and a working antibody test.

I'm probably just being dim here but it's staggeringly unclear to me what they're actually saying, there appears to be no effort whatsoever to distinguish clearly between asymptomatic over the whole course of an infection and pre-symptomatic snapshots. This could mean everything or nothing hinging on the meaning of a few words that may have very clearly defined meaning to those in the field but to the layman appear to be used rather carelessly. Is there some translation error?

It's very frustrating but I'm hopefully just railing at my own ignorance here.

jk

Contaminated environment and multi-step daisy-chained transmission within larger households with infections separated by incubation periods would delay the effect of distancing policies by several weeks assuming the incubation period is ~1 week and it survives on surfaces in the environment for days. Especially if the positive effects of distancing are offset by an acceleration in infection of those helping the afflicted.

We don't know, you're right. Let's hope for the best but assume the worst for now.

jk

Perhaps. Which bit are we to consider hyperbolic?

jk

How can they argue that lockdown is pointless when China has made it work?   China got it first, it has a population of a billion and its got it back in control with a total casualty count far lower than Italy.

I've a feeling that there's a particular group of epidemiologists that are going to look like first world war generals when this is over, clinging to doctrine even when it is obviously costing vast casualties.

It will but isn't the issue more of timing than policy? Sweden acting fast (CV establishing late) without the huge metropolitan hothouses of other nations has more and better options than lassiz faire Britain left itself.

jk

The government's initial response was never implemented, so it's quite difficult from a causation perspective to blame it for anything!

Sweden versus Denmark makes a good comparison. So far there are more Covid19 deaths in Sweden, but it's not at all clear that the difference is higher than the number of deaths that will be caused by the lockdown in Denmark. Coel's idea of using the austerity deaths framework to measure is an interesting one.

Edit: forgot that the average age of the infected is higher in Sweden than Denmark, so that would also account for some of the difference.

There are some similarities, but also isn't national differences. Especially with population density and housing outside the largest cities. 

The Stockholm cluster was a f*** up, the trace and isolate was working well until late Feb..  when they tracked two more skiers from Italy or Austria, what they missed was their taxi driver from the airport. Who was a Somali born worker living in dense apartment housing, the 2nd key mistake was not publicising the covid guideline in enough languages. The hotspot grew! 

There are other factors that may help sweden, perhaps Denmark too. 60% live alone here and average age for leaving home is 19, as said pop density, lots of folk have been home working for several months already it's more common than the UK, whilst bars and rests can open it's widely space table service only, all sport events are cancelled etc.. it's not quite like the UK press portrays it.

The negative, stockholmers think they are special and don't see why they aren't allowed to travel to other parts of the country. They've even been complaining in the press how they've been made to feel unwelcome when visiting elsewhere.

Time will tell. There is no cure, no vaccination, no medication..  so locking down and hoping might not work. How do you unlock? The key seems to be balancing the hospitalization rate with the number of beds. Yesterday there were allegedly 40 free ICU beds vacant in Stockholm and there are a few fields hospital built as well. So we'll see.

Tegnell does put across very reasoned points in his meetings and tv interviews. Better than listening to Hancock! 

Their argument is that a whole-country lockdown *now* won't succeed in eradicating it.  That's different from an early-enough and localised lockdown succeeding. 

Anyhow, a Wuhan-severity lockdown of the whole UK would cause mass starvation.  We don't have a "rest of China" to support us.

That makes no sense.  The government’s initial response is what it did initially.  Something that wasn’t implemented wasn’t a response.  It was an unused plan.

What our government did initially was very little.  Which was a mistake.

The Times continues to highlight the Swedish approach:

"Sweden has become an outlier in the battle against the coronavirus by refusing to impose a nationwide lockdown, instead allowing the virus to spread slowly through the healthy population while protecting the vulnerable.

"According to one poll, about three-quarters of the Swedish public is at least quite confident that the public health agency is taking the necessary precautions to deal with the virus. What is less clear is whether rejecting a severe lockdown will save lives in the long run. Research by scientists at Harvard, published this month, showed that enacting harsh social distancing measures now could lead to an enormous resurgence of infections in the autumn— causing more damage than if nothing at all had been done. “Having a very abrupt stop of the spread now would actually move the problem ahead of us,” Tegnell said.

"Not everyone is supportive of the Swedish model. Tegnell and the public health agency have been harshly criticised by some scientists who question their laissez-faire approach.

“Their policy has been to do too little and to do it too late,” said Holger Rootzen, a professor of mathematical statistics at Chalmers University of Technology. “I think it’s better to do too much now and then, two weeks later, you can roll it back if needed.”

"Scientists say it is unclear how many people in Sweden have already contracted the virus. Results from random tests of 1,000 people in Stockholm, due to be published early this week, will give an indication of how far it has spread through the population.

"Tom Britton, a maths professor at Stockholm University, has been modelling the spread of the virus. “I think by now around 10% of the population are infected,” he said. “This month, April, is where most of the infections will happen. How many will depend on how we act. But if I guess correctly about half the population could be infected by the end of April.”

"By mid-May, Britton said, 60% of the population could have been infected: the commonly used threshold for herd immunity.

“The advantage with herd immunity is that once you have it, the country is safe,” Britton said. “But the downside is that the country will get infected and if it happens too quickly the hospitals won’t manage. My point of view is that it is better to slow it down than to stop it.”  

https://www.thetimes.co.uk/edition/world/coronavirus-sweden-takes-a-differe...

Very interesting program on Radio 4 yesterday afternoon outlining a similar approach and result for South Korea, where they had the government backed App on their phones locking individuals down who were virus positive, and alerting government officials to any in this group who were going beyond the boundaries, whilst sending a very harsh message to the transgressors.

