Paper on Covid spread

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 Offwidth 04 Aug 2020

A preprint and based on small numbers so the usual caution should apply. In a study in Italy workplace spread was the most significant but in a domestic setting children had the higher risk of transmitting. Thanks to Matt on the other channel for spotting this.

https://www.medrxiv.org/content/10.1101/2020.07.16.20127357v1

Post edited at 08:06
In reply to Offwidth:

I have a bad feeling that the policy of reopening schools is based on desire to get parents back to work rather than any scientific reason to believe that it is safe.

Nobody, even Scotland, seems to be taking the kind of actions that might be necessary to make it safe.  For example, why aren't they saying children should isolate for two weeks before the start of term.   There will be many children going on holiday just before they go back to school and being put in large groups just after doing something which increases risk of infection.

It might have been wiser to focus on buying equipment and creating online learning for secondary school and having almost all secondary school kids and any primary school kid with a parent at home learn from home and use the space freed up to spread the kids that need to be in school out more.

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 Neil Williams 04 Aug 2020
In reply to tom_in_edinburgh:

> Nobody, even Scotland, seems to be taking the kind of actions that might be necessary to make it safe.  For example, why aren't they saying children should isolate for two weeks before the start of term. 

Because properly isolating children unless *absolutely* necessary (which also requires them to be away from their families within the home) is basically child abuse?  And isolating the whole family (as is what would happen if a kid got ill, nobody is going to lock them in their room on their own and only speak to them through full PPE) is basically reinstating lockdown, as most families have children, so you destroy the economy again.

> It might have been wiser to focus on buying equipment and creating online learning for secondary school and having almost all secondary school kids and any primary school kid with a parent at home learn from home and use the space freed up to spread the kids that need to be in school out more.

Going for a 50-50 type approach would allow every other seat to be occupied in the school (so distancing), and would give contact time with "extended homework" in project form for the other days?

Post edited at 10:42
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 wintertree 04 Aug 2020
In reply to Offwidth:

Largest daily rise in detected cases in almost 40 days yesterday, ONS random sampling’s latest update suggests a genuine rise in infection rates and R>1, government bribing people to meet indoors in social spaces without masks has just kicked in.

Its not looking great.  Not a rats chance in hell of hammering cases down before schools reopen.

3
 BedRock 04 Aug 2020
In reply to tom_in_edinburgh:

Schools in Sweden remained open and apparently they didnt see increased infection rates as a result. 

https://uk.reuters.com/article/us-health-coronavirus-sweden-schools/swedens...

Edited to add: 

https://www.pasteur.fr/en/press-area/press-documents/covid-19-no-cross-prot...

Post edited at 10:59
 Richard Horn 04 Aug 2020
In reply to wintertree:

> Its not looking great.  Not a rats chance in hell of hammering cases down before schools reopen.

I am not sure it matters, or even if it should matter. We should not see schools as simply one contributor to CV spread in a list of things we can pick or trade to keep the R number low. We are talking about the education and thus ultimately long term well being of the next generation(s). School opening should be the absolute priority, and people should be thinking about what they are willing to give up to make sure this happens, not arguing that schools should remain shut because of what it might take away from them (even if that includes a few months of life expectancy). Certainly I cannot believe people can keep a straight face advocating schools should stay shut whilst recreational facilities like climbing walls should open....

 DancingOnRock 04 Aug 2020
In reply to Offwidth:

Let’s see what the 90min test scales up to and how quickly the T-cell test gets sorted. 
 

If we can see that a large proportion of people are not susceptible to the disease it could affect who we shield and how much it costs to shield them. 

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In reply to Neil Williams:

> Because properly isolating children unless *absolutely* necessary (which also requires them to be away from their families within the home) is basically child abuse?  And isolating the whole family (as is what would happen if a kid got ill, nobody is going to lock them in their room on their own and only speak to them through full PPE) is basically reinstating lockdown, as most families have children, so you destroy the economy again.

I didn't say anything about isolating children from their families.

What I said was that people coming back from holiday where they will be doing things which increase their chance of catching the virus and then immediately mixing with large groups in a school is very likely to be a problem.   

Some form of reduced contact maybe combined with testing in the two weeks before returning to school buildings would make it safer.  Universities seem to have more complex plans than anything I have seen from schools.

> Going for a 50-50 type approach would allow every other seat to be occupied in the school (so distancing), and would give contact time with "extended homework" in project form for the other days?

Spacing desks out is better than nothing but lots of people indoors together for long periods is going to be a problem unless there's near zero infection.  There's examples where they've traced everybody that got infected in a restaurant and it is nothing like as simple as 'if you are two meters away you are safe'.

Fundamentally the number of infections is going up despite it being summer.  If R > 1 now then doing something drastic which will increase R further like opening schools isn't going to work unless it is balanced with some other significant step to push R back down.

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 wintertree 04 Aug 2020
In reply to Richard Horn:

>> Its not looking great.  Not a rats chance in hell of hammering cases down before schools reopen.

> I am not sure it matters, or even if it should matter. We should not see schools as simply one contributor to CV spread in a list of things

I never said they are “simply one contributor” and I never said they shouldn’t open.  I said that our window of opportunity to hammer cases down before they reopen is gone.  

Do you want to argue that it doesn’t matter that R is apparently more than 1 when we need to open schools, thereby rising it even more?  If matters.  I want the schools to reopen.  To me it matters in that we need to see other improvements to R so that when the schools reopen we don’t trigger another uncontrolled rise in cases that ends up forcing schools closed for longer as with March.  As you say, and as I’ve said on another recent thread, closures (or T&T improvements) will be needed when schools reopen.  Or it’s back to unavoidable school closures as the virus spreads out of control again.

You seem to be reading more in to my post than I wrote?  As I’ve made clear on another recent thread I’m strongly in support of schools reopening as a clear priority.

But looking at where we are, the situation isn’t great.  The full set of reopening measures haven’t all fed through in to R yet, and it looks like R is > 1.  A lot is going to have to close or test and trace is going to have to get a lot better by school opening.  I’m not sure most people will be so good at obeying closures and rules this autumn as this spring.  Hence, I think it’s not looking good.

> even if that includes a few months of life expectancy

As ever, it’s not about (not) shortening lots of lives, it’s about protecting the NHS from the effects of a pandemic.

Post edited at 13:55
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 ClimberEd 04 Aug 2020
In reply to Richard Horn:

> I am not sure it matters, or even if it should matter. We should not see schools as simply one contributor to CV spread in a list of things we can pick or trade to keep the R number low. We are talking about the education and thus ultimately long term well being of the next generation(s). School opening should be the absolute priority, and people should be thinking about what they are willing to give up to make sure this happens, not arguing that schools should remain shut because of what it might take away from them (even if that includes a few months of life expectancy). Certainly I cannot believe people can keep a straight face advocating schools should stay shut whilst recreational facilities like climbing walls should open....

Well said. This. Is. Really. Important. 

In reply to Richard Horn:

> I am not sure it matters, or even if it should matter. We should not see schools as simply one contributor to CV spread in a list of things we can pick or trade to keep the R number low. We are talking about the education and thus ultimately long term well being of the next generation(s). 

Education should be the priority but that doesn't necessarily mean everybody should be going to school (or university) buildings. 

The Tories are obsessed with buildings and face to face contact and they need to understand this is the 21st century and many things can be done just as effectively or more effectively online.   Secondary school pupils, particularly the last few years could be working almost entirely from home.  They should be buying IT equipment and having teachers working on getting material ready for online learning.

