it all comes down to Cummings calling the shots, while Johnson stayed away from it all… the absent PM leaving the country in the hands of a sociopath
While I am tempted to this view myself, I think we need to be careful trying to get the facts to fit our own beliefs as to what happened.
Do the Sage minutes cover the discussions about whether to lock down in useful detail? Some on the group must have been pushing for an earlier lockdown, unless full groupthink had kicked in - is there any indication how close previous decisions/advice were, or who over ruled who? (And maybe it was Cummings?)
They don't cover discussions, or dissension, at all, just top level findings and actions.
The SAGE minutes do not discuss differences of opinion but rather summarise the overall recommendations/conclusions. They still thought the doubling time was 5-7 days as late as the 18th March at which point they recommended shutting schools (only). Their next meeting was the 23rd March at which point they realised the doubling time was much shorter than they had previously thought, and Johnson gave his lockdown speech that night.
It's quite possible that some among them were asking for more action, sooner, but this was not what the group as a whole was saying at the time. In fact on the 13th they also explicitly stated that indefinite suppression was not practical and that China would have a second wave when it relaxed controls. They were still firmly in a mitigation mindset and thought incorrectly that the epidemic was still some way off at that point.
This is all on the gov website and easily googleable if anyone doubts my interpretation. But I've been following this in some detail for several months and am not wrong.
The reason I focus so much on the doubling time is that it's a critical determinant both of how soon the epidemic arrives and also how great a demand it places on the NHS. SAGE were saying we had time to spare up right to the moment they realised it was too late.
This is all on the gov website and easily googleable if anyone doubts my interpretation. But I’ve been following this in some detail for several months and am not wrong.
Yes, it is... but remember... the findings reported in the "minutes" already had political framing applied to them... unless we've still pretending that Cummings was involved in them for his expertise. Anyway, I care not whether the Sage bunker, or the Cabinet Office bunker dropped the ball.. I want to know why Cummings was left in charge of both, while our PM was hands off (well, apart from the hand shaking), and why outside voices, especially those closer to what was happening in European countries hit before us and where the spread was already being analysed, were ignored.
SAGE were saying we had time to spare up right to the moment they realised it was too late
The doubling time was stated as 5-6 days on March 18th. On the 20th SAGE were aware that deaths were doubling every two days and cases every three days. On the 23rd we locked down.
I agree that modelling failed in this area. I published my first prediction of doubling on March 14th.
There was no documented SAGE meeting on the 20th. There is a SPI-M consensus statement with that date, so presumably this sub-group had some sort of meeting at that time. Participation in which was not stated on the document. The first documented SAGE meeting after this was the 23rd (21/2 was a weekend, so it's not quite as inexcusable as it sounds).
My first documented mention of 3 day doubling was on the 9th March, but I certainly don't believe I was the first to notice this, and this mention is in the publication of a blog post I'd taken a day or two writing, so it was probably clear earlier than that to anyone paying attention. Of course at that point I had no idea that SAGE were so dozy so I didn't think it really needed shouting about. A week later they started talking about 5 day doubling and being 4 weeks behind Italy, at which point I think a lot of numerate outsiders started to wonder WTF was going on because it was obviously nonsense.
at which point I think a lot of numerate outsiders started to wonder WTF was going on because it was obviously nonsense
And that point should have come much earlier. The secrecy around SAGE at the time contributed to the mess we ended up in.
To be honest, I wasn’t following what was going on, but a groin strain meant I couldn’t ride that weekend so thought I’d have a play. No hard modelling was required, so no idea where the SAGE doubling time was coming from. I then did a little networking rather than shouting.
With the increase in cases in many countries, is it the bumpy tail of Peak 1, or the start of the 2nd peak?
With the increase in cases in many countries, is it the bumpy tail of Peak 1, or the start of the 2nd peak?
for me 100% just a continuation of peak 1. Saying its a "second wave" suggest we got over the first which the world really didn't. Boris misspoke but whats new there.
Is that significant?
Depends on the (govt and societal) response in each country. There may come a point at which we are too tired and broke to keep on keeping on with it. But I don't think we are there yet, and I don't expect any European country to get anywhere near as bad as in their first waves whatever happens. A whole load of the more vulnerable older retirees just don't have to go out much if they don't want to, and half the care homes have had it already, so that population won't be so vulnerable again. (Note: I'm not saying there aren't a lot of vulnerable people, just not the same 100% situation as in March.)
for me 100% just a continuation of peak 1. Saying its a “second wave” suggest we got over the first which the world really didn’t. Boris misspoke but whats new there.