By initial response, I mean the proposal of isolating the at-risk population and attempting a controlled spread among the rest of the population. Technically this was implemented but for all of, what, 24 hours? That's the response that I think may have been about the right balance.

Medicine is strange art. One of the origins of evidence based medicine was in a German PoW camp in WWII, when the MO - Archie Cochrane, as in 'the Cochrane Institute' - was denied any of the drugs conventionally used to treat TB. What happened was ... he achieved the same outcomes as he would have expected back in S Wales in peacetime. I.e. evidence based medicine has always been about challenging the received wisdom.

Tough call in the current circumstances though.

Yes - all these places  - Taiwan, South Korea, Hong Kong have previously contained outbreaks of coronavirus diseases (SARS or MERS) so knew about, and had the facilities to implement the test/trace/quarantine strategy.

Some critisism of the paper by another epidemiologist

https://mobile.twitter.com/nicolamlow/status/1246492640834715648

She's raising the same objections raised in the comments to the article, basically the danger of misinterpretation. I'm never a fan of suppressing data based on the possibility of misinterpretation. It's possible to misinterpret virtually anything, for one thing! But also, we can deal with any misinterpretation if and when it arises, without losing out on the data.

I noticed that she accused Jefferson of misinterpretation to say that large swathes of the population are already infected. She's incorrect--Jefferson is saying IF this does indicate a high rate of asymptomatic infection (which he makes clear that we don't know yet) THEN large swathes of the population may be infected.

We have the facilities. We didn't re-purpose, mobilise, provision and coordinate them when we had time and we didn't act to buy time when became apparent we'd f*cked up. Our government was asleep at the wheel.

jk

I'd agree with some of it.. but I doubt sweden will have a 50% infection rate by the end of April. 

"In theory" folk should not be travelling around very far, you can exercise, work, socialise locally. But holidaying, sports events, work travel around the country is forbidden. The same guidelines for pensioners and vulnerable to isolate exist too. The socially active and young generally live alone, they aren't squeezed into 3 generation households. There is a sense of collective responsibilty that most follow, which is probably also why the tax regime in Scandinavia works too. The problem will be the migrant and refugee communities, poor communication skills, cramped accommodation etc. This and nursing homes for the elderly, once it's in they are stuffed. 

She's giving her professional opinion (as an epidemiologist) on how the data has been misrepresented, there's no suggestion of suppressing the data, on the contrary.

From your link

"Jefferson said that it was quite likely that the virus had been circulating for longer than generally believed and that large swathes of the population had already been exposed."

That is the text she is commenting on.

From my own reading the consensus from epidemiologist on this is that we need more data.

Right. "Quite likely that" in light of the possibility raised by the data, which he points out is nowhere near a conclusive finding. No arguments from me that we need more evidence, but I would prefer we follow up on this sooner rather than later in case we have gone badly wrong.

You seem to be suggesting that by having too much lockdown, we have gone badly wrong.

If that is the case, I think you are deeply confused. With the current amount of lockdown introduced when it was, critical care in hospitals is still filling up and hospitals are already closing the door to everything except having a baby.   We’re probably more than a week shy of the worst overload yet.  Unless you think that less lockdown would have made the hospitals less busy, it’s very hard to see how you think we have “gone badly wrong”.  Unless you want the hospital system totally overwhelmed and far more people dying not just from covid but from treatable injury and curable disease?  Because that’s what would be happening right now if measured had been less strict.

Perhaps I have missed it but to me you keep hinting that our lockdown was too strict without providing a reasoned explanation for why considering the alternative.

You have made the case without presenting compelling evidence, that this lockdown is going to more kill people through economic damage than it saves.  There is a counter argument that letting the virus overwhelm healthcare would have such far and wide ranging consequences that it would also be catastrophic for the economy. It would I argue come at the loss of humanity from medical staff and the general population.

This.

The 'do nothing' option is for us to actively choose a slaughter on the scale of the last great war, not spread over years but weeks. We can pretend we'd act protect the vulnerable but there was no credible plan, there is no way it would be possible, to do so would only serve to ease our choice to sacrifice them until we could pretend it wasn't a choice at all. It's not at all clear we'd be able to maintain even basic services or the rule of law in the grip of that self inflicted crisis. To do this in order to protect an economy already stunned, probably ruined, to regain a normality already changed forever, to assume that choice wouldn't fundamentally destabilise our already fractious riven society... it's crackers!

jk

Exactly.  If alicia’s theory turns out to be true it’ll show in the hospital admissions having an otherwise inexplicable drop off, and plans can change accordingly.  Without running the risk of wrecking absolute carnage on people and society on a whim based on a minority view from the experts.

This is exactly what is wrong with this debate and why we are likely not going to be able to deal with this crisis effectively. NOBODY IS PROPOSING DOING NOTHING. I'm sorry for the all caps there but I'm so frustrated that people can't get this into their heads. Setting up a ridiculous strawman like this is causing us to fail to discuss the real issue and that could easily mean more people die or suffer severely negative consequences.

Wintertree seems to want to know what it is I think we should do. I'm not totally sure why that's relevant, but:

I think the approaches with the best evidentiary support currently are a lockdown of the at-risk population only and widespread testing, potentially with contact tracing or potentially not. Lockdown of only the at-risk population gives us a low enough hospitalization rate to keep the hospital services afloat, and it preserves enough economic activity to fund health care, ramp up testing capacity, and avoid a portion of the deaths that would result from a whole population lockdown.  It also avoids a disease peak in October, which modelling suggests would happen with a whole population lockdown right now and which would potentially be more deadly than an earlier peak.  It also avoids a scenario of rolling lockdown for 18 months, from which economic damage (and hence knock-on mortality) would be brutal.

