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How many projects rushed out in an emergency work straight away ?
None. All the more reason to go with a model that has been tried elsewhere and not insist on a red white and blue app that sends all our data to Cambridge Analytica.
If the Gov guy goes into a meeting and says to the Techs, when will this be ready and they say “15th of MAy….” that’s all they can go on…
Go and do some background reading on who was chosen to develop the app, and how they were chosen, why they shouldn’t have been, and why all the “techs” were saying from the outset that the wrong approach was being taken. Then come back and defend the “government” (Cummings&Warner really).
Assuming we can trust the reporting, bad news:
Not necessarily. Cyno monkeys have a particularly nasty form of COVID19 disease that may be worse than humans. It is possible that amelioration of symptoms may be a favorable outcome, or that better protection is conferred in humans for similar antibody generation. Or it might not work. Welcome to drug (and vaccine) development.
Paper is here https://www.biorxiv.org/content/10.1101/2020.05.13.093195v1.full
If the Gov guy goes into a meeting and says to the Techs, when will this be ready and they say “15th of MAy….” that’s all they can go on…
That's not how IT project management works, and there's a heck of lot more involved in a project like this than just writing code. Mass roll out of an app that tracks people and their interactions is a major project with huge security and privacy requirements to address. I'd be surprised if anyone with even a passing involvement in the industry thinks it was possible to deliver something as major as this in the timescales they were suggesting. There's no way the government were not aware of the scale of it, so I think, as usual, they are spinning and overselling progress and delivery. Continuing to behave like this is particularly stupid when you need people's trust in order to get them to use the app.
speedstar, the issue with the doubling time is the urgency of the problem. On the 18th March, SAGE were talking about locking down London (only) as they thought intensive care would reach capacity in 2-3 weeks based on a 5-7 day doubling time. On the 23rd, they said oops shit it's too late the doubling time is actually 3-5 days and we're ****ed. Lockdown started that night. Whatever you can criticise the politicians for (and there is plenty), it seems to me they actually pulled their finger out on that specific score pretty quickly.
Which isn't the impression you might get from the self-exculpatory letter the modellers wrote recently pretending that they had predicted back in early March that the country would be rapidly overwhelmed without drastic action.
https://docs.google.com/document/d/1fAbVQ0snTsUFsy9uuWYtL-LkMM8NUNbSS1912inIkms/edit
Of course a lot depends on how you interpret rapid, early, drastic. The first contact I had with an epidemic modeller (who signed that letter) was him arguing specifically on the 14th of March that we had to be careful to not act too soon!
It's good that you were pointing them in the right direction Tired but it doesn't look like they took much notice of you. I only got involved around that time and it took me a week or so to get up to speed and work out what the modellers had done. I rather naively assumed they knew what R was, or at least had a pretty good idea....and was basically brushed off when I did offer some advice slightly later. It took me a little while to get my head around the idea that with tens or even hundreds of thousands of lives at stake they had made these forecasts without performing the most basic calibration of their models....still blows my mind to think about it really.
I rather naively assumed they knew what R was, or at least had a pretty good idea
About three 😉 (with unknown generation time).
By contrast, I deliberately chose to do something data-driven because I used to do that modelling, and assumed (rightly) that this is what they would all be doing. Rebasing epidemics and estimating log-slopes is not sexy, but is informative - basically I constructed epidemic percentile growth charts and compared UK. It was a grim comparison.
On the 23rd, they said oops shit it’s too late the doubling time is actually 3-5 days and we’re ****. Lockdown started that night. Whatever you can criticise the politicians for (and there is plenty), it seems to me they actually pulled their finger out on that specific score pretty quickly.
This. One hopes my analysis played some part in that.
Interesting guys. It's interesting you are blaming the modelling and hence the scientific advice as I felt it was political resistance to plenty of people remonstrating doubling time was far faster than they were coming out with. I think once it's all said and done they are going to hang all scientists involved to pardon their decision making. I really don't want them to have ammunition to do so.
I don't think the politicians will absolve themselves of blame. There is plenty to go round, with the lack of preparation through Feb being particularly egregious. But there was a very significant problem with the modelling and they have to learn to do better. My area of research is also politically relevant to put it mildly and we all get tarnished by their failure. Brushing it under the carpet isn't an option.
