Lots of data
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
The government needs to get its head out its arse quite quickly. This isn't Brexit. Messages need to be clear and consistent and not leaked via Peston and/or Kuennesberg. This whole "Herd Immunity" fiasco is a perfect example.
Looks like Italy is introducing a points-based system for access to intensive care. Basically, if you're over 80, you're not going to get it. Younger people with significant co-morbidities also. Sounds brutal, but we live in brutal times.
Formalises the kind of decisions that medics will already be making over there, and over here shortly.
mudmuchers
...We would likely need 200k+ ICU beds to tackle this, so sadly the death rate will be 5%+ if they go for 40-50M infections.
They are talking about not treating the over 65s, so they won't need so many ICU beds, but the death rate may be higher.
The difference in advice between countries is striking. My daughter flies back from Spain today, and unless I have missed it the NHS advice is that there is no need to self isolate or anything unless one of us has a cough/fever. In pretty much every other country (ireland for example) returnees from Spain are asked to isolate for 14 days.
Sorry, your calcs are out by 10X. I assume you are basing on 50M being infected? If so…
1% = 500,000
5% = 2.5MWHO say 5% need ventilating in ICU (2.5M). We have 4K ICU beds, 3k already occupied.
We would likely need 200k+ ICU beds to tackle this, so sadly the death rate will be 5%+ if they go for 40-50M infections.
Only if the entire nation catch it simitaneously . If we can keep the new infection rate into the thousands a week , of the ,lets say 10,000 a week then by taking an average age of 38, most of those people will have to suffer flu at home , lets say half require medical intervention( 38yr -57yr old) , and half of those 57+ need ventiltaion / icu etc then thats down to 2,500 beds , ok some may need 2 weeks of care
I am not a stats man but people will panic and go into home lockdown when the body bags start stacking up slowing the pick up rate and giving the NHS a chance to save a few
Cant we convert Schools into instant hospitals? lots of rooms, heating, lighting, kitchens, car parks, playing feilds for temp structure, just need to fit them out with all the tech , that we dont have sitting around in warehouses waiting to be drawn down in the case of a national emergency
Sure it’s possible, I am only speculating. But I think that they haven’t been open with us because of what they think our reaction would have been. They have to wait til we’re ready to accept the measures.
Back to the government catastrophic change approach to handling things theory.
That's me clocking on for another shift in the rabbit hole.
The law of unintended consequences coupled with mismanagement. Massive crowds at US airports as people desperately try to get back into the country following the travel ban.
https://twitter.com/JasonWhitely/status/1238986444615618561
Lucky for them, and us, Jared Kushner appears to be at the helm of much of the White House's disaster planning.
BBC news now about possible 4 month self-isolation for over 70s. My dad lives on his own after mum died a year ago and we are 2 hours away. He doesn’t have a local network to support him. He wouldn’t cope wit this. Really worried. Even more frustrating he has just had an offer accepted on house near us, but I suspect virus will put a spanner in the works with that.
DIY Ventilator:
Only if the entire nation catch it simitaneously . If we can keep the new infection rate into the thousands a week , of the ,lets say 10,000 a week then by taking an average age of 38, most of those people will have to suffer flu at home , lets say half require medical intervention( 38yr -57yr old) , and half of those 57+ need ventiltaion / icu etc then thats down to 2,500 beds , ok some may need 2 weeks of care
The problem is 10K a week is it is nowhere near the levels to get the herd immunity they are after. 10K week = 520K/yr, so it would literally take 100 years to get 80% of the pop infected.
They need 1-2M/week to get this for their strategy to work.
As you can see this is 100X our NHS capacity.
Since the 9th February flood, we've had my 89 yo mother living with us, which has been a strain. Now it looks like we'll be quarantined with her. Not sure what the practicalities of taking a 17 year old away from college and two adults away from work for 4 months are......we could relocate partner and son but housing supply in the area is already strained, and friends with spare rooms are at a premium. Trying to find out what my employer (at least i'm not self employed) is going to make of this.