This is exactly what the whole population lockdown is doing.  It's simply not the safe option that people are simplistically portraying it as.

I thought I was clear. You are apparently saying you worry our current lockdown was too extreme. Yet, despite it we are still overwhelming hospitals and killing medical staff (likely through viral load).  So if you consider it too much, you’d presumably be happy with 8x the current daily death rate and a lot off hospitals imploding.  If we’d acted sooner the “emergency stop” could have been avoided or postponed long enough to built a more targeted and flexible lockdown.  Remind me, what was your position on this 3-4 weeks ago?

”Doing less” is very similar to “doing nothing” in that both would have been much worse than we are now.  You were very clearly suggesting action to date could be a terrible mistake in terms of being too severe. 

I agree that isolating vulnerable people is a key part of any strategy now the problem is so uncontained.  But to do that - which government are doing - we needed to preserve the basic functioning of society and healthcare and that was only possible - having left it so late - with a severe lockdown.  It seems pretty clear to me that lockdown is going to gradually both slacken and smarten up.  

Have you seen any serious modelling suggesting healthcare funding is at risk?  I haven’t.

Its also clear that we don’t yet understand all the risk factors for healthy and young people.  So we don’t know who to isolate.

Support for lockdown given where we are is not the *minority* view.  It’s prevalent amongst experts, and it’s widely adopted.  It’s also reversible, unlike totally overwhelming healthcare.  Some mistakes can be undone, others can’t.  The economy can bend and change, it’s not a rule or nature but a constructed tool to enable sharing between people.  Death is death is death.  

I harken back to an early comment about running headlong in to the dark.  It’s a damned fool idea.  A few weeks spent feeling our way is worth it - for the potential victims, for the healthcare workers, for our humanity and for the economy.  

I don't mean this to sound rude (it's hard with just typed words), but I started this thread to discuss an interesting new development in the situation, not the basics of a pandemic response.  It's clear that you're yet to really dig into the details of the arguments on the issues that you raise, so at this point I think it would make much more sense for you to read about them on your own, especially since my sense from your comments on all of these threads is that your mind is made up and there is nothing you could learn that would change it.

Don’t worry; you don’t sound rude.  You do sound totally unwilling to engage with my observation that healthcare is overloaded and going to get worse, yet you say our current lockdown is too extreme and should have been weaker - so you appear to be advocating for more action that would have lead to more overload and more death right now.  You seem totally unwilling to present any actual evidence that a weaker lockdown would be better.  You introduced an article that I would call “spitballing”.  You haven’t engaged with another poster’s reasoning that the documented disease progression places a reasonable limit on the ratio detected:undetected of infected far below what your view requires.  You have dismissed another poster with “do the math” but have no maths yourself.

Well you haven’t managed to present any.  I’ve found and read a few opinion pieces that follow a suspiciously similar track aligned with the usual groups.  I’ve not seen any serious study.

Its all spitballing until there’s hard evidence on the real scale of the infection in the UK

You’re god damned right it is. I think your suggestion our lockdown was too extreme is foolish in the extreme and borderline offensive when you look at where we are despite it.  I find it staggeringly hard to see how anything other than wishful thinking gets you there.

There is nothing you have presented to me and I suspect nothing you could present - or you would have.  My mind can and does change.  If evidence emerges that we have 4 million immune/recovered in the UK that changes everything.  If it turns out we have 400,000 that changes nothing.  In the mean time, we are about to overwhelm far more hospitals with infections committed before lockdown. Let’s not dellude ourselves into rushing to commit even more infections than we can handle for the sake of another week or two.  It’s bloody mindedness more befitting a world war 1 general screaming Tally Ho and leading the chaps from behind over the top. 

This whole post started with you cherry picking a single minority view that aligns to the stance you have had on this issue for about a month.  You had that before we hit close to 1,000 dying a day.  I think you were wrong then and I think you are wrong now.  The difference is I can’t understand it any longer.

I’m all for doing everything we can to reduce the personal and economic effects of lockdown, and to doing so as fast as we reasonably can.  That is when we understand the problem, and not now when hospital overload is *increasing*.

Except you don't seem to want to discuss it. It's been pointed out repeatedly that the article is seriously flawed by those here, in comments under the article and in other publications but you just keep ignoring that.  Unless you can respond to these criticisms of the article, it is dangerous to keep arguing for it to influence policy. 

You seem quite sure in your assertions, but as you know there are a number epidemiologist, as well as infectious disease experts, that do not share your sureness on this. So excuse me for taking the above with a pinch of salt.

The strategy you outline above may well be the best option, but it is quite clear that the health service needs some time to prepare, so it can stay afloat. That's what I'm hearing from medics I know, and reports about lack of PPE for health and care workers tally with that.

It's not a binary choice between 'just lockdown for the vulnerable' and 'lock down for everybody for 18 months'. This will be constantly reviewed. I would think the time to consider a relaxation is when healthcare professionals are confident they can deal with an increase in case numbers. 

You're going to have to give me an example of a criticism of the article that I haven't responded to, as I'm not seeing any.

A fundamental problem seems to be failing to distinguish between asymptomatic and presymptomatic infections. Have you addrrssed this? 

Reading your last post is reminding me of a good quote I saw in relation to a discussion of improving testing capability--that if the current crop of intellectuals had been around in the 1950s when the US got its ambitious motorway building project going, we'd still be arguing over whether it's possible to build roads.  You're wanting me to present evidence on the scale of the infection in the UK.  That is precisely the evidence I am suggesting we need to acquire, urgently, before we proceed with our current plan.  And the reason I suggest we need to acquire this evidence is because we have hypothesis-generating data in our possession now--the data that my OP is about.  