While this virus is around and there is no vaccine the general principle should be 'if you can do it online from home then do it online from home'.  Avoid shared buildings and public transport unless it is absolutely essential.

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In reply to wintertree:

> > even if that includes a few months of life expectancy

> As ever, it’s not about (not) shortening lots of lives, it’s about protecting the NHS from the effects of a pandemic.

.... and it is not 'a few months of life expectancy'.  Like instead of living to 88 you live to 87 and a half.  If you catch it you could be dead in the next six months or very seriously ill in a way which will affect you for the rest of your life.

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 wintertree 04 Aug 2020
In reply to ClimberEd:

> > [...] School opening should be the absolute priority, and people should be thinking about what they are willing to give up to make sure this happens, not arguing that schools should remain shut because of what it might take away from them (even if that includes a few months of life expectancy). Certainly I cannot believe people can keep a straight face advocating schools should stay shut whilst recreational facilities like climbing walls should open...

> Well said. This. Is. Really. Important. 

Nor has anyone on this thread said otherwise.

I am glad that you now apparently agree with the idea that other sectors are likely to require closures to enable schools to open whilst keeping the virus at least in-check.  What changed your mind from Saturday?  https://www.ukhillwalking.com/forums/the_pub/lock_down_trade_off-722890?v=1#x9...

Post edited at 14:16
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 Richard Horn 04 Aug 2020
In reply to wintertree:

Ok yes I get your point - I was trying to re-enforce that I think schools should prioritise over (almost) everything else, but I can see the problem if we end up with an R>1.

I see other nations have managed to keep their schools open without any sort of runaway virus transmission, I would hope we can learn some lessons from them. Personally (my son is 4 and starts school hopefully in September), I would be prepared to live a more isolated lifestyle myself in the short to medium term if it means he can go to school properly, if all parents take this view then the school would exist in more of a "bubble", so any outbreak would remain localised. 

 wintertree 04 Aug 2020
In reply to Richard Horn:

> I see other nations have managed to keep their schools open without any sort of runaway virus transmission, I would hope we can learn some lessons from them.

The problem is we probably already have R>1, both by random population sampling (NHS) and by pillar 1 and 2 testing (PHE).  Any R > 1 is runaway virus transmission.  It's just running away very slowly for now...   I agree that there are lessons to be learnt from abroad; perhaps less so now we're in relatively uncharted territory compared to them.  

> Personally (my son is 4 and starts school hopefully in September), I would be prepared to live a more isolated lifestyle myself in the short to medium term if it means he can go to school properly, if all parents take this view then the school would exist in more of a "bubble", so any outbreak would remain localised. 

We also have our first school starter in September.  I'm under no illusions about the ability of many of the other parents to "bubble" - some are healthcare workers, some have (need) jobs they can't do from home - short of creating separate "high risk" and "low risk" schools (which seems like an awful idea for all sorts of reasons) I just have to accept that.  Some of them just don't give a crap and have been visiting and hosting visitors throughout lockdown.  I find this very hard to deal with, but have no control over it.

We have been isolating our household above and beyond the guidance from before lockdown and are continuing to do so.  We're staging the timing of outdoors grandparent visits and my occasional trips in to the lab to give us the best chance of spotting and breaking a chain of infection in either direction. But I think this will become almost a futile gesture once school starts.  That's one of the leading reasons why I'd hoped the summer would be used to hammer down infections rather than to keep the level roughly constant whilst opening more and more - we have the social and a physiological effects of cold weather coming and school starting; a double or triple whammy of rising R.  It's a fine needle to thread to follow our current path without ending up with another lockdown.

Post edited at 14:26
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 jkarran 04 Aug 2020
In reply to DancingOnRock:

> Let’s see what the 90min test scales up to and how quickly the T-cell test gets sorted. 

> If we can see that a large proportion of people are not susceptible to the disease it could affect who we shield and how much it costs to shield them. 

Large fractions of small groups seem to become infected when exposed (example the recent meat packing outbreak in Germany), there's no real reason to suspect that doesn't scale to bigger groups, that there is a large cohort with significant innate immunity.

Testing and isolating only keeps a large organisation like a school meaningfully open where it is very effectively subdivided into small units (highly disruptive and probably impractical given the inevitable external cross connection of 'bubbles') or where the incidence of the virus at large is very low so outbreaks and their associated temporary closures are infrequent enough that a full syllabus can be delivered around them.

At some point, probably quite soon (with Christmas and flu season looming never mind the September school year start) we need to face up to our responsibility to really drive down the incidence in the UK, nothing else short of widespread vaccination delivers the space for us to function properly as a society and economy.

jk

 Neil Williams 04 Aug 2020
In reply to jkarran:

> At some point, probably quite soon (with Christmas and flu season looming never mind the September school year start) we need to face up to our responsibility to really drive down the incidence in the UK, nothing else short of widespread vaccination delivers the space for us to function properly as a society and economy.

And to be honest I reckon that could be done without adding any new restrictions if only people would comply to them fully (letter and spirit) rather than just paying lip-service to them.  For instance, why when I ring or go online to book a table at a pub aren't I directly asked how many households, and the table laid out accordingly, e.g. if it's two a larger table (or two nearby tables) is needed to allow 2m to be left between the two households.

 DancingOnRock 04 Aug 2020
In reply to jkarran:

They find they’re infected because we are testing. We don’t get any information on whether those people are having adverse reactions or not. 
 

In my wife’s office 1 person showed symptoms, three others were infected. The families of those infected were not tested, just told to isolate because the expectation was they were all infected. Of the 16 individuals concerned, one showed mild symptoms. If that scales up in the same way, it changes the whole outlook. My wife was not tested, I don’t know if she or I or my children have been. 

Post edited at 14:48
 DancingOnRock 04 Aug 2020
In reply to jkarran:

Essentially what I’m saying is if they identify the proportion of people who are likely to have T-cell immunity and hence very little impact and that could well be 40-50% of the population, that’s not herd immunity but it does tell us a bit more. 

Roadrunner6 04 Aug 2020
In reply to tom_in_edinburgh:

"I have a bad feeling that the policy of reopening schools is based on desire to get parents back to work rather than any scientific reason to believe that it is safe."

Massively.

Again it's the inequity in society. The more educated/better off can work from home, manual workers need to be in. Their kids need to be in.

In the US there is a big rich poor gap in who this pandemic is killing for a variety of reasons.

 Toerag 04 Aug 2020
In reply to DancingOnRock:

>  If we can see that a large proportion of people are not susceptible to the disease it could affect who we shield and how much it costs to shield them. 

The thing is it becomes pretty much impossible to shield people when there's a high level of prevalence in the community. This has become apparent in Florida where people were thinking things were OK because the virus was being spread amongst the younger community then blam! it got into the care homes again.  There's also the issue that there are so many people who would have to shield the economy would take a hit (20% of the population are elderly, 40% are obese, xx% have other co-morbidities), and the other emerging issue that hospitalised people are highly likely to develop brain issues after recovery.

 Toerag 04 Aug 2020
In reply to wintertree:

> That's one of the leading reasons why I'd hoped the summer would be used to hammer down infections rather than to keep the level roughly constant whilst opening more and more - we have the social and a physiological effects of cold weather coming and school starting; a double or triple whammy of rising R.  It's a fine needle to thread to follow our current path without ending up with another lockdown.

