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Deaths within 28 of positive test by date of death The headline panic number is too aggregated – the underlying rate is the 7-day rolling mean.
I just checked the government website and the 7 day average is nearer 400 - but rising.
Not surprisingly, having ignored the experts on 21 September the government has acted too late and too weak, and to my untrained eye numbers risk getting properly out of control again. I can only see a longer/harder/proper lockdown being needed and what's left of Christmas is cancelled.
Could it be that there are more vulnerable people this time of year who would be more susceptible if they caught the virus?
More elderly people going into hospitals and catching it there?
Basically the number of vulnerable going up?
Is there anything in this?
regional variations are greater than ever
Very much THIS. It's why the North is being hit but the South has modest transmission. Northern Ireland, Wales and Scotland all had significant interventions. Regional evaluation is more important than ever as there is a decoupling now that becomes ever more magnified due to the amplification of exponential growth.
There is good evidence that the growth rate is falling below 3-5% per day towards static and even shrinking rates.
For the more detailed death data click on deaths then select region
https://coronavirus.data.gov.uk/details/deaths
To track transmission, look at hospital admissions by region, these are a better measure of community infection levels. So for the North West
https://coronavirus.data.gov.uk/details/healthcare?areaType=nhsregion&areaName=North%20West
This data has a slight lag, but it's fine for robust inference. Admissions are by NHS regions deaths by ONS region (Midlands and North East and Yorkshire split)
Sefton
I remember from the last lockdown a quote of 50% of shielders being under 50.
That means there's a lot more vulnerable people with virus pathways into their homes now with schools open, than in lockdown 1.0 with them shut.
Back to that 80% asymptomatic thing, that More or Less discussion of that statistic is here https://www.bbc.co.uk/programmes/p08wy93c
As I think Kelvin pointed out, it was 80% had no symptoms on the day they were tested, but we know that people are most infectious just before symptoms show up.
As I think Kelvin pointed out, it was 80% had no symptoms on the day they were tested, but we know that people are most infectious just before symptoms show up.
What does that mean?
Does that mean of people who have symptoms or people who are infected?
What do we mean by symptoms given some fairly high percentage have "no symptoms" and others might have symptoms that are or are not related to SARS-Cov19? I mean presumably you could have the virus and show no symptoms then pick up a different strain of a corona virus or rhino virus and have symptoms for that?
Suppose you are infected for 14 days, but it takes 9 days before viral levels are high enough and disease sufficiently progressed to show symptoms. Then a random uniform sampling will show no symptoms on 9/14 days. It's not serial swabbing of an individual, it's cross-sectional sampling. It's also true that some people NEVER show symptoms (about a third), but that's not the same thing.
That's a better curve than REACT managed @TiRed but I don't like the fit through Aug and Sept.... looks rather too high. I'm going to have to have a go at that data set soon but right now working on the ONS survey stuff.
Suggest you follow the link Steve. It's only 10 minutes long
If you look on the hospital admissions tab here: https://public.tableau.com/profile/public.health.wales.health.protection#!/vizhome/RapidCOVID-19virology-Public/Headlinesummary
If you scroll down to the weekly admissions, you can see that the firebreak has had an effect. The graph makes it look like the admissions are still lower than the first wave which suggests when compared the BBC article that people are spending longer in hospital?
That’s a better curve than REACT managed @TiRed but I don’t like the fit through Aug and Sept…. looks rather too high
Indeed, it's just f(x) = exp(a0 + a1*DAY + a2*DAY**2 + a3*DAY**3), with a binomial likelihood. A quartic is a better fit (P<0.001), and a quintic too, but by then it's just for fun! pairwise polynomial is also presented in REACT, which is better, but taking triple surveys with curvature is probably more helpful - so 123, 234, 345, 456. At least then you can account for local changes in policy. No way would I trust a spline projection.
Drop me a note and I'll send you a post-processed analysis dataset with samples by date and region.
Suggest you follow the link Steve. It’s only 10 minutes long
I'm old and stupid and can't remember my BBC password ...