Yes, at 18:33 yesterday.

"I believe it's just at time of testing, but (a) it fits with small scale Italian data on a high proportion being asymptomatic throughout, and (b) with so many people, the likelihood of them all simply being too early in progression to have symptoms is low."

I’ve been clear that more testing is important for a long time.

You haven’t engaged with the comment from HansStuttgart, previously made elsewhere too and latterly echoed by me, that what’s presenting at hospitals gives a reasonable stab at a bound on the asymptomatic infection rate that’s nowhere near what the plan you advocate would require.

Another excellent point made by Hans is that having the answers we all seek on the scale of the infection changes *nothing* about the overload in hospitals now.  The key information for relaxing lockdown is “can hospitals cope”.  That information stems from admissions, which is about a week’s lag from policy.  We would frankly be insane to change anything much faster than fits that lag, antibody tests or not, as the consequences of getting it wrong are awful and irreversible.

You continue to completely ignore my point that you openly suggest our current lockdown was a mistake and too extreme, yet even with this we are overwhelming healthcare.  

No, I just think that anyone advocating that our present lockdown is too extreme, based on minority spitballing about the scale of the infection in the UK, and without data, is taking a very foolish and dangerous stance.  

We aren’t talking about motorway building, we are talking about decisions that if taken in the wrong direction lead to irreversibly committing death on a scale that overwhelms the health system within 10 days to the detriment of everyone.  

The early comment on running headlong into the dark was spot on.

Probably overly optimistic to assume that now that I've pointed out where you simply missed the response you were looking for, you'll be apologizing for this inaccuracy?

The problem is that this is equally true no matter what the infection rate is.  The basic principle is illustrated by the difference in models we saw from Imperial College and Oxford--what we're seeing *can* be consistent with a variety of situations.  

This has nothing to do with the rate of asymptomatic infections.

This has nothing to do with the rate of asymptomatic infections.

It is because that is indeed just ignoring the issue by pretending you can wave it away. Its exactly an example of what I meant. a) is false. There is no Italian data suggesting 70+% asymptomatic and b) irrelevant. 

Please at least make an effort to be accurate.

https://www.lastampa.it/topnews/primo-piano/2020/04/02/news/coronavirus-cas...

Edit:  if you don't get a translation option:  they have one-off data from blood donors that almost 70% of them had SARS-CoV-2 antibodies without ever having known they were sick.  That would be a truly asymptomatic infection, not just presymptomatic.  It was just a one-off data point, but that is exactly why people are finding this new Chinese data interesting, since it could be the explanation for the Italian finding.  

I appreciate that it's difficult to be aware of all of the news on the subject, but that's not an excuse for incorrectly stating that the data doesn't exist.  When you aren't aware of data, a more logical response is to say that you aren't aware of it rather than to affirmatively assert that it doesn't exist.

It has everything to do with your formerly clearly stated premise that tough lockdown would be too much, and your now clearly stated premise that the current lockdown is too much.  It is I imagine this premise that has you posting the article up thread.  

It also has everything to do with asymptomatic infections when considered with your clearly stated position, because that affects the size of the susceptible pool which you are assuming is now small as part of your justification that relaxing lockdown won’t be catastrophic.  Which is like playing with matches when there’s a good chance the air is stoichiometric with propane and you’ve got a blocked nose.

See above.  I fully accept a range of asymptomatic infections are possible.  I’d be surprised if it’s more than 10x the detected rate.  I have a serious problem with the idea that our current lockdown is too weak because their *may be* 100x asymptomatic out there.  

I think the key thing you're missing is the impact that a larger-than-assumed number of asymptomatic infections would have on the efficacy of lockdown.  This is what the epidemiologist in the article is referring to, i.e. that there would be a point where we could have so many asymptomatic infections that lockdown would simply not work.  If we are actually in that situation, we need to know that because we don't want to be employing a strategy that is both (a) damaging and (b) not going to work.

Not at all.  If there weren't multiple examples of lockdown working to reduce the detected rate of infections (generally against a backdrop of increasing test rates), in many different countries and at many different fractions of the population detected as infected, I might even consider it a relevant point despite its other flaws...

Regardless of how many people are infected and not showing symptoms, locking everyone down reduces close physical contact and reduces transmission and therefore slows the exponential growth rate.   Lockdown becomes more important with asymptomatic carriers.  If everyone was symptomatic when infections the problem would be much simpler to solve.

The only corner case I can see where lockdown doesn't slow transmission due to asymptomatic carriers is where lockdown is implemented in the very narrow window where almost everyone was infected because of the large, hidden spread from asymptomatic carriers.  It would be some coincidence for the UK to have done this.  Let's say we have - what happens next?  The rate of newly infected people presenting at hospital falls off a cliff as most people are quietly working through their infections to immunity.  We won't need antibody tests to see this - and we can respond by relaxing the lockdown.  If hospital admissions don't fall if it suggests that we are acquiring newly infected people at the maximum rate we can cope with.

Believe it or not this is all clear to me, I believe I understand it all and as far as I am concerned even if this monitory opinion from a few of the experts is correct it changes nothing about how we proceed - lockdown is driven responsibly to the ability of the health system to cope.

As I have said before - and you have ignored - the key metric is hospital admissions rates, as if we overwhelm that everything goes irrecoverably wrong.  

You persist as calling lockdown "damaging".  This is very one-sided.  It has benefits and costs.  The net balance of that is up for debate but calling it "damaging" is heavily loaded with false inference about the alternatives.  

I'm not ignoring your focus on hospital admission rates.  In the scenario I described, lockdown would be ineffective to minimize those rates.