If you look at the US as a model, they didn't drive their Wave 1 rates low enough before reopening and generally being assholes about social distancing etc, hence new spikes. We also did not get our rates particularly low before relaxing lockdown, so it's highly probable we will start to see a similar albeit less pronounced shape to our graph.
Fortunately, we have a world-beating test and trace system in place to save us...
One thing my other half noticed was that there appears to be a lower number of Pillar 2 tests happening now. The P2 results were what revealed the outbreak in Leicester. Perhaps that has been taken over by in-hospital testing, but it would be worrying if the kind of community surveillance that is needed right now is not happening.
Spain does look like it's heading for a second "spike" (in the North)... but it's all the same... they never got rid of the first wave (and neither have we). There are areas of the UK that are far more likely to trigger a second spike here though.
There may come a point at which we are too tired and broke to keep on keeping on with it. But I don’t think we are there yet, and I don’t expect any European country to get anywhere near as bad as in their first waves whatever happens.
I'd agree, the future is that we now have to live with it, and make the best of it, unless there is some kind of brilliant medical breakthrough.
Let's be hopeful..'until' there is a brilliant medical break through.
Let’s be hopeful..’until’ there is a brilliant medical break through.
I'm doubtful there will be a brilliant medical breakthrough. There should be a series of improved treatments which will hopefully reduce the impact of this virus in the vulnerable so that survival rates are improved and long-term health complications for survivors are reduced.
Signs of that already - dexamethasone, some promising antibody treatments, perhaps a vaccine which boosts the body's response rather than prevents it altogether, beta-interferon, a better understanding of the clotting/blood vessel effects.
But yes, this is something we have to adapt to and live with, rather than eliminate and proceed as normal.
There have been quite a number of significant breakthroughs in treatment and I wouldn't be surprised if the fatality rate has almost halved (on an age adjusted manner) since the start of the outbreak.
The Daily Fail are reporting that the Govt have signed up to 60 Million as yet non-existing vaccines from GSK...
When you ride down a hill you go faster. Applying the brakes slows you down. When you release the brakes you speed up again. We know what happens with and without the brakes. The aim is to get to the bottom of the hill relatively unscathed. For COVID that means with relatively few deaths. There is no first or second "wave", it's all part of the same downhill ride.
I wouldn’t be surprised if the fatality rate has almost halved
Steady - dexamethasone reduced overall mortality by about 12%. Management of mild/moderates may reduce IFR, but it is very unusual to see such large effects in almost any branch of medicine!
The aim is to get to the bottom of the hill relatively unscathed.
The aim should be to stay up the hill ‘till they’ve properly cleared the trail ahead. Go down it earlier and we know thousands die. Hold back and go down later and thousands of people will thank us.
[ edit : that was meant to support your analogy, not contradict it, hope it does ]
Not just dexawhatever, but also ventilation protocols and capacity. I've seen empirical claims of much reduced mortality in hospital cases though of course this does depend on who gets hospitalised. 50% may be on the optimistic side, but even 20% reduction would still mean a lot of saved lives.
I'd take 20% based on aggressive management of mild/moderate cases with more, earlier O2 and less ventilation. The problem has been that patients have presented to hospitals more severe than in the US and that the lack of capacity for HD/ITU beds meant the most likely to die did not receive the management that may have saved them. More capacity will help manage that dilemma and naturally improve outcomes. Treatments and vaccines will come, but not in time for this winter.
The Daily Fail are reporting that the Govt have signed up to 60 Million as yet non-existing vaccines from GSK…
Thats not the whole story, Sky reporting that the total is 250 million spread across a wide range of companies. I can see that they are trying to secure a pot of vaccines before they are whisked away by Trump, but this is a worrying level of trust with public monies.
There's a Tory MP on Five Live at the moment
Absolutely ****ing unbelievable. Truly beyond belief how detached from reality these people are
Asked what people should do if they can't afford to take two weeks unpaid off work to quarantine on return from a holiday...
His answer...
Go to a food bank
Seriously. That's his solution. The next thing, he's going to act surprised when people aren't doing two weeks quarantine
I see the latest figures for daily deaths in the US has had the largest daily rise since May. I guess the leap in infections they saw start several weeks ago has started to come through the lag now. Oh dear, they seem to be in a bit of a mess.
Absolutely ****ing unbelievable. Truly beyond belief how detached from reality these people are
Asked what people should do if they can’t afford to take two weeks unpaid off work to quarantine on return from a holiday…
His answer…
Go to a food bank
Is it just me who thinks that anyone who has to rely on food banks if they have to take 2 weeks off shouldn’t really be flying away on foreign holidays during a global pandemic?