33k yesterday 27k today, its looking like the flattening on cases didnt happen to me.
If you look at the cases graph here
https://www.worldometers.info/coronavirus/country/uk/
the 33k looks like it fits the curve if you ignore the flat bit in between. If you imagine 27k behind it it starts to look worse.
33k yesterday 27k today, its looking like the flattening on cases didnt happen to me.
a_a - reported cases are confounded by the testing strategy, and that is cases reported today NOT cases with a specimen date of today so any reporting delays on batches of tests will cause noise in the data. It's not worth stressing about changes in the daily reported case figure - check the 7 day average by specimen date at
https://coronavirus.data.gov.uk/details/cases
or look at the ONS/REACT case figures (or don't as fitting a curve to them seems problematic) or look at the ZOE case figures (or don't as they are ML projections rather than clinical data). Or forget about cases and as TiRed has repeatedly said, look at hospital data but don't expect that to reflect the current English restrictions for a while.
@ferrals - I did wonder whether people staying in longer might be having an effect. Add in better treatments meaning fewer deaths and there could be the issue of beds being tied up for longer looming too. Is till thin it's too early for the full effects of the firebreak to show just yet, maybe by the middle of next week things should look more positive.
33k yesterday 27k today, its looking like the flattening on cases didnt happen to me.
If you look at the cases graph here
When the 2nd lockdown was announced a lot of people piled into pubs/restaurants, visited friends and family for the last time Etc. Factoring in the incubation time, delay in getting a test, delay getting results and reporting delays the uptick in numbers in the last few days could possibly correspond to the period just before lockdown.
I believe flu admissions are initially being treated as suspected covid which makes sense.(about 3 weeks back the BBC said only 2 influenza admissions in 1 whole week in the uk)And if the covid turns out to be flu the data is retrospectively corrected? However how long does this take to correct? I worry if this is true then we are printing news from the latest (possibly wrong in this instance) information...and possibly making new restrictive policies based on this data...is anyone looking back to check?
a_a – reported cases are confounded by the testing strategy, and that is cases reported today NOT cases with a specimen date of today so any reporting delays on batches of tests will cause noise in the data. It’s not worth stressing about changes in the daily reported case figure – check the 7 day average by specimen date at
Looks even worse tbh.
Or forget about cases and as TiRed has repeatedly said, look at hospital data but don’t expect that to reflect the current English restrictions for a while.
You can do that and obviously its better data for making predictions, however I still maintain that its like driving a car looking out the back window. By this point we should be able to fairly accurately fit case data to hospital admissions and deaths down the line by using data on testing effort and daily cases.
Now clearly this current jump is just two days data but it should be making people twitchy somewhere.
Factoring in the incubation time, delay in getting a test, delay getting results and reporting delays the uptick in numbers in the last few days could possibly correspond to the period just before lockdown.
I also wonder what impact half term had just before as well.
Sefton, you really are just searching for anything that might possibly support the case for saying that the current restrictions are an over reaction, aren’t you.
By this point we should be able to fairly accurately fit case data to hospital admissions and deaths down the line by using data on testing effort and daily cases.
The more I hear about the positive test data the less I care about it. It seems to be subject to all sorts of problems around picking up the virus on the particular day of the test.
33k yesterday 27k today, its looking like the flattening on cases didnt happen to me.
If you look at the cases graph here
I'm only looking at the England data, but you need to look at the positive cases percentage, rather than the headline figures.
Over the last 7 days its seemed to level out at 8.5% of tests are positive.
It could be just random or the effects of the lockdown are starting to slow the rate of growth?
It seems to be subject to all sorts of problems around picking up the virus on the particular day of the test.
That doesnt change much though so would be factored in given the large number of tests.
Clearly admission data is better to accurately predict deaths but .gov should be acting sooner than this so predictions which are less accurate but earlier could be useful. The head in the sand attitude of our gov means it probably doesnt matter.
I believe flu admissions are initially being treated as suspected covid which makes sense.(about 3 weeks back the BBC said only 2 influenza admissions in 1 whole week in the uk)
Which if accurate tell you what?