I understand that it seems harsh to you to talk about the damaging impact of lockdown.  But keep in mind that that damage is directly linked to more deaths.  It may be distressing to think about there being downsides to the current approach, but ignoring them won't help the people who will die because of it.

Fair enough. If it is as reported that is interesting and potentially significant. The criticism of the. BMJ article remains however. The very first sentence in it is unsupported by the data. 

You are.  You're claiming our lockdown is too severe and ignoring every comment that we are exceeding the coping limit of some hospitals and continuing to raise the load in others.  Advocating decreased lockdown against a health service that's rushing to build out capacity as fast as it fills it is an interesting perspective.  What do you suggest we do instead?   Leave people to die in the hospital corridors, or refuse to transport them to hospital and leave them to die at home?  This is the choice to be made if we relax lockdown now and your preferred theory (that is supported by only a minority of the experts) is wrong.  

You've never to my reading actually described *how* this would be.  I in my previous message gave my best reasoned understanding of how having a large number of asymptomatic carriers would go on to mean lockdown has no effect - i.e. locking down just as we reach "majority of people are asymptomatically infected" status.  I explained how in this case we will rapidly see the dramatic effects in reducing hospital admissions and reduce lockdown accordingly - about a week later than if we did it on a whim based on a theory, but without irreversible consequences.   I believe I mentioned that no other countries data as shown a near total, unexpected drop off in infected that would tentatively support this.  The only places that have achieved it through very tough isolation, test/trace and quarantine.

No.  I am very well aware of how damaging it is.  I've poured my life and soul in to my family and my new biotech business in the last 3 years.  I'm watching my family miss out on almost all of their normal life and I'm apprehensive about my business.  I am also acutely aware that I am in a far better position than literally millions of people during this lockdown.  It's simply a matter of fact that it's damaging.

Yes.  I you mentioned "doing the maths" on this but have produced only words.  Everyone wants out of this as soon as possible.  Get it wrong and the effects may be worse than the damage you fear.

0.  Are you misreading my posts?  I did not say I was distressed.  I said "You persist as calling lockdown "damaging".  This is very one-sided.  It has benefits and costs.  The net balance of that is up for debate but calling it "damaging" is heavily loaded with false inference about the alternatives. "  I've gone ahead and used bolt to hi-lite how I clearly recognise that this is not one sided, and that I am pointing out how you do tend to revert to a very loaded, one-sided presentation of it.

1.  If we didn't have the current approach we would have far, far more people dying, and we would be mentally and physically destroying our healthcare staff.  That's going to have awful long term consequences.

2.  People would be dying now in larger numbers without lockdown - that much is obvious from other countries where lockdown clamped the rising number and held it - if your theory was true there, it admissions would have fallen off a cliff by now.   Failure to act now is irreversible in terms of impact on life and healthcare now.  Damage to the economy is not writ in stone in terms of hypothetical future deaths - as I said before the economy is a tool to enable people to live better.  It is entirely within our power and our wealth to ensure nobody in the UK dies due to poverty.  That this will likely happen is not due to the lockdown, it's due to a throughly broken, unjust and unfair political end economic system.  Killing a bunch more people now isn't going to fix that.

3. A fundamental of crisis management is to fix the immediately fixable and kick later problems down the line for later.  Too much focus on entirely hypothetical laters could complete screw the now.  The economy is far more under our control than this virus.

We all want an end to lockdown as soon as possible, and we all recognise the need for the economy to get back to full speed.  It is I strongly suggest better to look towards guaranteed solutions (test/trace, better home diagnostics, better workplace risk management, hammering the scale of the current problem down) than highly wishful thinking that is largely - but not totally - held in low esteem by the majority of subject matter specialists.

The funny thing about your post, the article you linked, the recent article in the Times and others is that they all chain this highly speculative proposition together with emotive statements about consequences of lockdown.  If there was strong evidence it would not need the emotive bolt-on, it would stand alone as the clear, obvious and most effective way to proceed.  It worries me greatly to see where some of this is coming from and to think about where it is going.  
 

Even if there were millions already infected, we don't know yet that they are safe from reinfection.

It could well be possible that a lot of people have had a small viral dose that is enough to show positive on a test, but not large enough to prevent disease with symptom when at a later stage another (possibly larger) dose is encountered.

There could be a subset of measures in the lockdown that have hardly any benefit in preventing spread of the disease, but still have significant cost. In that sense there could be an argument that the lockdown is too extreme.

There is something to be said for the government to relax certain measures in regions of the country where there is enough hospital capacity to gather some data on which measures work and which do little. Would also be good to show to the population that the government is actively working towards the best possible solution.

Yep, that's definitely another thing we'll need to prioritize for research.

If you're concerned about emotive statements about lockdown, I suggest this article.  It also is the basis for the "math" I was referring to many posts ago.  

https://drmalcolmkendrick.org/2020/03/29/a-health-economic-perspective-on-c...

As far as why lockdown would be rendered ineffective after reaching a certain threshold of infected persons:  I don't want to put words in the quoted epidemiologist's mouth, since he didn't explain this concept when referring to it, but the most obvious interpretation of his statement that this would be the case is that lockdown is a tool to slow the spread of disease.  Once the disease has already spread, you no longer need that tool.  

Unbalanced and emotive.  There’s a limit to how many times I can repeat myself.

Malcolm Kendrick?  Do you realise he’s strongly into pseudoscience, woo and denialism of mainstream science?

To no surprise his article has a narrow focus ignoring many of the consequences of healthcare overload I and others have mentioned and tries to lure the scientifically naive in by harping on about acronyms, formula and Big Scary Numbers with all the zeros written out.  I think here is where you claim I’m closed minded because I don’t agree with a pseudoscientific woo merchant who thinks a Secret Vegan Cabal is out to get him.  It’s a totally false premise that we can trade the cost of saving a life vs the value of that life.  It totally ignores the massive costs - including financial - of giving up and consigning people to die without trying to save them, or of trying and failing to save them totally overwhelming the health service.