....While I’m on a roll with the good news, The Italian doctors are warning there is a lot of younger people on ventilators.
I expect the age threshold to get one will drop quite low once we are 100x oversubscribed for ventilators.
Will start of with over 80s not being treated, then 70s, 60s, 50s, 40s etc., as the ventilators get taken up.
Bojo is saying he is looking into getting more ventilators. I suspect they are all sold out!
Just watching S Korean foreign minister on Marr. She's mighty impressive. Interesting they are not locking down but monitoring through phone apps and treating/isolating as soon as people become ill.
Plan based on super connected and disciplined population. S Korea rate of new infections falling
Bojo is saying he is looking into getting more ventilators. I suspect they are all sold out!
Has he also mentioned sorting out the space to put them all (40 new hospitals maybe?) and the staff to operate them and look after the people who are on them (50,000 nurses possibly?).
Might also need some trained doctors to assess whether people need them or not.
Just putting it out there... I'm sure the Government have all this well in hand and haven't been catastrophically stupid and short-sighted in every single NHS interaction over the last 10 years or so.
a strategy to get a herd immunity rate among the young and healthy seems worth trying.
It’s just dangerous nonsense. Drop it. The government have. If you were to be attempting this, how would you be keeping these million of guinea pigs away from their peers with asthma, diabetes etc? How would you protect teachers? Medical workers?
I'm no fan of Johnson - but the first way to increase capacity is to cancel all elective surgery and use the space and staff freed up to treat covid patients.
I realise the freed up staff will not be infectious disease or critical care specialists but at least its qualified staff
Just watching S Korean foreign minister on Marr. She’s mighty impressive. Interesting they are not locking down but monitoring through phone apps and treating/isolating as soon as people become ill.
Plan based on super connected and disciplined population. S Korea rate of new infections falling
Yes, I think Korea have shown this can be done in a democratic country through extensive testing and containment. We have a blueprint for something that will work with minimal deaths, but Bojo wants to proceed with getting us all infected.
https://www.worldometers.info/coronavirus/country/south-korea/
Interesting graph of the daily cases in Korea.
It has been dropping for 10 days now from 850/day, to 76 today.
Sorry, your calcs are out by 10X. I assume you are basing on 50M being infected? If so…
1% = 500,000
5% = 2.5MNow I’m really depressed !
Now your seeing why they’re rattled.
There will be redeployment of staff within NHS to fight this. For example, physios with basic medical knowledge working at testing centres. They won't be doing their day job but as NHS staff they'll be doing something different for the wider good
Since the 9th February flood, we’ve had my 89 yo mother living with us, which has been a strain. Now it looks like we’ll be quarantined with her. Not sure what the practicalities of taking a 17 year old away from college and two adults away from work for 4 months are……we could relocate partner and son but housing supply in the area is already strained, and friends with spare rooms are at a premium. Trying to find out what my employer (at least i’m not self employed) is going to make of this.
Hope you get something sorted.
Hey everyone, there’s a new and largely unknown virus in town, why don’t you all run out into the streets and play with it?!
That's really not what was suggested at any point. I know you're angry but stay rational.
I don't see how the lock down approach is meant to work anyway.
Laughable how little these buffoons know about UK manufacturing that they expect UK firms to switch productions lines designed for cars, diggers and jet engines to make ventilators.
That or it’s deliberate mis direction.
And why do we need to envoke ‘wartime spirit’ for every crisis. Have we still not got over the war we won with the help of two superpowers 🤷🏻♂️
It seems there's been a slight turnaround at work since I was last in on Thursday.
Then there was plans afoot to create a central testing laboratory to operate 24/7 to cope with the thousands of tests expected. Now they've ramped that down as members of the public will not be routinely offered tests,only those admitted.
Not sure if this is nationwide, but if the general public aren't being tested to any great degree, how can the outbreak be accurately monitored? Might lead to a potential, sorry term drop in new cases too.
Bojo is saying he is looking into getting more ventilators. I suspect they are all sold out!
