We're getting very close to what will need to be a 'grown up' discussion about death. And in particular what is an acceptable rate of it.
It is clear that the main driver behind the initial lockdown in March '20, and that behind the second in November '20, was the fear of 'bodies piled high'.
Is it fair to say that, even on the most pessimistic of estimates, the likelihood of further deaths reaching the tens of thousands is unlikely?
If the threat of excess mortality was taken equally seriously everywhere and everywhen, would we not have a tiered response - utilising enforced distancing, mandatory mask wearing, even targetted local lockdowns - every winter to counter flu outbreaks?
I'm concerned that we are on the verge of facing a 'reverse ferret' from the people who were expected to rebel against what they did not, but who may well rebel against it now.
'Pent up demand' could be expressed in all sorts of ways.
Is it fair to say that, even on the most pessimistic of estimates, the likelihood of further deaths reaching the tens of thousands is unlikely?
Possibly. Maybe even probably. The increase in cases has not yet become a big increase in deaths, and increasingly I'm growing in confidence it won't. But I think it is *just* too early to call it as an absolute fact. By maybe a week or two even, but if we blow it now and the increase starts after we've opened up then it's hard to stop.
The next phase of opening will cause more infections, but if they are of generally minor illness (even more so than previously, covid is minor for a large proportion) then we can live with it. People will die proportionally to infections, and we have to 'accept' that too. D = fC, we don't know what f is yet and if it is small enough to be tolerated.
There’s a whole world of (currently poorly measured) outcomes between minor illness and death.
The increase in cases has not yet become a big increase in deaths, and increasingly I’m growing in confidence it won’t. But I think it is *just* too early to call it as an absolute fact. By maybe a week or two even, but if we blow it now and the increase starts after we’ve opened up then it’s hard to stop.
The next phase of opening will cause more infections, but if they are of generally minor illness (even more so than previously, covid is minor for a large proportion) then we can live with it.
A lot of good points on there.
The problem is that while 20% of the population are unvaccinated as they are under 18, and maybe 20% are unvaccinated because they can't/won't, that's a huge reservoir for it to spread and potentially clog up the NHS with non-crtitical Covid patients who will prevent the NHS even starting to make inroads into the backlog of regular medical cases. This is an NHS that was at breaking point before this came along and is losing exhausted and experienced staff who can't be easily replaced.
As for the future - if more people washed their hands, kept their distance (or worked from home if possible) and wore masks if feeling under the weather, maybe the winter cold/flu would be less severe. I've not lost any riding time due to "illness" for 15 months now, which is some kind of record, and that's with kids being at school as well.
There are important lessons we should all carry forward from the pandemic. Going back to all the old ways of living in order to feel "normality" would be daft. (Yes, employers and government need to figure out how to manage and support that)
MCTD
The 40% unvaccinated, the kids we can discount, they really don't get seriously ill, the people who won't get vaccinated, meh, they can live with the consequences, the people who can't be vaccinated have to live with the risks from many other infections as well, they are often more at risk from other simple infections than the rest of us. Its an unfortunate fact of life. In reality at least some of the kids will be vaccinated and there's not much we can do to make people who won't take the vaccine unless we want to involve coercion and that's not the way our medical systems work.
As for not going back to the old ways, it will happen, many people still haven't been directly touched by this apart from all the restrictions, those that have been seriously ill or lost people have first hand experience of what this virus can do, they are in a minority and we know from previous experience the electorate in this country is quite happy to do things diametrically opposed to what's innit best interests. I can see some WFH continuing and some mask wearing when people have a cold but not anywhere near significant enough to maintain the low infection rates for Flu we've seen this last year. Ironically theres now concern they wont predict this years dominant flu strain due to the low infection rates.
If we allow a huge increase in cases over the coming months, it is not just the unvaccinated that will be at risk. Having said that, disregard for those who can’t have the vaccine and are relying on the rest of us, has been the most depressing “talking point” of the last 18 months, and still is. We can do better as a society. We have the tools and the knowledge, let’s use them intelligently.
Yes, for deaths read 'deaths and serious long term issues'
And while I agree the numbers are not well known for them (KCL study said 5% have symptoms >8 weeks, another ONS study said 13.7%), the majority of people do not die or have serious long term symptoms.