Your argument has never had much credibility with me - although I concede it could yet turn out to be correct - and that would be wonderful - but if you’re following Malcolm Kendrick your credibility has just dropped through the floor. That’s only with me and who am I but an internet armchair expert?  I’ll leave other readers to do their own research and reach their own opinions.

So you don’t actually know the basis of what you’re arguing for?  You seem to have come up with the same interpretation I’ve given twice - lockdown doesn’t help because the infection is already everywhere.  As I’ve said twice to no acknowledgment from you if that’s that case it will rapidly show in hospital admissions and we can rapidly relax lockdown.  This hasn’t happened anywhere else in Europe with lockdown substantially earlier than us... Which is why, not being totally insane, we lead the release of lockdown by evidence from admissions.

There is an argument to be made about the cost of what we are doing versus managing much larger scale deaths as cleanly and societally nondestructively as we can.  That debate can be had at any time, but dressing is up in the likely fairy stories about everyone already having the virus, cherry picked articles and references to a certifiable, pseudoscientific, woo selling person being persecuted by a vegan mafia makes it look like you’re following the alt-right playbook of obfuscation and window dressing.

Perhaps.  If we have to commit to a long lockdown into summer or beyond, it clearly needs to be smarter and more targeted.  On the other hand having regions desynchronised in their peaks allowed patients to be shunted around as in France, and lowers peak consumption of medical and PPE supplies.  

It’s increasingly clear that lockdown being the same for city and county isn’t working - there needs to be smarter, fairer access to green space in the cities.

The most credible estimate of the numbers infected appears to Ferguson's estimates at 30th March, putting the UK somewhere around 2.7% .  That is 1.7m people, and will be higher now of course but still someway from the infection rate naturally become sigmoid, or from herd immunity.

http://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/r...

Let me see.  Your argument consists of 95% "Malcolm Kendrick is a bad person" and 5% "he ignores the consequences of healthcare overload."  Obviously I'm not going to bother responding to the ridiculous first point, so let's talk about the second.  He does in fact take into account the consequences of healthcare overload, because he is using the Imperial College projections, and those incorporate such a danger.

Oh, I see you are also objecting to the use of numbers and acronyms?  Unfortunately numbers are going to be an unavoidable part of the data in this question.  As to the acronyms, I suspect you might be the only person who thinks the article would be better written if he had written out quality-adjusted life year approximately 50 times.

I haven't responded to your argument about the hospital admissions because there's nothing to respond to.  In your view, any drop in hospital admissions is necessarily caused by lockdown, and not by other causes.  There is no way, in your perspective, to falsify this claim.

I don't yet understand the psychology of a position like yours, which seems to have almost equal parts of facts and hysteria.  You seem to have a basic understanding of some of the issues we face and yet seem to be willfully failing to understand simple points like why a lockdown would be ineffective with a high proportion of infecteds and what impact this would have on hospitalization rates.  You complain about there being too much emotive language in the arguments against lockdown and yet, upon being provided an article based on facts and math, barely managed to respond to them (perhaps because it's quite difficult to make a reasoned argument to the contrary?) and instead went for bizarre, nonspecific accusations of fraud.  I would suggest really examining your motivations here and asking yourself what exactly is driving this sort of thing--is it simply a desire to have your personal hypothesis confirmed?  or is it perhaps that confirming this hypothesis would help give meaning to an otherwise chaotic time and prevent the lockdown period from seeming depressingly ineffective?  

Given your last post in particular, I don't see any possible of meaningful future dialogue with you, so I'll leave this thread all to you now.

I didn’t say that.  I gave a list of reasons why his scientific credibility is non existent.  I make no comment on if he is a good or bad person.

By word count I think my argument was closer to 50/50 than 95/5.  I’ve also made the healthcare overload point multiple times and you’ve ignored it multiple times before.

Why is it ridiculous to point out that your source is a pseudoscientific woo pedlar?  

Not in a financial sense they don’t, nor does he discuss it

Yes he did keep banging on about this one metric endlessly.

I don’t think you understand what you’re taking about?  If everyone has had asymptomatic infection, admissions plummet.  Claim proven.  If they level off and keep coming in week after week, there is a large reservoir of susceptible people out there.  Claim disproven. 

Hysteria?  Pull the other one.

Ooo, feel the burn 

I don’t just understand I gave basis for it twice.   On the other hand, given the wealth of data available some some grasping at straws you did up thread I’m not certain you’re at all qualified to comment on my level of understanding.

Look, for the fifth (?) time you’re missing my point that my main objection is when it’s totally unbalanced.  Emotive is a compounding factor.

It’s an article form a total nutter.  I accept the argument - always have - but I think it is a deeply flawed over simplified comparison.

No, I pointed out you were citing a pseudoscientific boo merchant who apparently thinks a secret vegan cabal is out to get him.

No, it’s to call out dangerous bullshit masquerading as an intelligent, well thought out alternative position when I see it.

 > or is it perhaps that confirming this hypothesis would help give meaning to an otherwise chaotic time and prevent the lockdown period from seeming depressingly ineffective?  

I think it would be criminally negligent folly to find out without hard data.

I don’t believe you can have meaningful dialog when you fail back on a pseudoscientific woo merchant with apparent fear of a secret vegan cabal as your argument, and when you start to go off the rails when I mention this.  You’re bringing playground level stuff from a pseudoscientific nutter to a matter of life and death.  