This is a good reason to slow the spread as much as possible. More time to produce ventilators (although there are not anywhere near enough trained staff to look after them, time to train more too I guess). More time to develop masks that are easy to use, but provide more protection than a surgical mask. More time to understand the virus and it’s behaviour, to develop a vaccine.
Not shutting schools immediately is a big mistake imho.
Please forgive me these crazy ideas, but some out of the box ideas will be needed I think, to best get us through this and I’d be interested in others ideas:
We need better instruction/guidance on how to isolate and how to reduce virus transmission in the home. Some sort of reality tv show that everyone would want to watch, where they try different strategies and discuss what works.
Since the main problem with the disease is the overreaction of the immune system - I seem to recall that some people have attempted to treat themselves in the past with parasites like tapeworm (but this was deemed to potentially bring about its own problems), has any progress been made in understanding how parasites dampen the immune response and begun to find a safer way to do this?
Again sorry for the crap questions, but I have numerous questions and half baked ideas that are difficult to talk about sensibly in a forum.
Herd immunity...
It’s just dangerous nonsense. Drop it. The government have.
Have the government officially said they are dropping this strategy?
https://twitter.com/leovaradkar/status/1239128244533825543?s=21
Shit’s got serious if they have to close the pubs. 😲
Big national holiday this week in Ireland (you all know what it is... ☘️). I imagine all parades etc have been cancelled. I’d propose a re-scheduling to sometime in July; let’s say...the 12th?
Sobering, 10 pages of obits in the Diario di Bérgamo
https://twitter.com/davcarretta/status/1238791068071661568?s=19
I’d propose a re-scheduling to sometime in July; let’s say…the 12th?
Sounds good. Has anyone mapped out whether playing a flute increases the spread of virus particles?
Not sure if this is nationwide, but if the general public aren’t being tested to any great degree, how can the outbreak be accurately monitored?
Counting back from hospital admissions and deaths. Covid-19 will displace seasonal flu activity shortly, and we don't test routinely for that, but still come up with numbers to reflect the size of this year's outbreak.
I would hope that some kind of sampling is being done for strain identification, but day-to-day, it's basically everywhere, containment policy (!) will apply everywhere, so the only thing that matters is forecasting the pressure on local and regional health services.
Sounds good. Has anyone mapped out whether playing a flute increases the spread of virus particles?
😃
Someone forwarded me this one which made I giggle...
https://twitter.com/orrcollins/status/1238407641631789057?s=21
According to a virologist I was watching on German TV yesterday, he suggested that the immunization of infected people who survive the illness is only short lived
The thing I've missed here is why Corona doesn't produce lifelong immunity - I'm sure there is a reason as I've heard this said by several sources but without the explanation. I'd assumed it was like flu (i.e. once you've had it you're immune to that strain, but you only have partial immunity to other strains).
Bojo is saying he is looking into getting more ventilators. I suspect they are all sold out!
I've heard that NHS Supply Chain has placed large orders with all the companies making ITU ventilators (which is no-one in the UK unless GE still have the Datex-Ohmeda anaesthetic machine factory in Leeds). However, I don't know the lead time, and I assume every other country in Europe has done the same.
They are talking about not treating the over 65s
I've not seen anything beyond social media suggesting there is any plan to ration intensive care based on age.
Sure it’s possible, I am only speculating. But I think that they haven’t been open with us because of what they think our reaction would have been. They have to wait til we’re ready to accept the measures.
Disagree.
What has happened here is that Johnson and Cummings were given "options" by Vallance and Whitty and they chose the riskiest response with the least amount of damage to the economy. Either Whitty and Vallance with their professional reputations being questioned by the sheer number of people in the scientific community or Johnsons political reputation being put at risk by the same, have backtracked.
Cambridge Maths department now weighing in https://www.cambridgemaths.org/blogs/handwashing-and-mathwashing/
The key message is this: models are not objective. And few who work closely with them would ever make this claim. Often however, the invocation of a model can be seen as a form of mathwashing: a way of lending credibility to an argument or justifying a course of action by appealing to mathematical authority (as if there were only one).