^^this. If the country can't get the infection levels down with helpful factors like school hols & warm sunny weather getting people outside it is going to be stuffed when autumn kicks in....which normally starts about the end of this week when the tail ends of hurricanes start arriving and causing wet & windy weather.  There's a whole world of pain coming for England, France, and perhaps Germany at least. I can foresee Ireland, Northern Ireland and Scotland implementing border controls unless England gets its act in order very soon.

2
 jkarran 04 Aug 2020
In reply to DancingOnRock:

> They find they’re infected because we are testing. We don’t get any information on whether those people are having adverse reactions or not.

If they're infected and well they kill granny more surely than if they're infected and feeling poorly, not going out. If you're infected you're infectious, that much is pretty clear whether you're feeling well or not.

> In my wife’s office 1 person showed symptoms, three others were infected. The families of those infected were not tested, just told to isolate because the expectation was they were all infected. Of the 16 individuals concerned, one showed mild symptoms. If that scales up in the same way, it changes the whole outlook. My wife was not tested, I don’t know if she or I or my children have been. 

We know what happens when it's rife: we start dying in the thousands daily while the NHS teeters on the brink of collapse unable to meet demand for normal services, people stop spending and many will pull their kids out of school whether they're told to or not. That's before flu compounds the pressure and the lethality.

What changes things is being able to keep the more vulnerable (large minority) safe from a less vulnerable majority riddled with disease but we haven't figured that out. The 'oldies stay home, the rest of the herd as you were...' order No.10 kited this week won't fly politically or technically. Realistically to live with it rife will require a widely distributed vaccine and the consequence of the mistakes made over who's actually vulnerable will probably still be measured in the tens of thousands of lives once a large fraction of the population is exposed. Doing so, allowing it to rip through the lower risk members of our society also closes our economy off from neighbours not operating the same policy and likely in that scenario the fear of infection, as deaths soar again crashes the domestic economy anyway so it's not really clear what the upside would be vs near elimination and effective outbreak control.

jk

Post edited at 16:09
 DancingOnRock 04 Aug 2020
In reply to Toerag:

It does if we continue to act conventionally. 
 

If we have to do a second lockdown we need to start acting unconventionally and come up with some pretty clever solutions. Solutions that people may not like the sound of. During the war we sent the children out of the cities to escape the bombing. 
 

I’m not suggesting exactly that, but if we identified exactly who was more at risk, instead of blanket Isolating everyone over 70, or people with diabetes we could be more surgical with the isolations. I know plenty of 80 year olds who can outrun 40 year olds. There’s no reason that their immune system wouldn’t be different. 

4
 DancingOnRock 04 Aug 2020
In reply to jkarran:

>What changes things is being able to keep the more vulnerable (large minority) safe from a less vulnerable majority riddled with disease but we haven't figured that out.

 

Quite. We haven’t figured it out yet. 
 

It was circulating in London for weeks and yet, to my mind, large numbers of people remained apparently un-infected. 


We are missing a big chunk of the puzzle here and hopefully testing everyone and isolating the people who are definitely at risk of a poor outcome, rather than those that meet the very general criteria would be much easier. 

1
 jkarran 04 Aug 2020
In reply to DancingOnRock:

> I’m not suggesting exactly that, but if we identified exactly who was more at risk, instead of blanket Isolating everyone over 70, or people with diabetes we could be more surgical with the isolations. I know plenty of 80 year olds who can outrun 40 year olds. There’s no reason that their immune system wouldn’t be different. 

'Surgical lockdown' to protect the vulnerable doesn't protect the economy, it isolates it as we become a pariah to our neighbours, domestically it smothers normal economic activity as we retreat in fear either to protect ourselves or our loved ones. It probably also doesn't protect the vulnerable since they don't and in many cases can't live in isolation.

jk

1
 DancingOnRock 04 Aug 2020
In reply to jkarran:

Only if you continue to think in terms of the way we currently do things. 
 

Currently everyone is in fear. Currently we need to get the economy moving. Currently we need to protect everyone. Currently we are waiting 24+ for a test. And then waiting 14 days for everyone in our household to not show symptoms. 

If we have whole families who are risk because of immunity or genetic issues then we need to take additional care around them and they need to take additional care during a localised outbreak. 
 

If we have a 90 minute test that reduces the 14 days. It reduces it further if we know people in the household have the ability to fight Covid using T-cell immunity. It identifies outbreaks sooner. 
 

Post edited at 17:15
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 girlymonkey 04 Aug 2020
In reply to Offwidth:

I feel discussions on Covid and who is vulnerable often just focusses on who is most likely to die (which is of course a relevant thing to consider). What it often ignores is the long term effects on those who don't die. I have a friend aged 38 with 3 kids aged 2 to 10. Her, the 2 year old and 10 year old all became symptomatic. I presume the middle one must have had it but been asymptomatic. They got infected in March 1st. She is still too ill to work with many post viral symptoms and the two kids also have had lots of post viral symptoms although I think they might be largely over it now. She should be a productive member of society starting to help get the economy back on its feet but she instead can only just get up and stay alive through the day. She had no known underlying health conditions or any other risk factors.

This is a complicated disease and not as simple who lives or dies

 mik82 04 Aug 2020
In reply to DancingOnRock:

The 90 minute test sounds interesting, but I can't find any details on how sensitive it is. If it's similar to the existing PCR tests at about 70-80% sensitive then it's only really useful as a rule-out test if there's a low pre-test probability of them having covid.  Currently you could be reasonably happy that someone with a cough who swabbed negative, outside of a hotspot or cluster, probably doesn't have covid. If we do start having more widespread transmission again then negative swabs are falsely reassuring.

Given social distancing is likely to continue in the medium term, I'm hoping that all the other respiratory viruses are going to be less common over winter too, otherwise it's going to be a nightmare to deal with.

 DancingOnRock 04 Aug 2020
In reply to girlymonkey:

>She had no known underlying health conditions or any other risk factors.

 

And that’s the point of mass testing for T-cells and seeing what effect they have on outcomes.
 

If, for example, we test millions of people who we don’t know whether they’ve had CV or not and make a record of whether their T-cells might offer some immunity and then monitor people with regular testing. At some point, when (or if) those tested become ill or not we can see how ill they become. 
 

It’s only complicated because we haven’t studied enough people and don’t fully understand the specifics. It seems to affect the obese - but don’t know why etc. 

1
 DancingOnRock 04 Aug 2020
In reply to mik82:

It’s very useful if someone tests positive to see what symptoms the rest of the household come down with and at what stage they test positive and for how long. Coupled with blood monitoring to see what’s happening to them. 
 

The 90minute test can be done by yourself and developed at home. No need to leave the house or send anything to a lab. 
 

If it can be done cheaply enough maybe we’d do them weekly or only when a local outbreak has been spotted. 

Post edited at 21:24
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 mik82 04 Aug 2020
In reply to DancingOnRock:

As far as I'm aware, this is the 90 minute test

https://nanoporetech.com/covid-19/lampore

It isn't something you can do at home

 wintertree 04 Aug 2020
In reply to mik82:

> It isn't something you can do at home

Quite. As it apparently still relies on amplification the sample handling is going to need the same high level of protocols and training that the current test does to avoid contamination and false positives.

As clever as these direct DNA readers are (it still astounds me how simple the concept is and how well it works), to do a test with them still relies on RNA>DNA translation for this virus and DNA amplification for weak samples.  So it’s not clear to me that it’ll have any better a false negative rate than the current qPCR tests as the limiting factor for both is the sample input into the conversion and amplification process, not the downstream detection technology.

Further, all these claims of 90 minutes vs 24 hours for the qPCR test seem a bit dubious to my limited understanding; a qPCR assay takes a few hours.  The covid test takes longer because samples have to be collected, labelled, moved, wait their turn in the lab/machine, processed, results inspected and communicated.