It’s interesting you are blaming the modelling
You must remember that the I in SPI-M is Influenza. All modelling projections were calibrated against an impending flu epidemic (the last battle of 2009). And that the academics come from a relatively small discipline (about four groups) with similar skillsets. So it is not surprising that they might all come to the same conclusion. The Royal Society launched a modelling effort from interested parties outside of Epidemiology, because, to be honest, fitting curves to exponential processes is not the premise of any one discipline. And you never know what you might find if you ask an Economist or an Electrical Engineer to analyze data.
I think once it’s all said and done they are going to hang all scientists
Will that be when Gove is PM, he loves experts who are frequently found to be wrong 😉
n0b0dy0ftheg0at
Member
Losing taste or smell is now officially a reason to isolate in UK.
This has been discussed for many weeks, I wonder why it wasn't acknowledged as a symptom until now?
Possible confusion with streaming cold (no cough/temperature) which might also give those symptoms? Colds being deemed a bit less prevalent now?
Tad concerned as I get hayfever each year from mid June to early July which is usually bad enough to cause loss of smell/taste...
This has been discussed for many weeks, I wonder why it wasn’t acknowledged as a symptom until now?
What medical Twitter was saying this afternoon.
It was acknowledged as a symptom, just not added to the list of “if you have these symptoms you must isolate”
The opinion of Prof JvT was that only a tiny number of cases would have lack of taste/smell without a cough/fever, so no point adding it to the isolation required list.
TiRed, I think in Ferguson being given the heave ho they are already subtly working at project "it was the scientist's fault." Vallance and Whitty might find themselves in a very isolated place soon if the recriminations begin.
I also want to get your opinion on whether you believe the virus is about to proliferate again? I don't see why it won't yet i see online so many businesses now making preparations for their grand opening. As a clinician I'm now trying to keep my mouth shut and just hoping for the best as any opposing POV will go down very badly. It fills me with dread to think about the potential negative outcomes for us all if it all just restarts again.
Restarts again? Again?! They haven’t waited for it to subside enough to enable successful containment of new occurrences, so it hasn’t stopped. They seem to have accepted, and expect us to accept, a high level of ongoing death and disruption compared to everywhere else (except USA, Russia & Brazil).
I agree with you Kelvin don't worry! But what's to be done? Also it may not happen. Right? Right?
Genuinely I also really worry about the effects on business. I worry people are simply going to come to accept the high death toll for the economy to survive. As a worker in the NHS with a relatively secure job I don't feel I can now argue much to the contrary.
I think a large chunk of the UK population will just accept just that… and in a few weeks time anyone complaining about deaths or serious illness in their own family will be labelled “snowflakes”… still furloughed workers as “scroungers”… and those still working at home referred to as “out of touch elites”… it’s coming.
^
It's already happening, it's come down from on high that when we return to work (some already have) that any complaints about working conditions will be frowned upon
I'm expecting it to grow again, but it won't be as quick or massive because lots of people have arranged their lives with much less contact regardless of any relaxation of the laws and lots of high contact businesses eg pubs and clubs will be closed for the foreseeable. I vaguely predict an increase in cases over the next week or so (not based on any specific modelling or calculation, just a hunch).
still furloughed workers as “scroungers”
This is happening. Several people I know have had WhatsApp/text argument or been to work Teams meeting where there's a jealousy over the fact that some people are being paid to sty at home, whilst others are working.
I also want to get your opinion on whether you believe the virus is about to proliferate again? I don’t see why it won’t
Pretty much how I see it, it might take longer to build due to ongoing behavioural changes but surely it still will?
It’s already happening, it’s come down from on high that when we return to work (some already have) that any complaints about working conditions will be frowned upon
First they came for the teachers, and no one complained, because they hate there own kids......🤣🤣🤣
And at the same moment that 1000s of foreign nurses are saving British life's the Home secretary is telling them they are not welcome anymore and they have to pay extra for the privilege of working here.
Anyone who voted Tory should be ashamed of the current situation.
I also want to get your opinion on whether you believe the virus is about to proliferate again? I don’t see why it won’t
thecaptain and I are in complete agreement here:
1) Do nothing - cases double every three days
2) Do lockdown - cases halve every eight-ten days
Anything in-between is possible. Where we might want to be is some happy half-way medium, where new cases are neither growing nor declining - endemic state (not due to lack of susceptibles) due to some control of contacts/transmission probability and more rapid treatment and test/tracing. In truth we won't go back to (1) for some time, maybe two years, due to human behavior.
