So how on earth do we work out how we ‘should’ have done it and who is ‘wrong’? That analysis is prob just an unreliable.
There will be another global pandemic in the next 50 years, learning lessons from this one is necessary to be more prepared in future.
Agreed. Hence the next para. But 'A public enquiry to hold those accountable who have made decisions not based on sound advice but based on other sources and advice from unqualified advisors.' won't prepare us for the next one, unfortunately.
Its been pointed out many times that the downside is that a mask that is not changed regularly (Ie every 30 min) can actually harbour germs you are trying to protect against..
I'm wearing a mask not for my benefit but for everyone else's benefit, in case I've got the virus.
Obviously this just applies to ordinary punters going shopping.
Its been pointed out many times that the downside is that a mask that is not changed regularly (Ie every 30 min) can actually harbour germs you are trying to protect against.
Yeah probably better to suck the virus into your lung then??
TiRed
That study, what does 'compassionate use' mean?
Yeah probably better to suck the virus into your lung then??
I have no idea, but I'm going to assume the people that have said that know far more about it that you or I. Either way certain posters have harked on about 'no downside'-, I was just pointing out there was one. Whether that outweighs the perceived benefits I don't know.
Certainly in there were proper effective masks available for all, I'd use one when leaving the house.
Do you only wear seatbelts which absolutely guarantee your life in the event of an accident?
Not at that dose. The hydroxychloroquine data is, however, sound and conducted in a controlled trial. I’d take that instead, personally based on available evidence.
Not being funny at all - have you a link TiRed ? I've not spotted a decent-sized trial
Its been pointed out many times that the downside is that a mask that is not changed regularly (Ie every 30 min) can actually harbour germs you are trying to protect against.
That's why Matt Hancock's absurd accusation that the NHS were misusing PPE / using too much PPE is even more annoying. Obviously it's a blame game, he's basically tryig to say "oh yeah, there's loads of PPE thanks to us in Government sorting it out but they're not using it right or they're using too much of it".
Things like gloves and disposable masks need changing regularly and disposed of correctly. Re-worn items like lab coats need hot washing regularly. Full masks need sterilised inside and out after they've been worn and then stored properly.
I don’t think simply throwing more money at the NHS is the best way forward, the stats for the section on obesity are an eye opener.
Like most things in the country, it's been looked at in isolation for decades. Same with things like road building, planning, infrastructure...
Looked at in isolation, the answer is always "throw more money at it". Looked at as part of a whole, the answer is to address social inequalities, lack of exercise, lifestyle choices, forward planning scenarios, education...
But that's kind of too complex so no-one has ever bothered. We're trapped in a spiral of short-termist thinking, easy soundbites, quick "wins" that look good on TV.
It's exactly the same as saying "Traffic is really shit, we'll build a bypass" (basically throw money at the problem without addressing any of the underlying casues of WHY the traffic is shit)
JonV - compassionate use really just means means "not on a proper trial but here's some anyway" usually because you don't fit the trial rules (kids, pregnancy, "wrong" disease or country where trials aren't running etc)
(That remdesivir report is a funny one - clearly from early on because the large majority of those pts wouldn't qualify for any current CUP that I'm aware of, unless the enrolling clinician was fairly generous with the term "requiring ventilation". There's a "moderate disease" open-label trial though, so not all "bad". Haven't seen the inclusion criteria for it though - might need to be huge to get proper stats)
And the avocado green bathroom suite!
Given that this virus is going to be with us for the foreseeable future talk of a public inquiry is somewhat premature. Looking at the data we already have a big percentage of those dying from this virus are either elderly (over 80) or have underlying health issues, first and foremost we need to establish a way of protecting the most vulnerable that still allows the country to function more or less normally, mass testing and tracking apps probably have a part to play in this possibly with targeted lockdown of infected hotspots. Long term we need to find a way of improving the nations general health and fitness instead of throwing money at the NHS (budget for 2019 was 134 billion pounds) there is no easy way out of this and it's going to be with us for a long time to come,we have to find a way of living with it in the long-term, the current lockdown isn't something that can be sustained for many more months before it's benefits are outweighed by the long-term damage that it inflicts on the vast majority of of the population
This privacy-friendly contract tracing protocol would seem to be a good part of the solution. I would install something like this for my family.
The Android/IOS API for it is being rolled out May for health services to write apps but the plan is that it’s going to be part of the OS so you won’t have to install an app but just give your acceptance of it.