Here is Richard Horten, editor in chief of The Lancet, someone else who knows more than you.
https://twitter.com/richardhorton1/status/1238817240839004160
The thing I’ve missed here is why Corona doesn’t produce lifelong immunity – I’m sure there is a reason as I’ve heard this said by several sources but without the explanation. I’d assumed it was like flu (i.e. once you’ve had it you’re immune to that strain, but you only have partial immunity to other strains)."
In laymans terms, for the same reason you have to get booster vaccines for certain diseases.
Apparently ISIS have asked its members to suspend operations in europe as its too dangerous...
You couldn't make this shit up..
The places that are in lockdown, how are they going to transition out of lockdown?
Once infections rates are zero, they could ease movement restrictions within the area/region/country... but you can't let people from elsewhere in, as they could bring the virus back in and it could all kick off again. I think we will see country borders closed for quite a while.
The 'herd immunity' strategy seemed to make sense at first, but I don't think it's going to work. Just one reason of many, companies don't want their workers to get ill so are imposing their own 'lockdowns' with asking people to work from home. With those people are unlikely to get ill, how is the 60% going to be achieved?
I rarely post but as I did post yesterday I may as well follow that up.
I got through to 111 last night. I was referred for a GP call back. My wife was referred for a call back from the Nurse and Paramedic Team, presumably because she has a condition that would make her a priority.
I got a call back an hour later. The GP was concerned, noted my records to this effect and told me to call 111 to start the next stage of the process.
I got back through to 111 this morning (15 minutes of holding, which I was surprised about) and they had no record of my call or or my discussions with the GP. I got referred to nurse who apologised and told me that the only people who could be tested were those who are hospitalised. She told this is because of a shortage of swabs/kits. The woman sounded totally defeated as she told me this and was extremely apologetic.
My wife didn't get a call back so she called again this morning. She was referred to a GP who said she should be tested. However the GP then put her on hold for 5 minutes before returning to say that she had been instructed to change her advice. No test.
Shortly after that she got the call back from last night. A nurse who sounded exhausted.
So in summary, we spoke to GPs who wanted us tested. 111 refused.
We have been instructed to continue to self isolate until we are recovered.
All of the staff we spoke to were great, but all of them were clearly under great pressure. Be nice if you have to call. Hopefully you don't. Stay safe everybody.
RE the long term immunological memory to coronaviruses.
https://www.ncbi.nlm.nih.gov/pubmed/24845462
Emerging respiratory coronaviruses such as the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) pose potential biological threats to humans. SARS and MERS are manifested as severe atypical pneumonia associated with high morbidity and mortality in humans. The majority of studies carried out in SARS-CoV-infected humans and animals attribute a dysregulated/exuberant innate response as a leading contributor to SARS-CoV-mediated pathology. A decade after the 2002-2003 SARS epidemic, we do not have any approved preventive or therapeutic agents available in case of re-emergence of SARS-CoV or other related viruses. A strong neutralizing antibody response generated against the spike (S) glycoprotein of SARS-CoV is completely protective in the susceptible host. However, neutralizing antibody titers and the memory B cell response are short lived in SARS-recovered patients and the antibody will target primary homologous strain. Interestingly, the acute phase of SARS in humans is associated with a severe reduction in the number of T cells in the blood. Surprisingly, only a limited number of studies have explored the role of the T cell-mediated adaptive immune response in respiratory coronavirus pathogenesis. In this review, we discuss the role of anti-virus CD4 and CD8 T cells during respiratory coronavirus infections with a special emphasis on emerging coronaviruses.
Follow up studies from patients who recovered from SARS suggest that the SARS-CoV-specific antibody response is short lived. In these patients, SARS-CoV-specific IgM and IgA response lasted less than 6 months, while virus-specific IgG titer peaked four-months post infection and markedly declined after one year. Despite the lack of virus-specific memory B cell response, SARS-CoV-specific memory T cells persist in SARS recovered patients for up to 6 years post-infection. Consistent with these human studies, results from animal studies also suggests that strong virus-specific T cell response are required to protect mice from lethal SARS-CoV-MA15 infection. The future vaccine interventions should also consider strategies to enhance T cell response to provide robust long-term memory. Since, tissue resident memory T cells provides better protection, boosting a local and systemic memory T cell response would be a useful strategy than either of these interventions alone.