People are not being admitted with anything but the most severe and immediately lkife threatening flu?
That SARS-Cov19 is roughly twice as transmissible than flu so the restrictions are holding back flu?
That people with flu can't get tested for COVID?
MoreCash
The more I hear about the positive test data the less I care about it. It seems to be subject to all sorts of problems around picking up the virus on the particular day of the test.
So I went for a hospital "Covid" test today ... in order to get tested I had to:
1) have my temperature test normal.
2) not have symptoms
3) not be living with someone who has been told to self isolate
This is what the letter called the "test".
So obviously I can't have COVID or I would have symptoms definitively (or a hospital doesn't know the difference which is even more worrying)
I may have some SARS-Cov19 that is a symptomatic
I've already been pore-screened to make sure I'm low risk
I can't even get through to be tested unless my temperature is "normal"
I'm not a epidemiologist but you'd think this might bias the results towards lower positives and higher asymptomatic amongst those who make it through the barriers to actually get tested.
I think its a fair question to ask.
ILI - influenza like illness, if admitted to hospital will be tested for virus. This is a PCR test - quite popular I hear at the moment. They will test for influenza and SARS-COV2. The COVID19 admissions are patients admitted with a positive SARS-COV2 test within 24hrs. It is also possible they might ALSO have influenza, but that's been rare. FDA have already approved a combined PCR test for influenza or SARS-COV2.
Peak influenza period is about the second week in the year. Still rather early for seasonal flu, but Southern countries showed very limited rates, most likely due to COVID social distancing precautions. There's been a lot of discussion on lockdownsceptics, but the truth is somewhat mundane. In July I stated that I expected COVID deaths to replace influenza deaths, with a net increase of 30k additional all-cause mortality deaths under appropriate controls. The worst case was 80k deaths.
[tl:dr] flu and COVID patients present to hospital with similar symptoms so the body count could be flawed. But testing for flu is the same as COVID and distinguishes the two viruses. We'll see the equivalent of a bad flu year with controls, a terrible year without them
Thank you...respect btw.
Coming on here has put my mind at rest on several occasions now.
Aug and Sept…. looks rather too high
Piecewise - (three rounds at a time) local regression (not spline) looks a lot nicer doesn't it? Adding a quadratic term means that there is a test for significant curvature, more in keeping with a local SEIR model solution subject to changes in policy.
burner - I would be much more concerned about multiple dodgy contract awards and politicians with undeclared interests.
GSK are a major global player and would be involved in vaccine development whether or not Vallance held shares.
Far be it from me to defend my former boss, but the shares were part of his previous remuneration as head of R&D at GSK (not vaccines btw, those are separate to his past role). He has to hold them for a few years to be able to sell them. I think he’s sold all past shares. GSK have said they will sell the vaccine for cost plus 10% I believe. It’s not going to be a money spinner.
Last point, he’s not responsible for vaccine procurement. But I think everyone would think it a good idea to purchase options on future vaccines from a diverse portfolio of possible suppliers.
My views not the company’s, but I’m proud to work for GSK. I don’t think my employment biases my interpretation of the science, but can you be certain 😉
Websites more interesting than gsk employee being paid in shares
Is that we've chosen not to go with the Moderna vaccine as EU & US have
Eggs in one basket etc
Any idea why we've missed out on it?
we’ve chosen not to go with the Moderna vaccine as EU & US have
I thought the gov were spraying money at every vaccine development project and buying options in all of them.
Might be supply based? We have orders for AZ/Oxford (virus), Pfizer (mRNA) and I imagine others including Sanofi/GSK and/or Merck (both spike protein). Moderna might have just sold out of (future) stock! mRNA is a low dose of protein, so you get a lot of doses per batch run compared to spike protein vaccines and virus, but the demand is equally enormous.