As unpalatable as it is, stumpyjon makes very real points wrt the unvaccinated. We cannot protect everyone indefinitely, not least those that choose not to protect themselves. Noting of course then 'we' will still be there for them when it goes pearshaped, MCTD point well noted.
the kids we can discount, they really don’t get seriously
I've read a couple of papers yesterday that are suggesting (early evidence) that the Delta variant may be leading to higher levels of long term Cov19 in teens and young adults.
the majority of people do not die or have serious long term symptoms.
However there are the clinically vulnerable.
There is an even smaller group for whom vaccination doesn't work, and are clinically vulnerable. Mrs_oab included.
Edit: to add. It's the god question. Are we at a place where deaths through other health issues, mental health, economic issues will kill more people than Cv19. You get to live, you get to risk dying.
I’ve read a couple of papers yesterday that are suggesting (early evidence) that the Delta variant may be leading to higher levels of long term Cov19 in teens and young adults.
This. What seems to be missing in the above posts is what we don’t know about the effects of Covid / long Covid on our kids. It my seem to be a non issue if my 8yo gets it now, but we don’t that she might encounter breathing difficulties later in life preventing not only opportunity but perhaps potential disability and fragility after her mid life years. On that’s basis I’m hugely reluctant to expose my children albeit accepting they need to get an education. We merely do our best with cleanliness and masks.
From our company though, sensible news. Offices are being prepared to be reopened with an acceptance of a “new Normal” and personal anxiety, with Covid prepared spaces, limited attendance, booked desks, enhanced cleaning and non mandatory attendance including more flexible wfh policies for those that didn’t have them in the first place. It seems to me that you’ll get a choice of where to work / meet and a series of guidelines to follow. Most sensible thing I’ve heard from our lot in ages.
We cannot protect everyone indefinitely
We can keep moderate control measures in place while we roll out the vaccines. Trying to make the second half of 2022 “normal”, or living in “indefinite” lockdown, are not the only two options.
The 40% unvaccinated, the kids we can discount, they really don’t get seriously ill, the people who won’t get vaccinated, meh, they can live with the consequences, the people who can’t be vaccinated have to live with the risks from many other infections as well, they are often more at risk from other simple infections than the rest of us. Its an unfortunate fact of life.
Doesn't take a big percentage 20 million people getting ill to **** up the health system for the rest of us, let alone the long covid issues that are unknown.
I get the balance of "life" versus dying as a risk exercise. I'm not convinced we have enough vaccinated to protect the NHS enough to go for it just yet.
I get the balance of “life” versus dying as a risk exercise. I’m not convinced we have enough vaccinated to protect the NHS enough to go for it just yet.
And it’s worth remembering we are only 4 months away from Flu Season…
And it’s worth remembering we are only 4 months away from Flu Season…
Where we may not have a working flu vaccine as there isn't much circulating to base it on....
There’s plenty circulating, just not in Australia, New Zealand etc. Their lack of a normal flu season leaves us exposed. We need to look elsewhere for the data. Not easy with everything else that’s going on in the countries we need to look to for that data.
We’re getting very close to what will need to be a ‘grown up’ discussion about death. And in particular what is an acceptable rate of it.
Agreed. It doesn't seem like the NHS is in any danger of being overwhelmed this time around, so the debate is simply around what is 'acceptable' in terms of deaths and long-term illness. There are unknowns around the impact on younger patients with the delta variant, and there is still the possibility that we will see a higher rate of deaths/morbidity in younger groups, and a noticeable death toll in the under 40s.
My view is that you do place a higher weighting on younger people dying or being made ill long-term, as the NHS does for all sorts of value judgements about where it spends its money.
It could be that the next two weeks will bring enough data about the likely shape of the wave, and the impact on unvaccinated groups, to make a call on reopening. The schools have only just gone back, and my feeling is that we won't know for a couple of weekends due to the lag in transmission/hospitalisation.
Personally, I think we should delay the final step for another fortnight, and obviously blitz vaccinate wherever possible. That little interruption in vaccine supply which shoved us back about three weeks may turn out to be more than inconvenient.
As for the future – if more people washed their hands, kept their distance (or worked from home if possible) and wore masks if feeling under the weather, maybe the winter cold/flu would be less severe. I’ve not lost any riding time due to “illness” for 15 months now, which is some kind of record, and that’s with kids being at school as well.
I'm not sure this will happen to any large degree, people still want their old lives back.... and also not sure if it would be a good thing overall. Lost riding time due to a cold is annoying, but doesn't our immune system benefit from regular exposure ?