I’m not the one who needs to have a long, hard look at how they got to where they are.  I entirely understand if you want to skulk off from the discussion now, your credibility to me is in tatters.  I stand my my views on this thread, and don’t give a shit what you think.  But I’d like to make it clear to anyone else reading this that there’s no scientific credibility to the person you’re learning on for your stance.  They pedal pseudoscience and woo and deny mainstream science.  It gives the impression you are running right out of the alt-right’s toxic playbook.  Perhaps you’ve just been drawn in to it and haven’t realised.

I’m not shy of wading in with a strongly different opinion on UKC, but this is the first time I’ve regretted wasting my time.  

The conclusion of that paper seems pertinent

Exactly. There are many epidemiologists who are actually explaining the concepts they are referring to, but you seem to have no interest in their opinions. Despite them also being epidemiologists. That cannot be repeated enough on this thread.

You are making the call to authority but are very selective about who you consider 'authority'. I'm sorry, but it seems to be based on who is telling you what you want to hear, and you have clearly had a sentiment on this for a few weeks.

It's becoming clear that health care professionals are at higher risk of serious health consequences and death from this. If we are asking them to go to work and put their health on the line, it would be at least polite to asses the evidence objectively, and perhaps hold tight for a few weeks until we have more data.

The piece you linked is detail light and so ambiguous I genuinely don't know what it's saying, as a basis for abandoning a precautionary approach proven to work I have seen stronger arguments.

What do they even mean by 'asymptomatic', is that over the course of the infection or at the time of testing. Everything hinges on that and it looks to me like they mean the latter (though with no certainty) but the argument you're making is based on the former.

Jk

Going back to the original 80% asymptomatic news article. There's a few papers (also with small sample sizes) that suggest that the majority of asymptomatic people with a positive swab will develop symptoms.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e1.htm?s_cid=mm6913e1_w

10/13 initially asymptomatic developed symptoms

https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaa119/580...

74.5% of asymptomatic developed "ordinary" or "severe" Covid-19

Both these are suggesting roughly 3/4 of initially asymptomatic swab positive patients do develop symptoms. If you apply that to the 80% asymptomatic proportion snapshot in the BMJ, then you'd end up with only 20% remaining asymptomatic. This is very similar to the Diamond Princess proportion of 18%.

I've just come across this thread and read it with interest.  Many people have brought up some of the things that crossed my mind when we discussed it elsewhere. 

You seem so convinced you're right on this...at times claiming that the way forward is clear based on the available evidence, when it is anything but clear.  I don't know thay your suggested approach wouldn't work best.  But you also don't know either way.  There is a lot of data out there... Much of it questionable, or at least incomplete. 

I specifically recall your list of numbers of deaths by country against lockdown/no lockdown.  While there may be a correlation the two variables may not be linked causally. 

Lockdown seems a decent, although less than ideal economically, precautionary measure if used for a brief period.  It may not be the best measure but there wasn't much time to decide. Switching based on the evidence you point to would be daft at this stage... As in my opinion that evidence has some large gaps and too many varies that haven't been controlled. 

I'm always wary of people making points or suggestions in such a righteously indignant manner.  When one is convinced one is correct it can be hard to consider all the available evidence... Instead one tends to tune in to that which fits one's own viewpoint.  On this issue, are you sure you aren't headed down this path some of the time? 

Perhaps you're correct... But others here have made some very valid counter points... Might be worth reading around them and the least it can do is hone your arguments... 

This is very obvious on Mark Hadley's graphs - the nations that locked down hard relatively early (China, South Korea) have seen a steep decline in cases, those that left it late aren't.

I'm glad someone else can see that I'm not just howling at the moon here.

I've been consistently impressed with Mark's plots and commentary.  

A side note. Higher a link suggeested antibody testing in Italy. I thought there wasn't a reliable antibody test yet. 

Latest news isn’t great - https://www.theguardian.com/world/2020/apr/05/coronavirus-testing-kits-coul... - suggestion that the tests only work well for people who’ve had a bad dose; these being the least likely to benefit from an antibody test as they already know they’ve had it...

This does rather beg the question of how one validated the efficacy of an antibody test on people who have only had mild, undetected infections...?

This is relatively old news...

Yet it is heartening, in that it shows that the authorities are being sensible and objective.

Yes - it's not news but it's news that the government scientists are clearly acknowledging it.  

Still - a 50% false negative doesn't make the test useless if that is understood, and if the false positive rate is very low.  It would still identify a lot of people who are recovered and therefore potentially immune, and it would not lead susceptible people to thinking that they are safe.  Either way, the big question remains around the relationship between the severity of someone's past infection, their antibody level and the threshold viral load to which they remain immune.  

Not to mention the significant possibility of the virus - now in perhaps 20 million people - evolving sufficiently that current antibodies recovered people have no longer confer useful immunity.  This is the terrifying risk and yet another one the naive false dichotomy of "we either let it rip or we destroy the economy" completely overlooks, and is another reasons to err on the side of caution when seeking to eradicate this virus.  

Have you, I'd love to see your calculations. Close observers will know that this sort of thing is a bit of a hobby horse of mine. Ive certainly not done the maths, I don't have the data or one or two of the very specific skill sets, but I've considered a few of key factors and its fair to say, its complicated.

I predicted tens of thousands of deaths as a result of austerity, the lancet said 130,000, for various reasons, I think it is the former rather than the latter, but when I first raised it on here in 2010 I was fairly roundly dismissed as melodramatic.

Want to take a stab at the number of deaths from a 31% decline in GDP (the level we're currently operating at)? 

Obviously it will depend on how long things go on for ...

Between 0 and lots.  

0: The UK can afford to maintain current levels of social care with less GDP than that.  How it does so comes down to factors in our control.  