Wait and see what happens. Much noise but little light at the moment - and I mean that with regards to eventual efficacy, protection, supply, cold-chain distribution, duration, repeat challenge, antigenic diversity, safety...... In fact just about everything! Pfizer have proven the concept of antibody protection for disease (COVID symptoms) for 28 days. Patience... It's just like being at work, people are always very fast to read into limited data all manner of things (positive and negative) 😉
As both Pfizer & Moderna mRNA, I suppose similar anyway
Still be nice to increase it options
In work we've just been told that government are putting restrictions on lab supplies: filtered pipette tips, gloves, rna QC reagents etc
As if it wasn't hard enough in work already!
That fit looks really good @TiRed! Can you diagnose growth rate/infection numbers from it for comparison with their official results?
Well you always have the first derivative of the local polynomial. R is simply this slope convolved with a generation time distribution. I’m now of the opinion that LOCAL regressions must be the way forward. Trying to describe the entire course of a process from March, with multiple policy changes, is a hiding to nothing. Covid-projections came to the same conclusion. Your ode method is pretty much the same, as long as the window is within the local dynamic range, you’ll get a nice fit and a reasonable forward projection. Until policy changes (again)!
Btw I’ve shared the methods with the react team.
I meant "can you" as in will you share the numbers with us not "can you" as in is it technically possible 🙂
I don’t know the right terms to use but there is a question I need to ask.
I was watching an interview with the top USA Virologist or Immunisation expert and he had some interesting things to say about the vaccine.
He reiterated the handling problems but also highlighted that it could only be handled and administered by trained personnel. It is not the same as a ‘normal’ vaccine. The logistics of administering the vaccine are immense and going to take a long time.
The question I have is – and forgive me if I use the wrong terms – if something is stored at -40°C wont it be solid?
If so does this require a controlled raising back to a specified temperature before use?
Yep exactly that. The pfizer vaccine will be a pain in the arse.
Apparently it is coming as a 2 component vaccine stored at -70°c.
The handling of mrna is delicate, I used to work with biopharms and we had to be very careful. This will be far worse.
First world vaccine only am just hoping the more traditional and easier to handle one's are highly effective.
The question I have is – and forgive me if I use the wrong terms – if something is stored at -40°C wont it be solid?
If so does this require a controlled raising back to a specified temperature before use?
The vaccine requires this level of handling because its m (messenger)RNA based, RNA is the intermediary step between DNA (the storage medium of genetic info) & Protein (the stuff our cells are made of)
Normally RNA only exists briefly as the genetic code is transcribed into functional proteins
Both DNA & Protein are relatively stable, often refrigeration at 4C or room temp is fine
RNA is degraded swiftly by enzymes in the body (free floating rna will interfere with gene expression so its unwanted)
Warm temps degrade RNA rapid, through chemical degredation & RNASE enzyme activity that is inhibited by super cold temps
RNA will be suspended in water so at -40 it will be solid, ideally you want to thaw it rapidly and use immediately to prevent degradation
What you really dunt want is to have it thaw during storage or transport, degrade & refreeze so you are using a reduced efficacy vaccine, you can have a temperature probe with your sample that will record how it's been handled
That's why cold chain logistics are something we will be hearing about & why companies that specialise in this are set to make £££££!
I hear from colleagues that AZD vaccine has sone good news to announce shortly as well, but as that's a viral vector, I'm not sure logistics will be much better, we have to store adenoviruses at - 80 so id guess it's the same for this
Asking for my mum: is the Pfizer vaccine a live vaccine? If so that rules her out of receiving so hopefully some other options are suitable for an immuno-compromised person. Thanks!
Can someone please correct me if I'm wrong but where has the supposed huge pandemic gone? Despite the continued doom and gloom in the media, the current weekly death figures don't appear anything that unusual like they did back in March and April? So what's missing from this graph?
KImbers, thanks for that description, very clear.
Asking for my mum: is the Pfizer vaccine a live vaccine? If so that rules her out of receiving so hopefully some other options are suitable for an immuno-compromised person. Thanks!
No, its an RNA vaccine, that means it's a stretch of RNA, it gets converted by your body into a chunk of covid protein that your bodies immune system can then recognise
that your bodies immune system can then recognise
Could be an issues for Lupus sufferers, as one of the major issues there is the bodies confusion with recognising such things.
jim_barclay
Free MemberCan someone please correct me if I’m wrong but where has the supposed huge pandemic gone?