A magic new lab based assay could give instant results and our current system would still take perhaps 20 hours to turn tests around.  

It’s great that there’s this new system and that it’s going to be able to do covid infection tests.  I’m not convinced that it’s such a game changer re: turnaround times of accuracy.  The main benefits I see are it being potentially cheaper (so roll out to more labs) and not requiring the primers needed by qPCR (so again, more scalable).

Post edited at 21:41
 DancingOnRock 04 Aug 2020
In reply to mik82:

Ah. Sorry. I misunderstood the “Doesn’t need to be sent to a lab.” 
 

Isn’t developed at home. Can be done at home and processed in a mobile unit. 

 Toerag 05 Aug 2020
In reply to wintertree:

The PCR tester we have over here can get a result in an hour if necessary. It's used in that way in case there's a medevac to the UK and they need to know that the patient doesn't have the virus.

For those interested, we're now going to a '7 day self-isolation + test' regime for certain low risk countries (<20 in 100,000 prevalence I think) here.  Hotspots within a country will still be 14 day self-isolation (e.g. Leicester, Brittany). Local modelling reckoned they'll catch 80% of cases 7 days after infection, and a national study reckons 94%.  This is why testing travellers on arrival as Heathrow wants to do isn't sensible - anyone infected just before or during travel won't be picked up. Details on www.gov.gg .  Today's media briefing explains more but it's not been put on the site yet (it was on States of Guernsey FB).

Post edited at 14:37
 Neil Williams 05 Aug 2020
In reply to Toerag:

Importantly, there's a big difference between 14 days of isolation and 7 in terms of what you'd be willing to agree to for a holiday or similar.

OP Offwidth 08 Aug 2020
In reply to Toerag:

I'm increasingly suspicious of testing in England. if you look at the ratio of daily positives to deaths about 3 weeks later our number is (currently around 10)  upto 5 times lower than elsewhere. Either case mortality is exceedingly high in the UK ( very unlikely) or we are only picking up up to 1 in 5 of positives compared to countries elsewhere.

Post edited at 16:14
 Robert Durran 08 Aug 2020
In reply to tom_in_edinburgh:

> It might have been wiser to focus on buying equipment and creating online learning for secondary school and having almost all secondary school kids and any primary school kid with a parent at home learn from home and use the space freed up to spread the kids that need to be in school out more.

Except that online learning/teaching is shit and running a dual system would place a ridiculous workload on teachers.

But yes, I fear the effects of a return to school. As ever, it is a balance with the disastrous effects of keeping schools closed.

 wintertree 08 Aug 2020
In reply to Robert Durran:

> Except that online learning/teaching is shit

I had to convert a load of undergraduate group lab projects to run remotely not long after peak lockdown.  “Shit” wasn’t a word anyone used, and much fun was had by many along with serious learning.  I think undergraduate level is very different to school level for this; there is some teaching that is more amenable to being moved online than others for sure.  Shunting some teaching online in a uni context can go a long way to allowing other in person teaching to happen with more physical spacing.  I can’t see it being great at school level at all.  Still, it’s better than no contact at all so has a role as a fallback if things get really bad.

> and running a dual system would place a ridiculous workload on teachers.

Absolutely agree.  There’s a few universities out there who would benefit from your wisdom...

Post edited at 17:37
OP Offwidth 09 Aug 2020
In reply to wintertree:

Some approximate examples of the ratios of cases three weeks back to deaths now. Given typical 2% case mortality around 50 might be expected.  As infection in Europe is said to be mainly spreading in the young the ratios should be a bit higher. The UK must be missing most of the cases with our current testing.

UK  12
Italy 30
Belgium 60
US 70
France 100
Spain 240 (this is so high it shows the vast majority of infections must be in the young)

 wintertree 09 Aug 2020
In reply to Offwidth:

I meant to reply to your last message on this.

It does indeed look like we’re not detecting 90% or so of infections.  Really bad news as the nights draw in and the winter flu season approaches.

PHE are getting later and later releasing their weekly surveillance reports; this weeks is missing the most recent Pillar 1 count from figure 1; despite the process having sadly become routine it gives the impression they have growing organisational problems.

I don’t know how appropriate the 2-3 week lag is in a decaying phase of infectivity though; for example if a small fraction of patients take an exceptionally long time to die, this wouldn’t affect the analysis much in an exponential growth phase but would cause a long drawn out tail not due to under-detection.  This is where understanding exactly what the reported deaths are is critical (died of covid vs died with covid) and I’m not clear enough on that to really understand what’s going on now.  

 Neil Williams 09 Aug 2020
In reply to Offwidth:

I'm sure we are because we only offer tests to those with symptoms and it is believed a vast majority of people do not have symptoms.

There is the "surveillance testing" which attempts to extrapolate that figure, but overall if we want to pick up more cases we need to be testing those who are contact traced too, perhaps after 7 days of their 14 day isolation.

In reply to Neil Williams:

The isolation is a joke.  

'Don't go out for 14 days, not even to go shopping.  But we won't be checking up on you.'

Say that to someone with a busy life who feels fine and how many are actually going to do it.

1
 ClimberEd 10 Aug 2020
In reply to wintertree:

> Nor has anyone on this thread said otherwise.

> I am glad that you now apparently agree with the idea that other sectors are likely to require closures to enable schools to open whilst keeping the virus at least in-check.  What changed your mind from Saturday?  https://www.ukhillwalking.com/forums/the_pub/lock_down_trade_off-722890?v=1#x9...

Are you stalking me?!

Please don't presume to know my mind. I don't think it's a game of whack-a-mole, and I don't think 'other sectors need to close to enable schools to open'. I think schools need to stay open. Just that, as a stand alone statement. 

7
 wintertree 10 Aug 2020
In reply to ClimberEd:

> Are you stalking me?!

No, but when you start a thread asking why would closing pubs have anything to do with opening schools, then close out the thread saying you don’t see a connection and you ignore most of the comments - starting with the very first reply - that spell it out - that sticks in my mind.  

Then, a few days later you contradict that saying people should think about what they can omit to allow schools to close.  This suggested to me that you had changed your mind.  Given you felt strongly enough about this to start a thread, I was curious ok now why you had apparently changed your mind when multiple, clear attempts by several posters to spell it out on your thread had done so.

Then today you go back to 

>  and I don't think 'other sectors need to close to enable schools to open'. I think schools need to stay open. Just that, as a stand alone statement. 

I think you are wrong,  I think you were right when you said “School opening should be the absolute priority, and people should be thinking about what they are willing to give up to make sure this happens”.  

The “respiratory outbreaks” plot in the weekly PHE Surveillance Report makes it abundantly clear that schools closing for the summer has been balanced by other parts of the economy opening up.  Unless there are significant improvements to mass individual observance of sanitary rules / social distancing or unless test and trace gets a lot better, R is going up a lot when schools reopen (which I agree is the absolute priority).  As R is about 1 now, it will be more than 1 when schools reopen (which we can’t tolerate), and so other areas must close if we don’t make the aforementioned improvements.

Post edited at 08:15
2
 ClimberEd 10 Aug 2020
In reply to wintertree:

fair enough. Better not start any threads in future.

3
 DancingOnRock 10 Aug 2020
In reply to tom_in_edinburgh:

>But we won't be checking up on you.

 

Where is your reference for that. The government have repeatedly said they will be doing spot checks and issuing £1000 fines for transgressors. 
 