Lots: If we carry on as we were, lots of people will be disadvantaged and few people will be advantaged.  Having lots of extra deaths happen comes down to individual and corporate greed and government policy.

It is disingenuous to treat the economy as some fixed process that’s as set in stone as the viral deaths.  The UK has the means to support everyone with this reduced level of productivity if we so choose.  Further, it seems likely lockdown will be gradually softened and optimised to prioritise raising productivity.  It’s disingenuous to treat the initial “emergency stop” as the indefinite pattern for the future.

No, largely because very different factors are in play. Most addition deaths will relate to NHS capacity, which would happen regardless of the economic issues, indeed could be much worse without the social distancing measures that have in part led to the GDP decline. Other positive factors such as the reduction in air pollution and road deaths would have to be taken in to account.

Is anyone doing that?

The usual "it's all the fault of the wicked Tories" refrain.

And yet, modern, Western capitalist societies (with redistribution of taxes and a welfare state) are actually the safest and with the highest standard of living for poor people of anything anywhere or any time in history.

Yes. We do indeed need to balance minimising cases against other important factors.

Is anyone doing that?

You appear to be.  The case you've been making for several weeks is that we have to tension the economic cost of lockdown against the cost to life and the value of the life lost through lockdown.  Doing so implicitly assumes that the future economic model will be basically the same as the current economic model.  It was within our power to have no excess deaths from the 2008 financial crisis.

Yes, you can tell that by how I never said that or anything like that.  Labour or Tory, our governments have been tweaking around the edges of the system for several decades.  

Yes, and I never said otherwise.  However, we have incredible wealth and we have death through poverty, and that divide has been getting worse, not better.  So, we are nowhere near as good as we could be.  The "highest highest of living" is coming at the cost of dramatic damage to the climate and is not sustainable.  It's a lot easier to live well if you do it at the expense of future generations.

Some of those factors are more in our control (how we choose to structure our economy) than those that aren't (the virus, a wave of up to 200,000 deaths in 3 weeks and the utter destruction that would have wrought on our society and our medical system).  You do keep reverting to presenting this as a false, simple case of A vs B.  It's very disingenuous.

If we kill people now and overwhelm healthcare now, we can't reanimate their corpses later and we will struggle to treat the depression and PTSD in the medical workers that survive.  Those who die remain dead.

If we harm the economy more now, we can change what we do later.  The economy is the mechanism that joins the productive capability of the people together.  That capability is still there.  More of it, in-fact, with better healthcare and with less grief.

You apparently don't think so and the OP clearly doesn't think so.  I think we are having an emergency stop that was almost certainly necessary to prevent the destruction of the health system with all the human and economic costs that would have.

I thought this opinion piece in Al Jazeera was very insightful - https://www.aljazeera.com/indepth/opinion/coronavirus-signal-capitalism-200...

Well yes, we do.

No, it doesn't.  All it assumes is that there damaging effects of lockdown (including lives lost) are real, and thus that we need to think about the best balance.

I'm not convinced of that.

So you're talking about a fundamentally different economic and social system.  OK, fine, but then it's dubious that it would work better (in terms of lives, safety, standard of living, etc) than what we currently have. 

As I stated, the current systems in Western nations -- while far from perfect -- are de facto much better than anything else humans have ever implemented.   We should be cautious about suggested utopias.

We had the wealth and the resources.  That is beyond any reasonable debate.  It was human factors that stood in the way of building a better world in the post-2008 period.

We should, but we should aspire to one, achieved gradually in small, careful steps in so far as possible.

We should also be cautions about pushing a constant narrative that human constructs within our power are inevitable.

I don't think we have to be that radical, but it's worth considering.   The economy is supposed to be a tool to support the achievements of people, not a whip and buggy to bind them.

They must have tested on mild validated infections from the early contact tracing and testing phase, that or the privately tested and 'VIPs'.

Does make you wonder how much immunity a mild dose might confer and why that does was mild, will it be next time.

jk

But if we change things "gradually in small, careful steps in so far as possible" then meanwhile lockdown (which is now and immediate) will have damaging effects. 

My point is that we need to consider the balance. I do agree that we can also aspire to improve society "in small, careful steps in so far as possible".  Indeed, Western societies have a pretty good record of doing exactly that -- with decade-upon-decade improvement in most things.

Why sure, and, again, Western capitalist societies have by far the best track record in giving people the opportunity and means to live their lives as they wish, pursuing their interests and achieving what they want to achieve.

We're no long working dawn-to-dusk in the fields of a subsistence farm to try to ensure we don't starve in the winter. 

Is it largely the same folk who dismissed you then for pointing out the danger austerity posed to the vulnerable now using the danger austerity posed to the vulnerable to argue a lifting of the lock-down to avoid economic contraction?

It seems to me some of the more right wing voices in our society are suddenly much more on board with the idea that 'austerity' (service cuts) kill and have killed than they were a few weeks back!

Interesting times.

jk

I'm sure you don't need telling who Steve Hilton is. This clip is astonishing!

https://www.foxnews.com/opinion/steve-hilton-flatten-coronavirus-curve-but-...

That is in large part a choice we make as a society longer term, unfortunately for the foreseeable future it's for this inadequate government with past form to make. It is not simply and inextricably linked to the size and duration of the economic shock but to disentangle the two requires radical and bold leadership we would be fools to expect.

jk

Wheh asked, they presented some high school level maths looking at the cost per person given access to treatment for covid vs the value ascribed to their remaining life.  This most definitely is not a future estimation of the negative effect (let alone the net effect) on lives from lockdown vs no lockdown.  Oh, and their source is a renowned anti-science person selling woo and pseudoscience dietary advice.