Thanks for all the replies. I wonder how much more social mixing is required to make it get exponential again? Surely in urban areas not a whole lot due to intense multiplication of any effect?
Yes, we are probably at about R=0.8 (ballpark national figure) meaning that we don't have a lot of headroom for more social contact before it goes over 1.
On the positive side, being a bit over 1 isn't an instant disaster, it is possible that it will be somewhat self-policing if people draw their horns in a bit when they see the numbers going up. That's a risky strategy though and there may be a lot of collateral damage along the way. I don't claim any particular insights into the behavioural side, just guessing really. We are in a hole and need a bit of luck.
The opinion of Prof JvT was that only a tiny number of cases would have lack of taste/smell without a cough/fever, so no point adding it to the isolation required list.
Is this “30th February” van Tam? Not sure I’m ready to rely on much he says.
If I am honest, we are now at point where behavioural science and medical advances must be the priority. Models have served their purpose, which was to characterise the epidemic gravity and make some suggestions about intervention. We’ve done those. We know what effect they’ve had. Back to my day job of finding new treatments.
And thankful we are too!
Interesting one today. I haven’t flown since 11 March, and no change on the horizon. Contacted by BA today - Penlon are looking to recruit grounded pilots on a short term basis for the testing of their new Ventilators. The job has been done by F1 techs, but they are going back to their teams. It’s nice to feel wanted!
1) Do nothing – cases double every three days
2) Do lockdown – cases halve every eight-ten days
I'm just speculating and have no specific expertise, but it seems to me that the variation of R between individuals may be more important than the mean value of R.
In (1), say mean R was about 3, perhaps for 10 infected people maybe one infected only 1 other, two infected 2, four infected 3, two infected 4 and one infected 5. In (2) mean R is say, 0.8, but the 10 infected people are behaving differently - maybe six of them isolate effectively and infect nobody, three are moderately careful but each infect 1 other and the tenth person is reckless or uninformed and infects 5. Depending how each type responds to lockdown, the effect on R could be trivial or huge.
Welcome to the world of mixing patterns. And nowhere is it more important that sexually transmitted diseases. Think about it. Most chains will be two, may be three long. Some will be longer. And then you have the ultra promiscuous and commercial sex workers. Who will you target? Why does HIV Prep make sense?
For COVID19 it’s exactly the same. Who are the super spreaders? My son for one#. You will need to put 80% of your efforts against those 20%! Be it testing, tracing, treatment, vaccination or just plain eduction.
#no he’s not promiscuous - he searches passengers at LHR! Dozens a day. Close up. And their luggage.
Sorry if this has already been asked but - our numbers are only declining slowly despite far fewer social interactions. So is it possible that most of the cases are now in places where contact is unavoidable such as care homes?
Do we even have data on where and how the cases are still occurring?
our numbers are only declining slowly despite far fewer social interactions. So is it possible that most of the cases are now in places where contact is unavoidable such as care homes?
Healthcare settings/care homes are surely the only place where lots of strangers have been getting up close and personal with each other in recent weeks so it's a plausible hypothesis and you're not the first to think of it:
https://www.spectator.co.uk/article/we-know-everything-and-nothing-about-covid
Healthcare settings/care homes
and personal homes if there are community care/nursing needs.
Latest announcement about anyone over 5 being 'eligible' for a test presumably doesn't mean there'll be a testing station nearby or they'll actually get one. I'm eligible to win the ernie bonds. Complete load of nudgery.
Some immunity perspective from a preprint following reinfection dynamics of the other four circulating coronaviruses. Basically expect about six to twelve months immunity. And perhaps a little cross-reactivity. Ten patients and 20 patient-years of data.
https://www.medrxiv.org/content/10.1101/2020.05.11.20086439v1
And for some bad news, an outbreak on two mink farms hints that there may be other reservoirs if/when the virus becomes endemic.
https://www.biorxiv.org/content/10.1101/2020.05.18.101493v1
And at the same moment that 1000s of foreign nurses are saving British life’s the Home secretary is telling them they are not welcome anymore and they have to pay extra for the privilege of working here.
Anyone who voted Tory should be ashamed of the current situation.