Remember in all of this, it’s a statistics game. It doesn’t require 100% compliance. It just requires that the majority of the people do what they’re asked. 
 

The disease doesn’t spread ‘easily’ and ‘quickly‘, and is not as deadly, compared to other diseases. If it was, you can bet that the lockdowns would be a lot harder and enforced a lot more rigidly. 

4
In reply to DancingOnRock:

I've not seen the government say they'd be checking up.  A tiny number of spot checks aren't going to stop people 'nipping out to the shops'.  From what I've heard people are walking straight through airports without being asked where they've been or where they are isolating for the next two weeks.

If they wanted to do this right they'd be putting people in hotels or recruiting enough people to do a lot of spot checks so there was a real chance of getting caught.

The English government has been incompetent and consistently under reacted.  Other countries have been far more rigorous in isolating people with Covid and as a result got it under control faster and with fewer casualties.

It's bullsh*t to say it doesn't spread quickly.  Remember a few months ago how fast we went from isolated cases to hundreds of deaths per day.

4
 Point of View 10 Aug 2020
In reply to tom_in_edinburgh:

It is arguable whether or not a more rigorous approach to enforcing compliance would have been beneficial. However, I note that there have been no significant differences in this regard between the UK and Scottish Governments.

 DancingOnRock 10 Aug 2020
In reply to tom_in_edinburgh:

I didn’t say it didn’t spread quickly. There’s a rate of spreads at uncontrolled. That’s nowhere as quick as measles etc. 
 

And several months ago people weren’t socially distancing, weren’t washing hands, wearing masks etc. 

1
 summo 10 Aug 2020
In reply to tom_in_edinburgh:

> It's bullsh*t to say it doesn't spread quickly.  Remember a few months ago how fast we went from isolated cases to hundreds of deaths per day.

Because of the people returning from football games, Cheltenham and skiing the UK didn't have a single focal point, it had hundreds if not thousands, which then grew. So it didn't spread so fast in some respects, as the spread was happening before these people even went home. 

 DancingOnRock 10 Aug 2020
In reply to Point of View:

There will always be people who don’t have full access to the data and will listen to the media and whatever scientific advice suits their political agenda or attitude to risk. 
 

I was watching an interview with a German epidemiologist who is questioning our understanding of how it is spread and how high the IFR is. It could be as low as 0.2%. Which still means 100,000s of deaths if run unchecked but with a better understanding of how it’s transmitted and how people’s immune systems act could tailor the way we are currently going at it with a shotgun approach rather than as snipers. 

Post edited at 11:46
1
In reply to DancingOnRock:

> And several months ago people weren’t socially distancing, weren’t washing hands, wearing masks etc. 

They started out with 'wash your hands and cover your face when you sneeze' and it didn't stop it.

The number of cases is rising, R > 1 they should be figuring out how to get it falling again.  Opening more stuff - especially major changes like opening schools - should be off the table until R < 1 again.  Maybe they need to shut pubs and restaurants to balance out opening schools.

3
 summo 10 Aug 2020
In reply to tom_in_edinburgh:

>  Opening more stuff - especially major changes like opening schools - should be off the table until R < 1 again.  Maybe they need to shut pubs and restaurants to balance out opening schools.

Or just have them all open, with a bit more focus social distancing and good hand hygiene, something which doesn't seem to be happening so much in and around pubs. If folk can go for a pint, it's madness that their kids aren't going to school. 

1
 Neil Williams 10 Aug 2020
In reply to tom_in_edinburgh:

> The number of cases is rising, R > 1 they should be figuring out how to get it falling again.  Opening more stuff - especially major changes like opening schools - should be off the table until R < 1 again.  Maybe they need to shut pubs and restaurants to balance out opening schools.

That certainly appears to be on the table as an option.

 DancingOnRock 10 Aug 2020
In reply to tom_in_edinburgh:

>They started out with 'wash your hands and cover your face when you sneeze' and it didn't stop it.

 

It wouldn’t necessarily as it was already pretty widespread within the community and they didn’t know that because, for whatever reason you chose to believe, we didn’t have high capacity high quality testing. 

 DancingOnRock 10 Aug 2020
In reply to tom_in_edinburgh:

>The number of cases is rising, R > 1

 

...in some areas. 

3
 DancingOnRock 10 Aug 2020
In reply to summo:

Indeed. And latest evidence shows the children don’t seem to be the super spreaders that they were assumed to be.
 

So maybe we need to be trying to find out why some people are spreading it more than others. What exactly are people doing in pubs that’s spreading it? 
 

On Saturday I saw a man meet 6 people and shake them all by the hand. 

 Billhook 10 Aug 2020
In reply to Offwidth:

You can't trust the experts.  Non have ever had to deal with anything like this before.

And I noticed there was another study linked in either The Times or Telegraph this weekend that showed that childrend pose little risk in children passing the virus on.

5
 wintertree 10 Aug 2020
In reply to DancingOnRock:

> Indeed. And latest evidence shows the children don’t seem to be the super spreaders that they were assumed to be.

Was anyone assuming that children were “super spreaders”?  I haven’t seen that.

Question: What evidence are you referring to?  

Today a minister has said a report is coming out showing there’s little evidence of transmission within schools.  Schools have been mostly shut (lockdown with reduced attendance and then only partially reopen at lower density, summer holiday period) so there’s not much data to examine in which one might find such evidence or refute such theories.

Opening schools isn’t just about school based transmission but the wider effects of releasing millions of parents from childcare duty.  Schools must reopen; the gamut of potential consequences of this must be prepared for.

Post edited at 13:10
1
 groovejunkie 10 Aug 2020
In reply to wintertree:

> > Indeed. And latest evidence shows the children don’t seem to be the super spreaders that they were assumed to be.

Although there also seems to be reports suggesting the age of the kids is crucial too. New York times reported a while back Korean study saying that there's a difference between the under and over ten year olds....total minefield!! 

/https://www.nytimes.com/2020/07/18/health/coronavirus-children-schools.html...

 DancingOnRock 10 Aug 2020
In reply to groovejunkie:

Children or teenagers? Guess it depends on your viewpoint. Legally they’re the same. For the purposes of anyone’s scientific or political point of view that may be different. 

 DancingOnRock 10 Aug 2020
In reply to wintertree:

>Was anyone assuming that children were “super spreaders”?  I haven’t seen that.

 

It was a concern that children spread germs and diseases in lots of other cases. Which is why they ‘erred on the side of caution’ and shut the schools.

 elsewhere 10 Aug 2020
In reply to Billhook:

> You can't trust the experts.  Non have ever had to deal with anything like this before.

It's an infectious disease so there is lots of experience, science and expertise. The transmission mechanisms are not new to science. Even the public health messages such as quarantine, distancing, hygiene and masks are not new.

 wintertree 10 Aug 2020
In reply to DancingOnRock:

> It was a concern that children spread germs and diseases in lots of other cases. Which is why they ‘erred on the side of caution’ and shut the schools.

My understanding is that we had done so little, so late, that by March 23rd, we were probably less than a week away from “locking in” enough infections to overwhelm large parts of the NHS and that schools were closing in droves before lockdown because teachers were calling in sick, and that everything was shut well past the point of caution, because it was perilously unsafe for any adults to meet when they didn’t need to, including parents and teachers, not just because of the risk of transmission by children.  
 

1
 wintertree 10 Aug 2020
In reply to elsewhere:

> It's an infectious disease so there is lots of experience, science and expertise. The transmission mechanisms are not new to science. Even the public health messages such as quarantine, distancing, hygiene and masks are not new.

