See testing and contact tracing. We need to build up that info first. And it’s now a much bigger/harder job then it needed to be. Some might claim impossible, and that a semi-lockdown future is needed for the UK for the foreseeable, unlike countries that are updating, rather then restarting, their data gathering and testing programmes.
Had a lovely bike ride with my boy. His schools houses are named after local hills so we have been riding them. Did Coombe last weekend, Watership today, we tried to do Beacon too but apparently the hill is closed to prevent it getting corona virus or something. Ridgeway next.
Anyway I was thinking, the answers to questions that interest me and should I hope interest our esteemed leaders I'm not sure can be answered by Tireds modelling. I wont pretend to fully understand it but from what I have gleaned it uses data from other countries to inform our progress. Like how does timing of lockdown affect things, the type of lockdown, the testing and tracing effort. I assume you could look at other countries r values and model stuff or would it need a multi variate model?
How do we think the government will relax the lockdown while keeping R<1?
Is it even possible
It's certainly possible if (a) infection results in immunity and (b) a high %age of the population has already been infected.
We had estimates 6 weeks ago that around 1-2% of the population was infected. At that time R would have been 3 or more, though it is now less than 1. Someone very clever could probably estimate what the current infected rate would be.
Or have we had a more up-to-date guess since 6 weeks ago?
Someone very clever could probably estimate what the current infected rate would be.
Someone even a bit less clever could estimate it if we'd been busy collecting test data to parameterise the models better.
😷 😁
Not a vaccine, those seem hard (forget the media noise). Clearly there would’ve been limited market for an unspecified future pandemic.
From the ITV link I posted above it seems the 'Oxford' vaccine people did exactly that. State funded at risk they developed a vaccine basis that they can just modify and (hopefully) produce in 12-18 months or so at a push. No private firm would bother because it might never pay off.
I appreciate these people have every incentive to big up their project to get more funding so it might all be smoke and mirrors but the *intent* was definitely to produce vaccine for future epidemics fast and it got funded and (if it works) will pay off in spades now.
is simply not true.
The link was in the post:
And that road traffic was up at least threefold on last week.
Local Police reported a 20% increase. They pointed out that a lot more businesses have found a way to reopen recently, but if they stop you and your journey isn't justified they'd be using fines.
And I'll add myself to those who need to apologise for things said on here. Sorry
Super busy out there! We had to go into some woods where there are no footpaths, to avoid the steady stream of people on the RoWs. Were rewarded by blankets of bluebells.
Driving home from work this afternoon the motorway was empty but the side roads, wow, loads of cars and crowds of walkers all mingled together. Almost like someone mentioned downward curves and lockdown easing! Never seen so many people about in the last few weeks
From your own link outofbreath:
The Robert Koch Institute now feels the same way. "We don't have enough tests to be able to use them senselessly," the institute's director, Lothar Wieler, warned last week. At the same time, though, the institute has loosened the recommendation that has thus far been in place - namely that patients with symptoms should only be tested if they had contact with an infected person or had been in a region with a high number of confirmed cases. Given that the pathogen is now essentially everywhere, the focus on at-risk regions no longer makes sense, an institute spokeswoman said.
That has been policy and that's what the vast majority of German testing has ben about. Just because one test organisation "only" got 10% positive doesn't mean there was anything random about what they were doing. Given that infected people are only likely to test positive for a few days and a level of infection in the populaiotn well under 10% tell us that even 10% positive is far from random. That article in itself is biased in that it's seeking to criticise and you'd do better to read a selction of the German press or watch a variety of channels to get a more balanced view. You've taken the equivalent of red top article and then posted your own interpretation of what you've read.
The vast majority of German testing has been anything but random even if it's been done by a large number of independant labs working to national advice - because that's the way the German health service works. They've been testing and tracing and in a targetted manner and it's helped reduce the spread.
One excelent thing about the German system's devolved nature is that you have lots of people in lots of regions for the media to talk to without risk of losing their jobs. Some have become media stars, there's debate by interposed media, but there's also a high degree of consensus on who gets tested and it's not random names from the phone book.
We had estimates 6 weeks ago that around 1-2% of the population was infected. At that time R would have been 3 or more, though it is now less than 1. Someone very clever could probably estimate what the current infected rate would be.
Or have we had a more up-to-date guess since 6 weeks ago?
Seems to be a lot of work going on in that direction but, apparently, it takes months:
https://www.nbcnews.com/health/health-news/how-many-people-have-had-coronavirus-no-symptoms-n1187681
I can't say I understand why it takes months and google seems silent on it. There's a working antibody test, surely you take a properly randomized sample of people and extrapolate. I understand some people kick CV before they develop antibodies in their blood (T-Cells and various other mechanisms) so you get false negatives but surely that number as snapshot is a useful starting point?