The latest ONS numbers are (IMO) easier to make sense of. You can see that red line ramping up nicely in figure 2. Whether that justifies a national lockdown, I don't know.
EDIT: as ever, that is packed full of interesting information.
the current weekly death figures don’t appear anything that unusual like they did back in March and April?
I analyse this data weekly and use a ten year background reference from ons (they only report five but list all data). In week 44, which was a week last Friday, 10,800 people died. That is 700 more than the highest number recorded ten-year number, and about 1400 (15%) more than the ten-year mean - so 200/day.
Before Christmas we will see a modest rise to about 20-25% above historic mean equal to an excess of 2000-2500 deaths per week. These are additional deaths over underlying respiratory deaths. Summing over the winter period will lead to 30k deaths, which would be a bad flu year, but a good Covid year. That’s a bad flu year with a second lockdown, tiers, working from home and possible further restrictions after Christmas.
So yes, there is an epidemic ongoing, but the contact restriction measures are slowing the spread. A vaccine may help replace social distancing to maintain mortality in 2021.
Well… I’ve deleted all that reply to you Jim… TiRed put it better. A little to add… deaths currently above not just the average, but also the highest, on your graph… and that’s with all the measures we have in place. That we haven’t had a repeat of the Spring is because we are (mostly) all acting to stop the spread. We lost our next door neighbour this week, and I lost my uncle last week… the epidemic is ongoing, the fact that we have it as “under control” as we do is great… but there are many real human reasons why some of us wish we had intervened differently in September, rather than waiting for these high death and hospital admission numbers, and then only half heartedly used the “stay at home” message.
Thanks TiRed, appreciate your reply. Are there any figures out there to separate those out who died 'from Covid' from those that died 'with Covid', i.e. a positive test result? My concern is spiked after reading this in our local paper:
https://www.dailypost.co.uk/news/north-wales-news/woman-who-fell-window-died-19270715
Old lady of 94 fell out of a window but tested positive for Covid whilst in hospital, listed down as a Cover death. Hopefully this is an isolated and tragic case but it highlights the importance of using the correct methods to identify genuine Covid deaths from those in hospital merely 'with a positive Covid test'.
It is concerning that there is a small level of excess deaths right now, and more so to hear that this could grow, but similarly are there any stats out there to show what is causing these? Could the concerns from people like Macmillan highlighting the possible 50,000 undiagnosed Cancers out there right now be part of this excess death impact?
Would you agree that Cancer patients having treatment and diagnosis delayed is a price worth paying if it means that Covid death rates are lower? No easy solution I'm sure but I'm really struggling to see how there can be an ethical trade off here which is why the 'from Covid' or 'with Covid' would seem such a critical thing to be aware of.
And around we go again… I know people who can’t get treatment BECAUSE we have the virus at the levels we do locally… If you let the virus rip, cancer treatment will come to a dead stop again, as it just about did in the Spring.
As for the “with” conundrum… that’s all you can do data wise. Everyone I know who has died thanks to COVID had a pre-existing condition. You can record who died with COVID in the system with a test… you can’t start trying to isolate who died from COVID alone, as comorbidities are very much the nature of this… be it cardio-vascular conditions, cancers, or accidents.
There’s a lot of noise about died with and died of Covid. COVID19 is the disease, sars-cov-2 the virus that infects and leads to disease. Epidemiologists count cause of death by an ICD10 code. They invented a new one for COVID19 the disease 🦠 in addition to influenza (99). ONS look at deaths by the ICD10 code and partition into respiratory vs other deaths.
We say in the business that death is the hardest endpoint. They may have died with or of, but they definitely died. So I switched to analysing all-cause deaths in April.
Cancer deaths will feed in with time and there are about 1000 diagnoses per day. But it is too early. Cardiovascular deaths and dementia are u likely to change but there has been a switch from dying in hospital to dying at home. But the numbers are steady.