It doesn’t seem like the NHS is in any danger of being overwhelmed this time around
It is currently overwhelmed. Or do you not know people who've been waiting for treatment far longer than normal? It might well be treating all patients requiring urgent care, but is most definitely overwhelmed, and kicking patients into the long grass because of the ongoing pandemic.
It is currently overwhelmed
Just we are so used to them being overwhelmed it doesn't register. We have winter waiting lists (and worse) in mid summer.
Maybe the vaccine will reduce the Covid crisis, but the NHS crisis is going nowhere any time soon
It is currently overwhelmed
More than 5 million people on waiting lists
I hadn't even seen the news today... these headlines came up when I searched for figures to back up the anecdotes I've heard about people waiting (including myself as it happens, for something minor in my case)...
SKY: COVID-19: Record high hospital waiting list in England as 5.1 million need treatment
BBC: Hospital waiting list tops 5m in England
Guardian: Number of people on England’s NHS waiting list tops 5m for first time
Bolton deaths did not go up again which is very good news.
I think we can be certain that the link between cases and deaths has changed significantly. This is due to vaccination.
Admissions have dropped despite cases remaining elevated. I do not know the cause of this.
There's overwhelmed and then there's overwhelmed. When we talk about overwhelmed re covid, what we mean is how close we were to every ICU bed being full and people just simply dying because they couldn't be treated. When we talk about overwhelmed in a normal winter we mean black alerts, individual hospitals turning people away. When we talk about overwhelmed re other things, we mean waiting lists. It's not all the same thing, sometimes it kills people in the next 24 hours, sometimes it's more subtle.
Well, people are being turned away. Not for "dead in 24 hours" stuff, for sure, but for "you need to go and get this done privately, because otherwise your condition will be irreversible in a probably deadly way by the time we get to you" stuff (I know people who have had that chat because hospitals are currently at breaking point, and will be for a long time yet... and that's without another wave of Covid hospitalisations... and that needs avoiding or things will get a whole lot worse).
Trying not to look backwards, but truth matters if we aren’t going to repeat mistakes…
https://twitter.com/reicherstephen/status/1402999585207853060?s=21
https://twitter.com/reicherstephen/status/1403001091663433738?s=21
https://twitter.com/reicherstephen/status/1403002780793540609?s=21
Admissions have dropped despite cases remaining elevated. I do not know the cause of this
People scared that they have CV19 and particularly a new variant?
People scared that they have CV19 and particularly a new variant?
Or the people getting it now are no longer that vulnerable / in danger of dying so coping at home?
Folks are only in hospital for days rather than weeks, you can see the numbers bouncing up and downs lot more due to this.
It's been slow progress (although in truth the whole vaccination pace is incredible tbh) but we're getting there 🙏🏻
Just watched the news seeing the snivelling shit Hancock being quizzed about the situation in care homes.
I really hope there are consequences for what happened.
My sister worked as an OT across a number of care homes in Sussex. Her accounts of what she had to deal with are worse than anything I have seen reported in this country, at the time or since.
Truly horrific and a direct result of government policy to free up hospital beds by discharging elderly Covid patients into care homes full of residents. It beggars belief really. She had to deal with several outbreaks and witnessed people dying who she had spent a long time caring for, who should have been protected.
A friend wrote a scientific paper along with (sorry can't remember the correct number) about 43 other scientists, to the government with the reasons why the country should lockdown 'now'. This was at the very start of this pandemic in early March 2020.
The government in its wisdom decided to ignore this very important advice.
I agree with Kelvin and others that we need to wait an extra 2 or 3 weeks to get more data, before the massive decision of 'opening up and people thinking the virus has gone away and everything is normal again'.
Regarding the nhs being overwhelmed, we know that many nhs employees are leaving, are worn out and are not or cannot be replaced.
I see your point but there comes a point when we need to test and learn our way to living with this virus. The current 3 odd week wait to gather a significant amount of data seems sensible, take the next step then maybe roll back, its just a very large scale AB test. Remove all measure in one go seems a little daft as I don't get how you pinpoint the reason it has or hasnt worked. But the next step of say upping capacity in restaurants for example seems a logical step.
Data from Public Health England confirms there have been 42 deaths so far in England with the Delta variant. Of this number, 23 were unvaccinated, seven were more than 21 days after their first dose of vaccine, and 12 were more than 14 days after their second dose.