The trouble with comparing one countries figures with another is that there are so many mitigating factors, population density, connectivity, cultural practices, health standards and resources, poverty etc. Conclusions can be subjective and subject to varience.
Individual nations response times and actions however are not subjective, they are falsifiable.
When or how did you limit travel.
When did you either begin or abandon conact tracing.
When did you begin testing.
Was your communication with the public clear or ambiguous.
With regards all these points I find it hard to conclude that our Government has done most things right.
Old saying;
'History will speak of us and she has a filthy tounge'.
That article in itself is biased
I cited the source. The source might be wrong in which case correct it by citing an alternative source that gets it right and we'll all learn something.
Until then, flawed or not, it's the most detailed article I could find on Germany's testing in the early stages so I'm kind of reliant on the facts it presents until something better comes along.
As someone else said a while back, this isn't some kind of competitive man test, STWers are just laymen trying to work out what's going on.
To put that 10% positive into context. I think we'd agree that Covid is much more prevalent in the UK than Germany. The UK per capita death rate is 5 or 6 times higher than in Germany and the health service isn't that much worse so it's highly likely that the number infected in the UK is much higher, and yet 90% of negatives was presented as perhaps wasteful and not targetted enough in that article. The UK figures from the Guardian:
1h ago 16:05
UK death toll rises by 621 to 28,131The local government secretary is speaking now.
As of today, 1,129,907 tests have now been carried out in the UK, he says, including 105,937 tests carried out yesterday.
182,260 people have tested positive, that’s an increase of 4,806 cases since yesterday.
182 260 / 1 129 907 x 100 = 16% positives.
We know just how targetted UK testing is because there's been a shortage of tests, and there are more cases to detect. It seems to me that an organisation coming up with 10% positives in Germany is doing a pretty good job of targetting.
. I understand some people kick CV before they develop antibodies in their blood (T-Cells and various other mechanisms) so you get false negatives but surely that number as snapshot is a useful starting point?
And, in the context of my question, do those folk have any (apparent) immunity? If they don't, then the number at risk hasn't gone down by as much as we'd want and lockdown takes longer.
Poland has 37 million people living there (so ~ half of the UK), but only ~664 deaths.
You can talk about population density/reporting methods all you want, but that pales in comparison to our 26,000 (with maybe an extra 15,000 "uncounted").
We've had more people dying in a day than they have all through it....
And, in the context of my question, do those folk have any (apparent) immunity?
It's certainly not detectable with the antibody test.
Do they have immunity? I can't resist guessing: Seems to me those guys haven't got a load of ready trained antibodies but they *have* naturally got really good "earlier" defences, in the short term is that worse or better than antibodies? If it is a cast iron defence for those people, can they be carriers?
Yet another fascinating series of questions about CV that the media haven't addressed as far as I can find.
Poland has 37 million people living there (so ~ half of the UK), but only ~664 deaths.
I was just reading about this. Article here if you’re interested
https://www.ft.com/content/f9850a8d-7323-4de5-93ed-9ecda7f6de1c
The transcontinental divide is striking. So far, Spain has recorded 517 deaths per million people, Italy 453, France 353, and the UK 325. By contrast, Slovakia has recorded 4, Poland 16, the Czech Republic 21 and Austria 65. On Tuesday alone, Spain, Italy and the UK all suffered more deaths than the Czech Republic, Hungary, or Slovakia have recorded during the entire crisis.
Dated April 30th
Also the article claims;
Italy and the UK had their first infections in January. The Czech Republic, Poland and Slovakia, by contrast, did not record their first cases until the first week of March
Fingers crossed they keep on top of this and don’t follow either our, or for that matter Russia’s path.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944327/
Thanks for the info. I thought this was a good understandable explaination of vaccine trials but it is American so some of it will be different.
I know a few will be aware of what’s happened in Guayaquil.
Is the discrepancy between what appears to have been a very severe outbreak and the reported infection and fatality rates simply a case of inadequate resources to confirm?
Seems to me that most of the people going for a test (or having one posted out to them) are doing it because they can, not because they have symptoms.
‘Seems to you’ ?
There are so many viruses with similar symptoms, many tested with symptoms won’t have this virus.
Seems to me that most of the people going for a test (or having one posted out to them) are doing it because they can, not because they have symptoms.
I'd hope the majority of people getting antigen tests are doing it so they and their family no longer have to self isolate. (and can go back to doing important work.) I'm struggling to see any other sane reason.
I know a few will be aware of what’s happened in Guayaquil.
I'd never heard of it, but I have now.
https://www.theguardian.com/world/2020/apr/22/ecuador-guayaquil-mayor-
Experts say one possible reason for the number of cases in Guayaquil is the high level of air traffic between Ecuador and Spain, which has the world’s third-highest number of deaths, after the United States and Italy.