I'm sure someone will look at the data properly at some point to remove old ladies who fell out of windows, but perhaps also include people who died from Covid-related health problems post 28 days.
I'm going to stick my neck out and say that the second group is going to be significantly larger than the first.
Would you agree that Cancer patients having treatment and diagnosis delayed is a price worth paying if it means that Covid death rates are lower? No easy solution I’m sure but I’m really struggling to see how there can be an ethical trade off here which is why the ‘from Covid’ or ‘with Covid’ would seem such a critical thing to be aware of.
Cancer treatment is ongoing.
Cancer testing and diagnosis is ongoing.
The lockdown is enabling this to happen by relieving pressure on hospitals and the NHS.
It is maintaining capacity for patients to be treated, including cancer patients.
Without the lockdown and other social distancing, it would be a lot harder for them to continue to treat cancer.
The lockdowns have prevented my hospital being overrun and enabled them to treat me with 6 CT scans, monthly blood tests, a biopsy, a cancer op, three cycles of chemotherapy, and all the associated remedial medication needed over the last 8 months.
It is a horrible misrepresentation to suggest it is either/or.
Keeping covid cases, admissions, and deaths low is a massive benefit to cancer patients. Treatment and daily life.
Letting it rip would be catastrophic for our treatment and outcomes.
Would you agree that Cancer patients having treatment and diagnosis delayed is a price worth paying if it means that Covid death rates are lower? No easy solution I’m sure but I’m really struggling to see how there can be an ethical trade off here which is why the ‘from Covid’ or ‘with Covid’ would seem such a critical thing to be aware of.
See this grips my shit, I dont understand how people able to type coherent sentences can be so stupid.
Its not lockdown or treat cancer patients, its lockdown to enable the nhs to treat other things. How is this hard....wanders off muttering....
My initial reaction was similar to A-A's, but loum has put it so much better and coherently.
If only our idiot government could communicate the wider picture so well.
All the best with the treatment loum.
It’s an often overlooked point, but the average age of death just happens to coincide with the average age that treatment and ITU admission is denied. A functioning healthcare system not swamped by COVID19 cases is in everyone’s interest. Sadly the only available means of controlling that tidal wave of cases is currently contact restriction.
In a tsunami, it’s not the initial wave, it’s the surge behind it that just keeps coming.
And yes loum I hope the treatment goes well. I know first hand how stressful any interruption of cancer treatment can be.
Apologies if posted already but this is pretty interesting piece about how other countries are handling quarantine etc
https://edition.cnn.com/travel/article/selina-wang-asia-covid-quarantine-intl-hnk/index.html
Would we trade individual freedom/rights for being able to return to mostly normal society? The chances of us being able to run these systems vaguely competently seems pretty slim anyway.
jim_barclay
Free MemberThanks TiRed, appreciate your reply. Are there any figures out there to separate those out who died ‘from Covid’ from those that died ‘with Covid’, i.e. a positive test result? My concern is spiked after reading this in our local paper:
Back-of-the-envelope calculation:
The ONS are saying that the infection rate is about 1% at the moment.
And very roughly, about 10,000 people a week die overall. So that should mean you would expect about 100 people per week to die _with_ SARS-Cov-2 but _of_ something unrelated (falling off a ladder).
The actual weekly number is 2890 for the past week.
(Disclaimer: I am not a statistician at all, I can barely even do sums. But I can spot an order-of-magnitude difference).
TiRed...please could you allaborate on the denial to intensive care for 80plus patients?
Its not lockdown or treat cancer patients, its lockdown to enable the nhs to treat other things. How is this hard….wanders off muttering….
I was under the impression that there was a deliberate policy to delay treatment to non-Covid patients to free up capacity for possible Covid patients. GP appointments very hard to come by, non-urgent operations cancelled, screenings cancelled, patients given the impression that the NHS needed to be saved rather than used?
But what are we saving the NHS for exactly? Is it not there to be used in full or are we saving to up for some possible future event? Having paid for it, is the NHS not there to save us, or have I got something wrong?