One could almost imagine that there are whole fields of experts who have studied dozens to hundreds of such events from the past, and that they have noticed that certain actions universally lead to better outcomes going right back to the black death.

Then perhaps one or two of them discovered modelling and it all went a bit titsup as they got carried away by the cleverness of their under-constrained models without genuine predictive power, and forgot all those hard won lessons...

Post edited at 14:11
1
 elsewhere 10 Aug 2020
In reply to wintertree:

> One could almost imagine that there are whole fields of experts who have studied dozens to hundreds of such events from the past, and that they have noticed that certain actions universally lead to better outcomes going right back to the black death.

A historian would have a good chance of getting the advice right, the basics really are that old.

Post edited at 14:43
 DancingOnRock 10 Aug 2020
In reply to wintertree:

All my teacher fiends were petrified of the children bringing it in and spreading it around. There were plenty of staff available. 

 jkarran 10 Aug 2020
In reply to summo:

> Because of the people returning from football games, Cheltenham and skiing the UK didn't have a single focal point, it had hundreds if not thousands, which then grew. So it didn't spread so fast in some respects, as the spread was happening before these people even went home. 

Britain still has covid cases almost everywhere as it did in March. If we relax so R climbs much above 1 it explodes again then it inevitably gets to the vulnerable because it's everywhere and people start dying in droves again.

jk

1
 summo 10 Aug 2020
In reply to jkarran:

> .....it inevitably gets to the vulnerable because it's everywhere and people start dying in droves again.

Solution....isolate the vulnerable. Most countries must have learnt that lesson by now?

 balmybaldwin 10 Aug 2020
In reply to DancingOnRock:

> Indeed. And latest evidence shows the children don’t seem to be the super spreaders that they were assumed to be.

> So maybe we need to be trying to find out why some people are spreading it more than others. What exactly are people doing in pubs that’s spreading it? 

> On Saturday I saw a man meet 6 people and shake them all by the hand. 


What latest evidence?  If you mean Gavin Williamson's study, which was conducted in July in UK schools only (you know... the ones that are like ghost towns with a few essential worker kids in tiny groups) I don't think that counts as evidence opening schools at fully capacity isn't dangerous?

https://www.forbes.com/sites/williamhaseltine/2020/07/31/new-evidence-sugge...

 wintertree 10 Aug 2020
In reply to groovejunkie:

> Although there also seems to be reports suggesting the age of the kids is crucial too. New York times reported a while back Korean study saying that there's a difference between the under and over ten year olds....total minefield!! 

Sorry I didn't see your post earlier.  Yes, this is kind of important and  "the kids" range from age 4 to age 18 in the UK.  Totally different levels of susceptibility, infectivity, ability to understand and follow behavioural changes across that spectrum.  I get the distinct feeling the governments in the UK and USA are being very selective with science and evidence here.  I think there needs to be very close, coordinated public health monitoring around the schools as they reopen and very responsive policy and risk control measures to make sure we can keep the schools open.

 wintertree 10 Aug 2020
In reply to balmybaldwin:

> if you mean Gavin Williamson's study, which was conducted in July in UK schools only (you know... the ones that are like ghost towns with a few essential worker kids in tiny groups) 

I'm getting the hang of this...

  • "No evidence" of Covid spread in schools (when schools were almost empty.)
  •  No evidence of Russian meddling in the election (because we didn't look)

Related rant:  Traffic surveys mandated as part of planning permission for large scale developments, that are then carried out in school summer holidays...

 Billhook 10 Aug 2020
In reply to elsewhere:

> It's an infectious disease so there is lots of experience, science and expertise. The transmission mechanisms are not new to science. Even the public health messages such as quarantine, distancing, hygiene and masks are not new.

Really?  I'm 70.  I can't remember ever having been told by the government or the NHS to quarantine, self Isolate, maintain social distancing or wear face masks.

3
 Oceanrower 10 Aug 2020
In reply to tom_in_edinburgh:

> The English government has been incompetent and consistently under reacted. 

Whilst it's obvious that you are a complete xenophobe, surely even you know there's no such thing as an English government...

3
 elsewhere 10 Aug 2020
In reply to Billhook:

> Really?  I'm 70.  I can't remember ever having been told by the government or the NHS to quarantine, self Isolate, maintain social distancing or wear face masks.

That may be so but it is not new to experts or historians who learnt from other infectious diseases.

 colinakmc 10 Aug 2020
In reply to Oceanrower:

In this context, aye, there is

OP Offwidth 10 Aug 2020
In reply to wintertree:

I was beginning to think I was going mad as no one commented here and most were sceptical on the other channel. It looks very significant to me. I think the sensitivity to deaths from 3 to 6 weeks is likely low as test numbers don't seem to be on a steep curve in that period for anywhere. I think the UK has a problem and the sooner testing is devolved to local areas the better. Germany, Netherlands, Canada, Sweden and Korea  all up around or over 100 as well.

 Billhook 10 Aug 2020
In reply to elsewhere:

> That may be so but it is not new to experts or historians who learnt from other infectious diseases.

One of the 'experts'  (Neil Ferguson) we currently have was also an 'expert' the government recruited to advise on dealing with  the 2001 Foot & Mouth outbreak.  He He gave the advice which led to  the destruction of 6,000,000 death of cattle, sheep & other cloven hoofed animals.  This cost farmers £355,000,000 and and over £3 billion to the private sector.  Many, many dairy farmers were put out of business for ever.
And foot and mouth has not been 'cured'.  Doesn't sound like expertise to me.
(Oh, and he, and no doubt any of the other experts had ever dealt with Foot and Mouth before either.)

 

3
 wintertree 10 Aug 2020
In reply to Offwidth:

>  I think the UK has a problem and the sooner testing is devolved to local areas the better.

I got the impression from several news stories - and confirmed in one instance by a poster here (Mick Ward re: Wigan I think), that there is test/trace running locally out of what ever remains of local public health teams in parallel to the national system, which is also in parallel to the paper based phone number lists maintained by restaurants etc.  

One other way of looking at it is to look at the estimate of the number of people currently infected from the ongoing ONS pilot infectivity survey.

  • This is based on random population testing, and is independent of the PHE/NHS work.  
  • Their most recent estimate of infection rate based on this is During the most recent week (27 July to 2 August 2020), we estimate there were around 0.68 (95% credible interval: 0.38 to 1.17) new COVID-19 infections for every 10,000 people in the community population in England, equating to around 3,700 new cases per day.. [1].  
  • The 95% CI is - by my maths - (2100 to 6400) [cases /day] 
  • Taking the 7-day moving average in detected cases through Pillar 1 / Pillar 2 from Worldometer for the middle of that period gives ~750 cases detected per day.   So the hospital admissions and test/trace are catching an estimated 20% of cases with a 95% credible interval of between 11% and 28% of cases.
  • The lower bound of the CI tallies with your observation on fatality rates inferred from the NHS/PHE data
  • Even the higher bound of the CI is way to low to make a difference, for example SAGE estimate test and trace needs to be running at 80%. 
  • So, test and trace is currently failing to make a significant difference.
  • In the last week or so there's been a gradual rise in the number of detected cases; let's hope that that's test and trace improving - the ONS survey has weak support for the actual number of cases remaining level.  Still, it's not improving anywhere near fast enough.
  • Why isn't this the focus of investigative journalism?  What coverage there is, is about the dodgy nature of various contracts and not the likely possibility that its not working well enough.

[1] https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/con...