I don't think anyone should be away for their holidays this year either... but that is not what the government have been saying... and, don't forget, there are other reasons to move between countries... visiting family you haven't seen for ages, or, heaven forbid... your work!
Anti-IL-6 trial from Roche was negative. All the endpoints are going in the right direction (albeit with modest improvements), but ultimately the trial was too small to measure the size of any effect (450 subjects). Remdesivir is being tested in a trial 10x bigger.
https://www.roche.com/investors/updates/inv-update-2020-07-29.htm
Had high hopes for this one, as it makes a lot of mechanistic sense in the blockade of cytokine storm. Sarilumab also had a negative trial and they work essentially the same way.
https://www.sanofi.com/en/media-room/press-releases/2020/2020-07-02-22-30-00
BTW in the "how to read pharma press releases 101" course, when you read the headline, if it says Company XXX will provide an update on YYY, then it is negative. Positive headlines leave no room for interpretation.
That's all 🙁
Positive headlines leave no room for interpretation.
Sounds like the old maxim of "thin letters always say no" - not sure what the modern email equivalent is.
@TiRed do you have sufficient data to test the WHOs "young people causing the spike" conjecture?
That’s all
Damn. Good that there are so many different ideas being tried out, we need to be ready for lots of negatives... but for you and your people that's cold comfort right now.
And where someone else in this thread was moaning about the government promising money in so many different directions as regards drugs companies... I say let them dangle that carrot at our expense.. whoever delivers deserves the finance... but so do those trying and coming up short (to a lesser extent).
I see the latest figures for daily deaths in the US has had the largest daily rise since May. I guess the leap in infections they saw start several weeks ago has started to come through the lag now. Oh dear, they seem to be in a bit of a mess.
They still have a long way before the catch us up in deaths per head of population, another 75k deaths in fact.
They still have a long way before the catch us up in deaths per head of population, another 75k deaths in fact.
About 2 months then 🙁
This one may be connected to the BSL4 Virus lab in Wuhan. Cannot rule out the possibility of an accidental/ non accidental spillage from the lab.
That conspiracy theory is so last month, we're onto 5G on here you know!
And where someone else in this thread was moaning about the government promising money in so many different directions as regards drugs companies… I say let them dangle that carrot at our expense.. whoever delivers deserves the finance… but so do those trying and coming up short (to a lesser extent)
I think you’ve misunderstood the complaint. Of course organisations should be funded to find, then mass produce vaccinations. The issue is with the governments scattergun approach using public money to “buy” non existent vaccinations in the hope that one appears. It’s a bit like me as a cyclist throwing £2k of my money to each manufacture and hoping one of them Provides their perfect machine for me. A bit early to throw public money at the promise of Uneducated hope imho.
How much public money is being spent up front?
Ok fair point, I don’t know and maybe none. But they have signed deals, so the intention is there.
If we end up with more than we need, I’ll be both shocked and not at all bothered about the overspend, considering what is at stake, in terms of lives, quality of life, state spending, and the economy as a whole.
But Kelvin, the real question is how much of that spend/contractual arrangement - assuming they can't get out of it - will be pissed down the drain on a company that achieves nothing? There should be some due diligence and contractual exit - maybe there is - on the basis of the vaccines success.
Its not about ending up with more than we need, its about paying millions of taxpayers money to companies with as yet now or potentially later, no tangible results.
Another analogy Kelvin - give me all your money, savings etc and I'll try and quadruple it by next March. But if I don't so what you don't get it back, hard luck. Would you? Of course you wouldn't, and I'm hoping put Government are cleverer than that despite current evidence to the contrary.
Rather depends on what we've actually done - have we paid up front for a non existent vaccine, or have we reserved the vaccine if it is developed?
The government may well have to sink money into projects that don’t come to fruition. It’s not just successful trials and development that need funding.
In the US BARDA and NIAID have funded trials and even manufacturing upfront. In the U.K. I don’t think this is true. It’s promisery notes for future purchases. I doubt but don’t know if actual money has changed hands. Makes good copy though.
When new treatments and vaccines come, it will not be competitive, it will be all you can make. Companies have signed an anti-competitive note in the US to this effect on manufacturing capacity.
Companies with manufacturing capacity because their drug didn’t work will probably manufacture other competitors. There is always a shortage of bioreactors. Vaccines may turn out to be the same.
I think pharma will come out of this pretty well, personally, and am proud of where I work.
Isolation to increase to 10 days