I spoke to a consultant friend at our local main hospital here in Wales last week and asked her how many Covid-19 patients they had in. 7 was her answer, just 7. Yet the hospital are still not seeing my wife in person for a potentially serious condition that needs a proper diagnosis. 6 months she's waited, you know - because of Covid!
I also understand to that our hospitals, depending on area, are currently running at between 80% and 95% capacity right now but that this is completely normal for this time fo year? Also our Nightingales remain largely unused? Is it just me that thins this is crazy?
80 is not any kind of automatic cut-off for ITU.
Many people younger than that are often not considered able to benefit from ITU and the consideration of that is the deciding factor in any admission to critical care. There is little point admitting someone who will die despite any intervention; it is cruel and inhumane. People are sometimes admitted but with a definite ceiling of care; often they would be admitted but would not be considered for ventilation if that was considered futile.
The ethical judgements surrounding admission to ITU are many and complex, but age alone is not a major consideration.
I was under the impression that there was a deliberate policy to delay treatment to non-Covid patients to free up capacity for possible Covid patients. GP appointments very hard to come by, non-urgent operations cancelled, screenings cancelled, patients given the impression that the NHS needed to be saved rather than used?
But what are we saving the NHS for exactly? Is it not there to be used in full or are we saving to up for some possible future event? Having paid for it, is the NHS not there to save us, or have I got something wrong?
Think that might have been the case at the beginning of wave 1, when we really had no idea But the more recent messages have been to encourage people to access the NHS. But again, the point is that WITH massive restrictions, lockdown etc, we're reaching capacity. Without them, clearly we'd be exceeding it.
Bit of a Big one...but how do you think we would look at the current situation if say for example our NHS had maybe 30% more capacity in all areas?
Also our Nightingales remain largely unused? Is it just me that thins this is crazy?
they were always pretty much a hail mary idea - where are the staff to come from to staff them?
5.5% of patients admitted to ITU have been 80+
https://www.icnarc.org/DataServices/Attachments/Download/6167f9f7-ea25-eb11-912b-00505601089b
That proportion has been declining as more people have been admitted to hospital with COVID-19.
Mortality will of course be age-dependent, but an additional factor is treatment. Benefit risk must be considered and routinely admitting the elderly and subjecting them to invasive ventilation may not be in their best interests. This was brought up as a “scandal” in the Sunday Fail a few weeks ago, but is nothing of the sort.
It was suggested that a triage rating scale be used that required 8 points or fewer for ITU admission, where age and comorbidities are factored. Being over 85 gave you 9 points. This scale was worked up but not introduced because healthcare was not overwhelmed.
My point is straightforward, as ITUs are overstretched, harder decisions are needed for those in their 70’s, then their 60’s and so on. Maintaining control of resource is vital.
TiRed, what percentage of people in ITU are there because of Covid, compared to those there for other things but have had a positive test for the virus?
Bit of a Big one…but how do you think we would look at the current situation if say for example our NHS had maybe 30% more capacity in all areas?
Think there would be more people willing to risk opening up. But given the vaccine news looks promising, would suggest that the majority will support restrictions. Having more capacity means you're further away from catastrophic failure, but there's not a lot of public support for allowing 1000's of daily deaths, is there?
Afraid I don’t know, but I am willing to bet that it is an order of magnitude higher than the null hypothesis, which is the population prevalence (I.e., <5%).
There is also the issue of covid+ patients vs covid- patients vs covid unknown patients. We can run theatre lists as usual, but have to seperate all three categories of patient which means separating out theatres and theatre staff and having covid+ wards and covid- wards and testing everyone to attempt to keep them all safe. Some people test positive while in hospital and then have to be moved to the appropriate place.
Many staff are off either with covid or isolating due to contact with covid+ relatives or having worked with other staff who tested +.
Many others are totally and utterly fed up of the whole thing; they've been doing this since March, getting moved around at short notice, ending up working in places they are not used to, with people they don't know.
Would we trade individual freedom/rights for being able to return to mostly normal society? The chances of us being able to run these systems vaguely competently seems pretty slim anyway.