These are people who voted a self-serving liar into office in the hope he would enact their xenophobic/racist 'return to a golden age' fantasies.
They are incapable of feeling shame.
Thanks for that TiRed. I have been looking for experience from other corona viruses but not seen any (apart from the Russian Flu 1889 pandemic likely being the crossing point for one of our current 'only a cold' corona viruses - HCoV-OC43 - couldn't find any literature about reinfection with it though).
My mum swears blind that she had it at Christmas - we were at my brother's in northern France so she's smugly pointing to the BBC article that it was likely circulating there at the time. She then went to see my sister (where she basically stayed in bed for a week and was pretty poorly). I have been counter arguing that my sister would have been properly exposed then (and indeed felt mildly ill) so the fact my sister was diagnosed with COVID19 (and was much more ill) a couple of weeks ago makes it unlikely that either had an early instance. Short spans of immunity, however, would ruin my argument. I think, in the circumstances, I would prefer to be right...
And for some bad news, an outbreak on two mink farms hints that there may be other reservoirs if/when the virus becomes endemic.
There has also been reported cases in domestic cats (In Australia and China) which is more worrying.
On public understanding and reactions to logarithmic graphs…
Common cold coronaviruses – not actually harmful in the overwhelming majority of patients, so no need for vaccines which nearly always carry a very small risk of side-effects etc.
As I pointed out "economic reasons". Globally - Days/productivity loss is billions per year.
There is still hope for therapies which reduce the severity of the infection, but dialling it down to a sniffle seems very much out of reach.
But it is a sniffle for many... for others potentially life threatening and for others largely fatal regardless of current interventions.
Other than age and general frailty there seems very little joined up understanding of why a perfectly healthy 30yr old will die and a 50 yr old parent asymptomatic.
If we understood why then we might be well on the way to making it less than fatal.
Much as it seems truly random that seems unlikely and given the differences it seems to me like it may be several reasons rather than one. This is based on my experience modelling other things this points towards having some unknowns that effectively make different use cases.
Very simplistically we have a trigger (virus) and an outcome we are trying to avoid (death) but there are multiple pathways between them and the most successful interventions to avoid this outcome don't of necessity have to be the same.
ICU is by it's nature reactionary, they treat the symptoms but it's entirely possible/probable that earlier more specific interventions can prevent the disease getting to that point.
If we could incrementally identify those that can be protected or treated differently and the threat minimised we could be well on our way to a herd immunity that kills far fewer people.
Herd immunity if it requires a % of the population can be achieved by preventing infections in those for which there is an elevated risk that can't be managed.
You could say this is what the current planning is doing .. targeting school age kids but it is doing so in a very crude way without considering that they may not be ill and quite often asymptomatic but they will spread the virus regardless.
How does herd immunity work if natural immunity wanes after 6 months?
TiRed
By contrast, I deliberately chose to do something data-driven because I used to do that modelling, and assumed (rightly) that this is what they would all be doing. Rebasing epidemics and estimating log-slopes is not sexy, but is informative – basically I constructed epidemic percentile growth charts and compared UK. It was a grim comparison.
We seem to come back to British exceptionalism.
Forget for now anything more sophisticated than a semi-log graph at which point do we expect the virus to behave differently in the UK than Italy, Spain and France?
How does herd immunity work if natural immunity wanes after 6 months?
If you forgo international spread then the virus MAY simply die off of it's own accord.
It might not... but it will radically reduce infections whilst we continue to work on both a vaccine and better treatments that target specifics. We don't even know it's 6mo... it might be longer for a vastly reduced response?
Either way what I should probably have said more explicitly is we don't know near enough at the moment to be considering this.
My mum swears blind that she had it at Christmas
Well I spent 5 weeks through December and January with a constant cough. Went through all of us at work, one of my colleagues had brought it back as a present from one of our investigator meetings. I can't recall exactly where he'd been but we do a lot in Asia and China is now a 5 or 6 meetings a year destination for us. So after a few days in the company of 100 or so medics from a number of countries he came back coughing which he gave to the rest of us. All of us except the boss who is on immunosuppressants who was fine.
I'm sure hundreds of us can now come up with anecdotal stories of symptoms we could somehow link back to this but they are just anecdotes, nothing more. There are a million and one other things we could have had in our office far more likely than this.