Spain, where more than 21,000 people have died, is home to more than 400,000 Ecuadorian migrants and the first Covid-19 case recorded in Ecuador was of a 71-year-old woman who flew into Guayaquil from Madrid in mid-February. She died there on 13 March.
The precise scale of Guayaquil’s tragedy remains unclear although few doubt the number of deaths far exceeds Ecuador’s official nationwide death toll of 507.
Viteri said independently gathered figures from cemeteries and graveyards suggested the death toll in Guayaquil alone could be more than 8,000.
Well here's a thought or two ... may be a little uncomfortable.
Thought 1. Our contained "run rate" on deaths is around 400 to 500 a day, so if we assume this is the current best case with a questionable lock down? We are not likley to have a functioning ecomomy with a death rate less than this until a vaccine turns up?
Thought 2. The vast majority of deaths are in people of pension age.... so lets look at the economic impact of that over lets say 12 months of covid at an average death rate of say 300 pensioners per day.... so now lets look at the maths... 300 x 356 = 106,000 ish so with an average state pension of say £150 per week produces a cost saving of £826,000,000 per annum and lets assume its a 5 year reduction in life expectancy per person that adds up to a.... big cost saving...
There are economists inside and outside government that are running these numbers.
So if you want to be brutal... fire up the ecomomy and reduce your burden? Bet Dominic is flying that flag...
Just for clarity i am 57 with underlying health issues that indicate i am not likely to do well if i get covid.
There are some decisions that will be made based upon the above.
Hell, it would be cheaper just to shoot the ill than go to all that expense of treating them
Just reading the New Scientist where there’s a fascinating corona virus article. Apparently 20-30% of colds are caused by a group of 4 human corona viruses. All with catchy names like HCoV-NL63, HCoV-229E, HCoV-OC63 and HCoV-HKU1.
Recently virologists have researched their paths from animals to humans. For some this can be estimated at hundreds of years - back to the Middle Ages - where the emergence of a novel virus would probably blend in with all the other diseases capable of drastically shortening people’s lives.
For OC63, however, its jump to humans can be calculated to be in the 1890s - coinciding with a pandemic known as the Russian flu pandemic. It’s kind of a bad news, good news, more bad news thing. Obviously, emergence of novel corona virus is bad news, good news is that it becomes less virulent over time, bad news that this is not immediate and that this corona virus leap seems to be a regular phenomenon.
However, also maybe we’ll look more closely at the common cold again for patterns of how viruses become less dangerous over time but also how (even after all these years) they are all still more dangerous as you get older. What is it about them (and us) that leads to this pattern?
Anyone else read the article? It was one of the most interesting things I’ve read in a long time - if not exactly edifying.
Hell, it would be cheaper just to shoot the ill than go to all that expense of treating them
Is that what’s happening in care homes now?
So if you want to be brutal… fire up the ecomomy and reduce your burden? Bet Dominic is flying that flag…
It's not even a choice, though. Not really.
Which country has been most desperate to 'reopen' for business? The US. And why? Because, put simply, the US is doctrinally against a social safety net for its citizens. Shut down the economy and a large swathe of the population is ****ed. Too much of that and there is civil unrest.
We are part way there. We've pissed away our legacy from our days of being at the forefront of world 'progress'. We have pimped ourselves to the spivs and wide boys of the world and we actually have very little of real substance to fall back on. We will open up again before it is actually safe to do so because we can't do anything else.
If we want to find those 'lost' billions we would need to look offshore through a series of transactions and accounts. No chance.
Interesting R4 program on the virus hunters who search for zoonotic viruses 🦠, not a job I’d fancy doing
Interesting to see how people are thinking about restrictions being lifted for different sectors of the economy (Guardian article, poll 3rd of the way down the article), is there actually any call for the early lifting of restrictions that some are calling for?
Or is it more a case of the public and business being one step ahead of the govt like it was at the beginning? Shops and businesses had already started social distancing before the restrictions were announced and when they are lifted are we going to see some businesses slow to open and people stay away in large numbers too? I sure as hell won't be going to any pubs, restaurants, cinemas etc for a long time even when we're allowed to.
https://twitter.com/richardhorton1/status/1256701125937582081?s=21
Interesting thread about Remdesivir. I’m not qualified to judge the argument but the bottom line seems to be it has little or no value but the results of trials were manipulated by drug companies.
DrJ - see TiRed's post on pg257 which said pretty much the same.