Aren't masks for general use basically a very simple thing:
1. It won't offer much if any protection to the wearer.
2. It will reduce the projection of virus from someone who is infected.
Everything sane I've read about them suggests that it's the latter that makes them worthwhile, you're protecting other people from your exhalations and, in partcular, coughing that spreads the virus further in droplet form. If the US guidelines are right, they don't need to be clinical grade, a double layer of tee-shirt cotton will work. Or even an insert of folded kitchen paper.
I reckon a Buff with a double layer of cotton under it would do the trick, but as I haven't been outside in living memory, I've not actually tried it. Would happily use one though.
Pro tip: both Berghaus and Arc'teryx has produced hooded fleece jackets with a built-in balaclava-type feature that covers the face from the nose downwards.
A long-time road race organiser I worked with died today after contracting covid19.
https://twitter.com/AussieLarry/status/1248900654589976576
Well, I've just had my etickets from jet2 for our trip to krakow next weekend.
It will be great to get away from covid19 for a few days 👍
big percentage of those dying from this virus are either elderly (over 80) or have underlying health issues
Evidence please.
I'm going to have a minor moan about Johnson snr - Boris hasn't taken one for the team. People who's lives have imploded with the control measures - they've taken one for the team. Front line NHS staff and their families - they take one for the team. Key workers - they all do.
This sort of take one for the team nonsense if you catch the virus needs to be stopped before it gains momentum and we're all back to herd immunity. Even some of the main stream media starting to theorise about releasing the restorations for certain groups is a bit concerning. Although I'll only be very worried once the right leaning media start the serious postulating on this one. I don't think I'm to far form the mark in saying nothing good came from having an enforced two tier society.
https://metro.co.uk/2020/04/03/coronavirus-deaths-age-uk-12506448/
Also remember that in England, those numbers do not count those dying outside hospitals and where no test has been undertaken.
Fair enough on age. Here's another view of the data.
https://twitter.com/ActuaryByDay/status/1246866119597621248
Ignorant Dog walker rant alert..
Just out with my hound in field behind my house. Dog off leash runs up and starts leaping round mine, who is on lead. Lady walks up, absolutely no rush and starts calling dog who ignores her. Eventually she has to wander right up to me, well within 2 meters to grab her dog.
I tell her to keep Her dog on the lead if she can't keeping under control as we are meant to be keeping 2 meters apart...she tells me to calm down as it's a big field...I point out if it's such a big field why is she having to invade my personal space.
Social distancing is pretty hard when we are surrounded by selfish ignorant fools.
Compassionate use means that under the circumstances, there is nothing else that we can give you, so try this. Pharma often has compassionate use trials available for drugs that may not yet be approved but may offer benefit. My sister spent two years on our own compassionate use BRAF/MEK trial for Stage 4 melanoma, as the combination was not approved in the EU.
In this case the reasoning goes, these patients are critical, there is nothing we can give them, administering the antiviral is unlikely to do harm and may be beneficial. An absence of control makes the results challenging to interpret In other areas like oncology, early trials are also uncontrolled, but approval trials are against standard of care (not placebo). For ARDS, there is no standard of care.
Nobody reads the results of these trials in an unbiased way - that includes me btw. Randomised trials are coming.
You may like to read this https://en.wikipedia.org/wiki/Randomized_controlled_trial
Invented here by the MRC 🙂
[TL:DR] To properly understand whether a new medicine works, you must test it carefully against a comparator. It's also quite common to use experimental drugs in patients who have NO other options, even before they are approved.
Well, I’ve just had my etickets from jet2 for our trip to krakow next weekend.
It will be great to get away from covid19 for a few days 👍
People who’s lives have imploded with the control measures – they’ve taken one for the team.
And this x1000.
THE unsung heroes of this epidemic are those who will be materially out of pocket due to lost employment, who have bills to pay and food to buy and have seen their income disappear almost overnight. I am not one of those people, but expect and welcome taxation changes that means I can support them.
So Yoram Lass says "In the US about 40,000 people die in a regular flu season and so far 40-50 people have died of the coronavirus". Well now the number of deaths in the US is almost 19k with nearly half a million active cases.
Two interesting facts among those experts - the guy from Stanford is right, case fatality rate is most definitely less than 1% (as it was on the cruise ship of more elderly passengers), and the virologist who states that in those infected, SARS-COV-1 was more pathogenic as it targeted the deep lung alveoli, rather than the upper respiratory tract. That said, my deep lungs are hurting after two weeks and I still feel a bit breathless. Get it deep, like SARS-COV-1, and it will not be nice. It's not influenza, there is no background residual immunity.