Post edited at 21:08
 wintertree 10 Aug 2020
In reply to Billhook:

> One of the 'experts'  (Neil Ferguson) 

There is an issue with experts vs 'experts'.  I'm increasingly of the opinion that the politicisation and game playing in higher education (and presumably healthcare, but outside my expertise) has created systems where progression is based as much in hubris, self-publicization, political game playing and so on as in genuine expertise and merit, let alone an ability to realise one is carrying out numerical modelling in epidemiology way beyond ones apparent understanding of the generic science underpinning genuinely predictive numerical modelling.

It is to be fair a difficult situation where you have to decide which experts know what they're talking about and which don't.  In this instance it was quite clear to me early on that the supermajority of experts nationally and internationally were in disagreement with the government (and therefore SAGE as it now transpires).  This started to float about in public with some crystal clear open letters in the weeks before lockdown.

 elsewhere 10 Aug 2020
In reply to Billhook:

Experts aren't miracle workers - they don't promise a low cost cure. It might be high cost and it might not be a cure - see NZ for example - no cure but more back to normal than everywhere else and no community transmission for 100 days. Similarly for foot and mouth in UK - costly, no cure but back to normal.

Post edited at 21:28
1
OP Offwidth 10 Aug 2020
In reply to wintertree:

Cheers, I'll cut and paste to the other channel if you don't mind.

 wintertree 10 Aug 2020
In reply to Offwidth:

> Cheers, I'll cut and paste to the other channel if you don't mind.

Go for it.  I’ve been trying to think of counter examples compatible with this, where test and trace is working.  The best I can do is a lot of long chains of infection in young, healthy, largely asymptomatic people meaning T&T never finds a chain.  

In reply to Oceanrower:

> Whilst it's obvious that you are a complete xenophobe, surely even you know there's no such thing as an English government...

It sits in Westminster and it was voted in by England.   

The Tories got next to sweet f*ck all in Scotland and haven't had a majority of Scottish seats since about 1950.  They are a colonial government imposed on Scotland by England.

5
 profitofdoom 11 Aug 2020
In reply to tom_in_edinburgh:

> It sits in Westminster and it was voted in by England.... They are a colonial government imposed on Scotland by England.

GIVE

IT

A

REST

TOM

1
 DaveHK 11 Aug 2020
In reply to Billhook:

> One of the 'experts'  

Are you Michael Gove?

 Blunderbuss 11 Aug 2020
In reply to tom_in_edinburgh:

Looking forward to you blaming the 'English government' for any issues Scotland has with all kids returning to school this week....

1
 MG 11 Aug 2020
In reply to Blunderbuss:

I was waiting for the explanation of how the Aberdeen cluster is entirely the fault of the English.

1
 Robert Durran 11 Aug 2020
In reply to MG:

> I was waiting for the explanation of how the Aberdeen cluster is entirely the fault of the English.

I think you will find it can all be traced back to Prince Charles self isolating at Balmoral back in April. English colonial bastard that he is.

 Robert Durran 11 Aug 2020
In reply to tom_in_edinburgh:

> It sits in Westminster and it was voted in by England.   

No, it is a UK government voted in by the UK and it sits in Westminster because it is in the capital of the UK.

I know you don't like the UK and want to see its end (and I have some sympathy with that), but denying it's existence just makes you look stupid.

1
 Toerag 11 Aug 2020
In reply to summo:

> Solution....isolate the vulnerable. Most countries must have learnt that lesson by now?


...except you can't practically do this in the UK. Vulnerable = obese, old, diseased. UK has 40%+ obese, 17%+ old, and unknown diseased in its population.  You can't realistically isolate what is probably 2/3rds of the population for what is likely to be months because the economy would collapse. Those 2/3rds of the population also have too many contacts to isolate effectively. If you were to truly let the virus rip you'd also still hospitalise so many 'normal' people you'd crash the NHS - the capacity of the NHS is such a tiny percentage of the infectable population that would need it. You also need to keep the virus out of hospitals to enable treatment for the 60%+ vulnerable population, and keep it out of care homes when all the staff go home to their infected families each night....

 wintertree 11 Aug 2020
In reply to summo:

In addition to what Toerag just posted, it's still not really clear what makes some healthy people vulnerable to the "cytokine storm" component of the pathology.  This is killing far fewer healthy, young people than it did with the Spanish flu, but it's still killing.

 elsewhere 11 Aug 2020
In reply to wintertree:

> In addition to what Toerag just posted, it's still not really clear what makes some healthy people vulnerable to the "cytokine storm" component of the pathology.  This is killing far fewer healthy, young people than it did with the Spanish flu, but it's still killing.

And ruining the health of many more (10-15 % ???) than it kills (0.5% ???).

https://www.sciencemag.org/news/2020/07/brain-fog-heart-damage-covid-19-s-l...

 DancingOnRock 11 Aug 2020
In reply to elsewhere:

Although there is evidence to suggest that the IFR is closer to 0.1% and that only 1/3 of seriously ill patients develop antibodies that are still detectable 6-7 weeks after infection.

We really need to get on with these T-cell tests.  

 wintertree 11 Aug 2020
In reply to DancingOnRock:

> Although there is evidence to suggest that the IFR is closer to 0.1%

The number of excess deaths in the UK attributable to COIVD casts serious doubt on that, as we have already lost about 0.1% of the population and there's no credible evidence that we've all had it, and as e.g. the Aberdeen pub crawls shows, it doesn't take much to start sewing many new cases.  Therefore I suggest that said "evidence" is rater questionable.  We've been here before on the forum in early April with what in effect were suggestions that the IFR and fraction of symptomatic carriers were much lower than was commonly claimed.   At the time I was quite clear that in my view the evidence was of very poor quality, the thinking wishful and the potential consequences of acting accordingly were reckless.  I've annotated today's Worldometer plot below to put that into context...  As it stands I've not changed my mind.

> and that only 1/3 of seriously ill patients develop antibodies that are still detectable 6-7 weeks after infection.

The seroprevalence for London (peaked around 16%) doesn't agree with this unless 50% of London have been seriously ill from Covid which seems astoundingly unlikely.  I agree however that seroprevalence appears to fade with time.  

However, there is data available to address this claim over the IFR - the UK seroprevalence is broken down by region.  This is useful information as the London region has between 2x and 4x the peak seroprevalance of other regions, so whatever fraction of Londoners have had it, between one half and one quarter the number of people have in other regions assuming the conversion rate of infection > seroprevalence is universal across England.  This gives us an absolute maximum bound of between 50% and 25% of people having had it in the other regions (by assuming everyone in London has).   The relevant weighted average suggests that the IFR can't be smaller than around 0.2%, and that become a lower bound - it's likely to be higher as there's no credible evidence close to 100% of Londoners have had it...

This sort of basic maths multiplying and adding a few numbers to find a bound is very powerful.  It's back of the fag packet stuff, although Physicists sometimes call it "Fermi Maths" to make it sound cleverer.  Theoretical epidemiologists appear to have a blind spot to it, however.  

> We really need to get on with these T-cell tests.  

As I understand it, these won't tell us how many people have had this virus (SARS-CoV-2) as the T-cell immunity is keyed against a protein fragment shared by SARS-CoV-1 (2003), SARS-CoV-2 (now) and some as-yet unidentified virus/viruses in past or present circulation.  So, there is some cross-immunity  for some people against this new virus.  The test tells us about immunity and cross immunity status, not past infection to a specific virus. 

I for one am hoping my annual winter exposure to respiratory diseases from all over the country+world and subsequent miserable colds/flus over the last 10 years has included this mystery virus. 