Horton's comment is based on the Lancet publication. There is some evidence from the NIAD NIH trial remdesivir is doing something. There will be differences in patient severity, time from onset etc. My personal understanding is that the earlier the treatment, the more likely it is to do something, and the longer the treatment, the more drug accumulation in cells. The dose to match preclinical rhesus monkey data is x too low (at least). Remdesivir is a prodrug, it gets converted to something called a nucleoside. This molecule is inserted into assembled DNA and stops the replication - great Pharmacology https://en.wikipedia.org/wiki/Nucleoside
The results have not been manipulated by evil Pharma. Gilead conducted a proof of concept trial that was uncontrolled (it showed 5d worked slightly better than 10d, but there was no real difference). Chicago Hospital reported a set of case controls. Only the NIH data (press release) and the Lancet China publication are randomized placebo controlled trials. The data from China is unequivocal, sadly.
Gilead are now running their placebo controlled Phase 3 trials. these will provide gold standard data for formal (not emergency use) approval by the FDA. I would be nice if they work, but easy to explain why they might not. Early and mild would be my guess.
Somafunk thanks for the link to the podcast, it's interesting. A further book that might be of interest is also called virus hunter by cj peters, he kind of made the mould for further virus hunters.
Early and mild would be my guess
Mine too - and what's the point in that ?
Until they can lock down prognostic indicators and reliably predict likelihood of progression to severe disease we'll be pissing away drug (and now money, I assume, if it has a FDA licence) into a majority of people who were always going to recover spontaneously
Reluctantjumper,
I was thinking the same. How many of us watch the daily briefings waitng to be told what we knew already, waiting for the government and medical advisors to catch up with us.
The approach has been reactionary. Not only in relation to the virus but also in relation to the public. Populism is an abdication of leadership, it's about rolling the dice, see what happens then react to the public mood and even in that they were too slow. Everything becomes tactical.
This time they rolled the dice and the numbers came up huge, they threw a double six and had to throw again, and again, and again.....
I would be nice if they work, but easy to explain why they might not.
It’s a sign of the times that failed trials are seen by many as part of “evil pharma conspiracies” rather than taken for what they are, an inevitable result of essential measures to make sure treatments are effective and safe. In no trials failed, then I would be highly suspicious.
re. "failed trials"
I haven't read the last few pages back but assuming we're in context of remdesivir and the ACTT study, stopping it when they did means that we have very little chance of KNOWING that it saves lives. That it's become the FDA's messiah is just weird
There's a suggestion that it reduces duration of symptoms but that study allowed relatively early starting in subjects with pretty minor symptoms (if you like - "the 'flu" as most would experience it). I don't give a shit in the current situation whether those folk feel fairly shit for 10 days or 9; I care about whether (and if so, how to) it saves people from needing critical care support for prolonged periods or worse, dying
Sorry - typo above should have said 3x too low. There was previously debate about intracellular levels of nucleotides in HIV therapy. We are probably re-discovering the Vitamin C/scurvy debate. But unlike HIV, remdesivir NEEDS the drug accumulation in cells to work. That in turn means 10 days of treatment in the earliest mild patients. I don't anticipate much activity in the first few days, either. Their Phase 3 program will provide the necessary evidence. First 600 patient interim analysis is in two weeks, I believe.
I don’t give a shit in the current situation whether those folk feel fairly shit for 10 days or 9; I care about whether (and if so, how to) it saves people from needing critical care support for prolonged periods or worse, dying
You’re not in luck then. Not all treatments reduce mortality, some just aid recovery. Look elsewhere for your silver bullet. If a huge proportion of us may end up with this virus before a prophylactic treatment is widely available, then drugs which limit the damage, and recovery time, for those that would have pulled through without serious intervention anyway, is still to be welcomed.
it's not my silver bullet - it's the FDA's
(and if that's all it does it's arguably risking overloading health services by mandadating admission and i.v. administration just to you they go back to moaning about lockdown a day quicker)
Really? All other research has stopped, has it?
The registration endpoint is proportion of treated patients who achieve a two-point change in the FDA-approved 7-point categorical scale (you don't want to be a 1)
The scale is as follows: 1. Death 2. Hospitalized, on invasive mechanical ventilation or Extracorporeal Membrane Oxygenation (ECMO) 3. Hospitalized, on non-invasive ventilation or high flow oxygen devices 4. Hospitalized, requiring low flow supplemental oxygen 5. Hospitalized, not requiring supplemental oxygen - requiring ongoing medical care (coronavirus (COVID-19) related or otherwise) 6. Hospitalized, not requiring supplemental oxygen - no longer required ongoing medical care (other than per protocol Remdesivir administration 7. Not hospitalized.
Gilead's trial is here https://clinicaltrials.gov/ct2/show/NCT04292730
they are running another trial in severe disease too. the interesting thing is that this may well work in mild COVID19, but needs an IV infusion daily. So you'll have to be hospitalized.
Really? All other research has stopped, has it?
Not based on my calendar for next week!
Really? All other research has stopped, has it?
man, I'm getting a passive aggressive semi just re-reading your stuff. Don't stop...