So some basic assumptions:
A) If the Case Fatality Rate is 0.1% (1 in 1000 cases die) - probably reasonable lower bound.
B) If 60% catch it - it is very transmissible under normal contacts could be as high as 80%!
C) If 80% are asymptomatic (slight cough, easily confused with other bugs at this time of year)
Then...
Deaths = 60 million x 0.6 x (1-0.8) (cases) x 0.001 = 7200 deaths
We are well above that number, so which assumption is incorrect? Answer... We don't actually know because we don't have solid testing data for A), B) or C)
You are the Government, you have had planning in place for an influenza pandemic for about 20 years. Sirens are ringing in countries with similar if not better healthcare systems than the NHS. What would you do?
@flaperon,firmly tongue in cheek my friend as apposed to my father in law who is adament he is going to tenerife
In early May.
If it's a ~1% death rate (after medical treatment?) that would suggest just short of a million people in the UK have been infected at a minimum given that deaths are current just shy of 9,000?
You are the Government, you have had planning in place for an influenza pandemic for about 20 years. Sirens are ringing in countries with similar if not better healthcare systems than the NHS. What would you do?
With that fantastical gift of hindsight, do as NZ did.
Easy for me to say though. 😓
What would you do?
Massive top priority, manage B, since there's a chance that you can.
Start early. Test and trace but even if you can't, educate your population EARLY. For all the social isolation 2 metres stuff I bet it's pubs, massive crowds at big events and failure to manage public understanding of this shit that has put populations where thay are today
Also helps A in a couple of ways: Delay your national cases as long as you can, until consensus (even drugs) emerges as to how to treat, keep your services functional by avoiding overload. Use the luxury of others' experiences to maximise your response, hence outcomes
You can't affect C, other than point it out by mass education, which should be clear and consisitent and would help to control B
that would suggest just short of a million people in the UK have been infected at a minimum given that deaths are current just shy of 9,000?
Well over that if projections from Scotlands {ex} CMO were well founded. Her estimate of 140,000 in Scotland alone was two weeks ago and we can reasonably expect the number to have been doubling every 3 days. That would make it 2. 5 million in Scotland - around 50% of the population.
Even if it hasn't been doubling at quite that rate, it would appear that some parts of England are ahead in infection rates.
All these measures are leading to self-destruction and collective suicide based on nothing but a spook.
Please do not spread fake news.
https://rationalwiki.org/wiki/Globalresearch
https://en.wikipedia.org/wiki/Michel_Chossudovsky#Centre_for_Research_on_Globalization
I've already reported that post
I think history will show we could have probably bought another week or so by social distancing, that we just about managed the healthcare system, but that we were seriously found wanting with regards to testing capability.
Public Health England will not come out of this well. The private sector will, however. The facility to test at scale has been found wanting. We’ve just had a call for volunteers to staff the joint GSK/AZ Cambridge testing lab. When the call comes action happens. But if you don’t make the call...
Indeed. Lack of testing, when WHO and countries already effected made it clear it was an essential tool, was a mistake that was pointed out long ago. Also, preparing the NHS for this could have started earlier. Especially as regards PPE, as any extra kit bought and not used wouldn’t be wasted, it would just mean buying less later if not needed for the pandemic. Social distancing should have started earlier. Spanish football fans, bets in person at Cheltenham, one last Friday night down the pub, no stay at home rules for people flying back to the UK, all the result of poor decisions taken at the highest level.
I thought it would be far worse for 100,000 people to all go to the pub every night for a week, than to go to a football match for 2 hours. It takes 3 days to start shedding virus, so it’s the repeated social contacts that are far worse than 1 big one.
https://wavelengthmag.com/corona-public-shaming/
That's worth a read - some interesting ideas around distraction techniques to avoid Government getting any awkward questions. Focus on those people over there, the little bastards who are doing "other" things.
than to go to a football match for 2 hours
The Atalanta vs Valencia Champions League match is thought to have a significant cause of the outbreak in the Lombardy region.
Two interesting facts among those experts – the guy from Stanford is right, case fatality rate is most definitely less than 1% (as it was on the cruise ship of more elderly passengers), and the virologist who states that in those infected, SARS-COV-1 was more pathogenic as it targeted the deep lung alveoli, rather than the upper respiratory tract. That said, my deep lungs are hurting after two weeks and I still feel a bit breathless. Get it deep, like SARS-COV-1, and it will not be nice. It’s not influenza, there is no background residual immunity.