Essentially, I wouldn't take a gamble on the herd immunity plan, especially when actual virologists are having doubts.
@cyclelife Thanks - that's helpful in expoing the mechanism. If it's saying 6-12/12 retained immunity, then those at risk will all be getting annual coronavirus immunisation in the same way as flu, then (assuming a practical vaccine can be made, which remains to be seen).
Essentially, I wouldn’t take a gamble on the herd immunity plan.
100% agree. We don’t want to find out this doesn’t work after we have wiped out 2-3million people.
Also there is no knowledge if 2nd and 3rd infections become progressively more dangerous. There seems to be a concern about pulmonary fibrosis even in mild cases. That might mean increasing mortality the second time you get it. Infecting 50M people when this is unknown is madness
IANChrisWHitty nor Dominic Cummings, but...
I'm not a believer in herd immunity as a wave 1 strategy (and I'm willing to believe that the CMO and CSO have been misreported by dicks like Boris) but, if you could delay this shit "long enough" I'd hope that experience from early cases worldwide will increase and inform subsequent management. What works and doesn't - drugs, ventilation, ECMO and then things like convalescent serum - half of the world's confirmed cases are recovered (if Johns Hopkins' site is correct) and their plasma MIGHT modify severity. I'm assuming it's been/being tried.
Some time long after that, vaccines'n'shit.
I don't really see how the less aggressive measures early on, as applied in UK, can possibly help with that delay. They (have been reported to) talk about how pressurised the NHS will be next winter as though that might justify "getting it done" earlier, and imply how non-compliant the public would be with draconian measures. As I see it, the sort of things that bung up the NHS in winter may well be reduced by the same measures anyway (noro, flu would both drop significantly if we all stay away from each other and wash our hands) and JCB might have loads of nice yellow ventilators for us by then too. We could have (more) properly addressed the possible use of extra sites for low-grade NHS work by then as well. Trained more NHS staff to meaningfully help crtically ill patients, supported social care to a point where the risk groups can be supported in isolation, ... Almost all of that would also be of longer term value to the nation (for the next time)
My guess also is that the public would modify its behaviour even in the fairly long term if "real" preparations were visible
A genuine, if inappropriate thought this morning - anyone know what the funeral director business is saying about response/shortages if this kicks off?
anyone know what the funeral director business
Spoke with bro in law who is in that business this morning.
Says they are moving to a a+b shifts working at separate times.
But they are scaling back advertising due to the sensitivity of the subject (large national you will have seen on the telly)
They also expect to be less busy in the short term as folk cut back on irresponsible mass gatherings of vulnerable people.
Long term - they expect to be busy.
As far as shortages and storage....that hasn't really impacted yet and from the way they are talking it's going to be a take it as it comes, there is little they can do in the short term to increase capacity.
His dark sense of humour at the moment says *eat lots of ice cream* .....like they do on the submarines.
I’ve heard that NHS Supply Chain has placed large orders with all the companies making ITU ventilators (which is no-one in the UK unless GE still have the Datex-Ohmeda anaesthetic machine factory in Leeds). However, I don’t know the lead time, and I assume every other country in Europe has done the same.
They will all be sold to other parties long before NHS supply chain. Would sell to someone who pays in arrears at the lowest price and demands weeks of paperwork?
Chatting to my friend in Belgium this morning about how the more extreme measures are being taken by the people. He said everyone is on board with it and realises the gravity of the situation.
Also they are genuinely amazed the U.K. isn’t taking this seriously
Have the government officially said they are dropping this strategy?
Officially they have said very little. Latest news, from a paywall article in the Torygraph is that Hancock is saying that there was never any "herd immunity" strategy. That was just a leak to a useful idiot like Peston who then tweeted it to test reaction.