Agree with you joepud, and I fully expect the government to do some release on the "freedom day" the papers have got over excited about, but not remove all measures. There are many intermediate steps we can take this year, rather than going all or nothing at the end of this month. To make this a bit more personal... increasing the number who can attend weddings, rather than having no limit at all or sticking with the current limit, for example. More graduation of release, rather than off or on. More generally... perhaps INCREASING mask use as we remove other restrictions, rather than doing away with masks... that's something I'd like to see considered.
More generally… perhaps INCREASING mask use as we remove other restrictions, rather than doing away with masks… that’s something I’d like to see considered.
I think mask use a really interesting one. I personally can't see me getting on the tube or going into tesco without one any time soon. I feel like it should just be a given that people have to continue to wear a mask. This idea of "freedom day" and suddenly the covid risk ends is really dumb... but that seems to the the wider thinking in this country. What is it Drakeford said a little while ago just because you can doesn't mean you should.
A slight aside with the TDLR being “Could I have had Covid”?
For my bike training I have a surprising inability for short hard efforts - power at VO2max or Z5 efforts. It’s dropped my ability for a 20 minute effort.
Now, in Feb 2020 I was ill with a “Flu and Gastro” virus according to the docs, and I always wondered if I’d had Covid, after I’d spent the whole of January 2020 surfing the Tube.
No other issue, could this be a minor Covid issue for me?
This idea of “freedom day” and suddenly the covid risk ends is really dumb… but that seems to the the wider thinking in this country. What is it Drakeford said a little while ago just because you can doesn’t mean you should.
Absolutely agree - some things maybe can should be relaxed, but not everything, otherwise how do you know what behaviour might be causing spikes?
Not sure how we've ended up with a press and public who can only see "all or nothing" - on any issue.
Given the current scenario a reversal of lifting of restrictions would seem sensible, we've got an increasing incidence of a variant we're not very sure of, which is probably going to grow exponentially with a delayed reaction on hospital admissions and deaths, all within a month of lifting the need to wear masks in secondary schools and other freedoms.
Pieface +1
Did you mean a halting of the lifting of restrictions, rather than a reversal of the lifting, which sounds like reimposing some?
Many secondary schools round here kept the face mask requirement, and they all encourage the wearing of them. Still intrigued how one had 170 positive tests straight away though, must have genuinely been licking each other
What's the need to extend the lockdown when the NHS is currently a million miles from being overwhelmed? We're at just 7 covid related deaths a day in England, I'm not sure how that justifies continued emergency restrictions unless anyone would care to explain.
I think that going ahead with lifting restrictions on the 21st of June is insanity.
Given what's been happening in the last couple of weeks, exercising a bit of Plan > Do > Review I would like to see some restrictions being re-imposed. Don't ask me which ones though!
The Roadmap was all based on the assumption of the virus behaving in a known way and vaccination working in an asusmed way. Unfortunately a combination of a significant lifting of restrictions, the Delta variant and our cack-handed border controls means that the roadmap needs reviewing, and we should possibly consider a detour or U-turn with an overnight stay in the Holiday Inn.
Seeing the majority behaviour of people when on holiday last week you'd think Covid had gone away.
What’s the need to extend the lockdown when the NHS is currently a million miles from being overwhelmed?
You skipped the previous page, yeah?
SKY: COVID-19: Record high hospital waiting list in England as 5.1 million need treatment
BBC: Hospital waiting list tops 5m in England
Guardian: Number of people on England’s NHS waiting list tops 5m for first time
There's a huge backlog to work through. Adding another wave of Covid to that needs to be avoided. We also need to actively do something to help and retain burnt out staff.
There’s a huge backlog to work through. Adding another wave of Covid to that needs to be avoided. We also need to actively do something to help and retain burnt out staff.
Yes there is, some of which has been a perpetual problem for decades from a lack of investment, shite staff morale and compounded by staff leaving in flocks, and the rest are from GPs refusing to see anyone for the last 14 months leading to health issues not being nipped in the bud and scaring the public into not going to hospital for critical care because they were told the NHS has better things to be focusing on.
The first is nothing to do with covid and society shouldn't be paying for it with lockdowns, and the second is just irresponsible behaviour from politicians, the media and the NHS.
Yes, but that is ignoring just how bad things currently are. Saying there were waiting lists that could/should have been reduced before the pandemic is true, but things are now many times worse… and will get worse still if the NHS has to deal with another wave, even if that wave involves far fewer deaths than the previous ones.