So some basic assumptions:
A) If the Case Fatality Rate is 0.1% (1 in 1000 cases die) – probably reasonable lower bound.
B) If 60% catch it – it is very transmissible under normal contacts could be as high as 80%!
C) If 80% are asymptomatic (slight cough, easily confused with other bugs at this time of year)Then…
Deaths = 60 million x 0.6 x (1-0.8) (cases) x 0.001 = 7200 deaths
We are well above that number, so which assumption is incorrect? Answer… We don’t actually know because we don’t have solid testing data for A), B) or C)
You are the Government, you have had planning in place for an influenza pandemic for about 20 years. Sirens are ringing in countries with similar if not better healthcare systems than the NHS. What would you do?
A few points...
I believe they gave the diamond princess passengers remdesivir. Great for the passengers, but sadly clouds any data that would have been useful in understanding CFR.
I also don’t buy the 80% asymptomatic assumption, they found it was around 20% in Korea who tested widely.
Also isn’t your CFR of 0.1% already taking into account the 80% asymptomatic assumption?
Personally I think the actual CFR will likely be 1-2% when all said and done.
Assuming 1.5%, then...
66M x 0.6 x (1-0.2) x 0.015 = 475K dead ie we are only 9/475 = 1.9% of the way through.
From the outside, it looks like a combination of complacency and poor risk management. It doesn't appear that much was done to hedge against 'the models' being wrong. Not much in the way of precautions beyond nudge factors such as advice to wash hands until the 11th hour when it was too late to prepare. They hoped for the best and didn't much prepare for the worst. One wonders if decisions makers (the politicians) were properly advised about how much uncertainty was packed into the models.
The hardest CFR data we have is in nursing homes. That was from an Australian study and found 25% mortality and about 80% infected. You might be interested to know that some of the best original influenza data came from a boarding school a long time ago.
I suspect a CFR, after adjusting for reporting bias across the globe, of 0.3-1%. That number is consistent with my analyses of the global data, but the spread is very wide.
If it has a case reproductive ratio of even 2, then that’s 50% endemic infection. We aren’t there but testing would help. I also believe that social distancing is VERY efficient, probably more than the models predict. The standard logistic model is not the best description of the data, providing support for reduced contact transmission.
I doubt most politicians understand level of uncertainty in a scientific context, bit like senior managers, they like nice simple conclusions that make course of action obvious. They don't like making a judgement call.
I thought it would be far worse for 100,000 people to all go to the pub every night for a week, than to go to a football match for 2 hours. It takes 3 days to start shedding virus, so it’s the repeated social contacts that are far worse than 1 big one.
Not sure where to start with this but I think its fair to assume people didnt choose to a) go to the pub b) go to a football match or c) go to the Cheltenham festival.
I doubt most politicians understand level of uncertainty in a scientific context
It’s also true in Science btw. In drug discovery, uncertainties are my day job. It gives a different perspective for sure. But decisions have to be taken on uncertain information. Failure to take a decision, even a wrong one, is normally the worst option.
My job is to try and give the clearest picture for the decision, whilst capturing the uncertainty.
The Atalanta vs Valencia Champions League match is thought to have a significant cause of the outbreak in the Lombardy region.
Thought that was being linked to Chinese workers coming back to factories after going home for Christmas/New Years?
If it has a case reproductive ratio of even 2, then that’s 50% endemic infection. We aren’t there but testing would help. I also believe that social distancing is VERY efficient, probably more than the models predict. The standard logistic model is not the best description of the data, providing support for reduced contact transmission.
@TiRed Do we have more advanced models that take into account the differences in human behaviour across a population when calculating final infection levels. I understand how R0=2 —> 50% infection, but wouldn’t this only apply if all the possibly infectious subjects all behaved the same I.e. they all had the same number of interactions with each other. It might work for organisms in a petri dish or maybe even a population of rabbits, but humans have quite different levels of social interaction / hygiene levels.
So what I’m saying is could the apparent R0 at the start of an outbreak be skewed by the people who have a lot more social interaction and therefore once they are infected/immune the spread would slow more dramatically than predicted by the maths that assumes the population has an equal amount of social interaction. If this was the case could the virus fizzle out at a level of infection much lower than 60%?
Just curious.