I would gladly make the trade, but agree re competence.
This is a very sobering read
BBC News - Coronavirus doctor's diary: The Yorkshire cemetery struggling to keep up with burials
https://www.bbc.co.uk/news/health-54938735
compared to those there for other things but have had a positive test for the virus
If you’re in ITU for ANYTHING, then having the virus really isn’t good news for you.
compared to those there for other things but have had a positive test for the virus
Throughout the Covid-19 pandemic there has in fact always been ICU capacity available. As the National Audit Office have confirmed, around the peak of Covid-19 hospital admissions on 14 April, NHS providers in England had 6,818 ventilator beds operational, of which: 2,849 (42%) were occupied by Covid-19 patients; 1,031 (15%) were occupied by other patients; and 2,938 (43%) were unoccupied.
Do not confuse COVID-19 the disease with infection with SARS-COV-2 the pathogen. The majority of people infected with the virus may develop symptoms of "COVID"; cough, temperature, aches, loss of taste/smell, but do not go on to develop COVID-19 the pneumonia disease with hypoxia that leads to hospital admissions and perhaps the ITU. Patients in ITU with COVID-19 will be the latter. They'll be diagnosed possibly with a CT scan (ground glass effect), with a differential diagnosis of influenza or other bacterial pathogen, and by PCR test. They have COVID-19 and it is a very serious disease (speaking from personal experience now). About 25% of people admitted to ITU will sadly not come out.
There is a willingness to believe that there is a testing epidemic that is leading to admissions of lots of people with a positive test. In fact that is not true. Patients are being admitted to hospital with SYMPTOMS not a test. The admissions data counts people testing positive within 24hrs because they have their disease confirmed after admission. Since September there has been an increase, notably in the North, of people presenting with shortness of breath and other symptoms. This was much earlier that the conventional influenza season, and they were confirmed to have COVID-19.
[tl:dr] ITU patients with COVID-19 the disease took up about half of all ITU beds, but due to careful management of the NHS (closing all other services) the NHS was not overwhelmed. This time the other services are staying open. People with COVID-19 have symptoms (hypoxia) before a positive test when they are admitted to hospital.
[tl:dr] ITU patients with COVID-19 the disease took up about half of all ITU beds, but due to careful management of the NHS (closing all other services) the NHS was not overwhelmed. This time the other services are staying open. People with COVID-19 have symptoms (hypoxia) before a positive test when they are admitted to hospital.
If things dont change we will exceed the patients in hospital peak of tye first wave very soon, less than a week will we not? I suppise it depends how fast people die or get better. 1.9k admitted today and we are about 5k from first peak max number in hospital.
ITU patients with COVID-19 the disease took up about half of all ITU beds,
Intensive Care capacity in my hospital was doubled in response to the issue.
No extra ITU nurses were recruited because they are not available at such short notice. We also opened a number of non-covid ITU beds to deal with those who didn't need looking after in full PPE.
TL DR: an awful lot of people have worked way above and beyond to provide high quality care to a population who, on occasion, seemed not to appreciate the effort involved.
jim_barclay
Free MemberAlso our Nightingales remain largely unused? Is it just me that thins this is crazy?
OK, you need to understand what the Nightingales are/were. They're the place you put the overflow out of sheer desperation when the normal hospitals can't cope, so that you don't have dead people in the car park. They're not a good choice, if you use them it's because they're the last choice remaining. And of course, if hospitals are flat out, you can't just magic up more doctors- fairly easy to put beds in a conference centre, not easy to staff it.
Mostly they'd have been a place to go to die, so that hospitals could deal with the people who had a better chance to live. They're not a real alternative to a hospital- we can't use them for cancer treatment or whatever, as people keep suggesting. They were, literally, created because they were better than nothing and that was the two options.
But I hate when people say they were a waste of money because they didn't get used. They were there as the last resort, and we never quite needed that. But it's like saying your seatbelt was a waste of money because you never crashed that car.
seemed not to appreciate the effort involved
Most people do. And thanks again Crikey.
Boris has just tested positive for Covid AGAIN!!