 

Post edited at 16:05

 Blunderbuss 11 Aug 2020
In reply to DancingOnRock:

> Although there is evidence to suggest that the IFR is closer to 0.1% and that only 1/3 of seriously ill patients develop antibodies that are still detectable 6-7 weeks after infection.

What evidence?

1
 summo 11 Aug 2020
In reply to Toerag:

If UK general health is the back ground problem, opening pubs and restaurants isn't the solution!! 

 DancingOnRock 11 Aug 2020
In reply to wintertree:

Has the Gangelt super spreading event study now been disproved? Sweeden seem to be showing similar figures. 

 wintertree 11 Aug 2020
In reply to DancingOnRock:

The German study didn’t support an IFR of 0.1%; more like 4x that.

Sweeden can report all the numbers they want, but I’ll eat my hat if the IFR in the UK turns out to be less than 0.2% for the detailed, evidence based reasons I set out in my previous message.  As we’re almost certainly not living in the worst possible timeline (ie we aren’t anywhere near 100% infected in London) it’s presumably a fair bit higher still for the UK.  It’s possible that we biased this with the mass unloading of untested, sometimes infected care home residents from hospitals back into their care homes...

An IFR of 0.1% is a pretty indefensible claim.

Post edited at 20:49
1
 mik82 11 Aug 2020
In reply to DancingOnRock:

ONS Covid deaths England and Wales: 51,710

Population of England and Wales: 59,439,840

So 0.086% of the entire population has already died from Covid-19. For the IFR to be close to 0.1% then the majority of the population has already had it, we've reached herd immunity and we should not be seeing sustained onward transmission.

I would also hate to burst the bubble regarding t-cell immunity and antibodies but anecdotally all of the people I know who had even mild symptoms are still antibody positive 4 months later.

 DancingOnRock 12 Aug 2020
In reply to wintertree:

I didn’t say it was close to 0.1%. I said it was closer to 0.1% than the figure ‘elsewhere’ gave. I’m basing my wording on figures commonly banded around of 1%. The Germans and Swedes are saying around 0.3%.
 

If it’s 0.3% and there is something going on with T-cell immunity that’s is making it difficult for large numbers of people to catch it in the first place. Then we could be looking at maybe 100,000 deaths in total. 

Post edited at 10:58
 DancingOnRock 12 Aug 2020
In reply to mik82:

>anecdotally all of the people I know who had even mild symptoms

 

What about all those who have technically been exposed but not had symptoms. The German study was showing people living in the same houses who were unaffected. 

OP Offwidth 12 Aug 2020
In reply to DancingOnRock:

Because a few hundred people died of unrelated causes after testing positive for C19, England can now kick thousands of covid deaths into the long grass. If you survive with severe symptoms in intensive care longer than 4 weeks from the positive result it's no longer a C19 death (and never was in the other countries in the union)!?

https://www.bbc.co.uk/news/health-53722711

Post edited at 19:40
2
 summo 12 Aug 2020
In reply to Offwidth:

> Because a few hundred people died of unrelated causes after testing positive for C19, England can now kick thousands of covid deaths into the long grass. If you survive with severe symptoms in intensive care longer than 4 weeks from the positive result it's no longer a C19 death (and never was in the other countries in the . . 

Sounds different to what's report here. 

https://www.bbc.co.uk/programmes/p02nrss1/episodes/downloads

Scotland you have to die within 28 days of a positive covid test for it register as a covid death. 

England you can have a positive covid test in March, get hit by a bus in July and it will still be classed as covid. 

They say the error margin induced is only around 10% and the trends aren't altered. 

OP Offwidth 14 Aug 2020
In reply to summo:

That's what they say but official UK daily deaths have just dropped from a rolling 7 day average of about 50 a day to 12. So it seems most covid hospital deaths were long term intensive care cases over the 28 day point. That Scotland Wales and NI were using the 28 day measure is no excuse. The majority of these lost deaths were seriously ill people with covid. It's fiddling the stats.

 DancingOnRock 14 Aug 2020
In reply to Offwidth:

The whole world is ‘fiddling’ the stats. 
 

The point of using 28 days is to determine whether the disease is reducing or increasing. It’s not ‘fiddling’ it’s using meaningful stats or collating stats that tell you the information you’re after. 
 

Ideally you’d compile other stats like excess deaths and use them to look at the long term problem. but really if the majority of people are dying 21 days after diagnosis that’s not going to be very interesting. 

OP Offwidth 14 Aug 2020
In reply to DancingOnRock:

It looks like fiddling to me and most of the western world doesn't have an arbitrary 28 day cut off and when a significant number of those seriously ill on a ventilator, who subsequently die, are still alive after that cutoff. Wintertree looked at the ONS data and demonstrated the UK is missing around 80% of the infections out there: that also seems dangerously unusual for a western economy.

Post edited at 12:13
1
 wintertree 14 Aug 2020
In reply to Offwidth:

>  Wintertree looked at the ONS data and demonstrated the UK is missing around 80% of the infections out there: that also seems dangerously unusual for a western economy.

I was going to revisit this today anyhow; a handy reminder.  It looks like recent fatalities were significantly leaning towards those who took > 28 days to die.  Even if they were all Covid related after 28 days, such data in the tail salts an analysis of infections detected ~ 3 weeks ago to deaths today; this spoiling effect only dominates in a decaying tail such as were we aren now.    It's only in a decay phase that the small fraction of people who take a very long time to die can outnumber the larger fraction who die faster.  

Using the revised data for this approach now suggests pillar 1 and pillar 2 are catching 30% to 50% of infections depending on ones take for the IFR; with the upper bound for my crude matching of the independent ONS survey figures to pillar 1 and 2 data being about 30%.  So I'm going to revise my estimate of what we're misusing down a bit from 80% to 60%-70%; still not great, but better.  The revised tail on the PHE data gives me more hope that the rising trend in the pillar 1 and 2 data is mainly down to test and trace gradually getting it together, which is a step in the right direction.. 

Aside: As I understand it, the PHE data never has linked COVID directly to the death other than through a positive test, it's a separate ONS dataset that looks at cause of death by death certificates, but this takes much longer to collate than the daily PHE updates.   It's also significantly larger in number than the PHE data either pre- or post- 28-day revision.

Post edited at 15:22
 wintertree 14 Aug 2020
In reply to summo:

> England you can have a positive covid test in March, get hit by a bus in July and it will still be classed as covid.

That's a bit disingenuous as a way of presenting it.  You could also now spend 29 days in ITU with the virus then die and be classed as a non-coved death in the PHE data, as I understand it.  

I don't have a problem with either way of classifying the data as long as it's clear and transparent.  It's long been recognised that any time window post- a positive test is not a very good measure as it is not based in cause of death.  However, it is one that can be put together and circulated daily, which is important for making responsive changes to policy, and both measures have their place as a quick test.   The data separately collated by cause-of-death from death certificates is (a) more accurate (b) larger than either PHE measure and (c) not fast enough to be as useful in immediate decision making.

The choice of cutoff time from a positive test does have big consequences for interpreting the data now we're apparently in a phase where deaths are dominated by people who caught the virus relatively far back in time. 

OP Offwidth 15 Aug 2020
In reply to wintertree:

I have a big problem with official  UK government figures on deaths from covid (the ones most viewed across the world) moving in a day from 46,000 to about 41,000. Especially in the context of ONS numbers being over 55,000 and the actual numbers that we will never know (as cause of death wasn't investigated properly) probably being closer to 60,000.

Post edited at 17:01

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