UKC

Picking up this post from two months ago.  (Sorry; rant alert...)

It was a suggestion - presented with no scientific basis but an unspecified allusion to looking at the data - that the data from France suggested that covid had already killed all the susceptible in France and “therefore returning to 'normal life' is the best course”.  

https://www.ukclimbing.com/forums/off_belay/france_covid_cases_vs_deaths-72...

Today, France has about 36,000 cases per day, about 250 deaths per day, a case fatality rate of over 1% on a 14 day lag from detection to infection, has deaths and cases increasing exponentially and just went in to lockdown.  I’ve made a figure to illustrate some of this - from Worldometer data, see below.

What bothered me at the time about the linked post was not that it was clearly absurd to me to draw such a conclusion let alone to do so without actually explaining in a numeric way how the data supported it, but that it very rapidly got a lot of likes.  I think people - quite understandably - are looking for comfort and an easy way out of this awful mess.  I wish it was that simple, and what bothers me about people taking comfort in these false prophecies is that said comfort could go on to undermine the personal commitment to doing the right thing despite the often low level of immediate personal risk and the onerous and sometimes really quite negative personal effects from following best practice in controlling spread.  But superficially the data at the time was very comforting and most people reading the thread don’t spend their lives with their head in data and so couldn’t be expected to verify or invalidate the poster’s theory. 

Anyhow, if you bothered to read to the end of this, take comfort in the plot below instead - if shows how long it takes for cases or deaths to double in various countries.  That the UK’s doubling time for deaths is larger than most nearby countries is really promising - this tells me that the sacrifices we are all making are having a big effect compared to neighbouring countries and compared to our crisis in March/April.  We wouldn’t have to do that much more to tip it over from a doubling time to a halving time, meaning that cases are decreasing.  Keep the faith, be careful and there will be light at the end of the tunnel.

/END OF RANT

The UK's case rate increase has definitely slackened over the past week or so, before then it was constantly increasing daily. Live case numbers are still increasing steadily by ~5,000 a day.   However, is this just the university spike coming out of the system only to be replaced by a general increase? Something to keep an eye on I think.

France are stuffed, BBC says 50% of their hospital beds have covid patients in them at present, these will have been generated by the case load a week or so ago...... which is about 5/8ths of what it was yesterday. So they're highly likely to be overwhelmed in a week or two's time.

As explained clearly by President Macron yesterday evening in his broadcast. Not looking forward to another confinement but I'm not sure there was any real alternative. Hopefully we won't be restricted to a km radius of home this time

My guess is that we have seen a slight flattening of the overall UK rate increase over the last week or two caused by the flattening of the increase rates in areas that have the highest current rates (including but not only areas whose rates were temporarily increased by Universities). But as other areas catch up as they are now quickly doing, their figures will become more significant to the overall total and unless they also begin to flatten considerably then it will start to increase the overall total faster again.

Today's react study seems to show this support this, with r much higher in areas of the south with lower current prevalence. It makes sense but I struggle to understand why the national figures aren't now increasing faster already. Lack of testing still? Or possibly just that we are always looking at data that is 5 days old... but then so is react.

Edit to say that not all areas of high prevalence have flattened since the beginning of October, just most. Eg Blackburn looks really bad.

I agree re: universities masking things in cases.  I think two things are causing the growth rate of detected cases to slacken more than the underlying trailing (1) the university fresher’s spike falling down again has been masking the national level exponential rise in headline figures and (2) the gap between detected cases and actual infections is rising.

They need to remove the uni cases from the cases for their areas and look at what the background rates are doing. 

280,000 tests processed yesterday.  Going with 100,000 actual cases that would be a 36% positivity rate.  I think the WHO guidance is that it shouldn’t be higher than 5% for effective testing, meaning we’d need a capacity of 2,000,000 tests per day - but at that point I think the logistics just explodes.  Test and trace is a pruning system and beyond a certain point in the exponential growth curve it becomes largely ineffective.

I think every day the cases are falling further behind the actuals. 

The PHE and ONS updates will be interesting to say the least.

They'd have to start batch testing if they wanted to test way more people. That might require some better coordination. 

I really can't understand why France (and Spain and Germany and the UK) have let it get away again - I guess western governments can't really act until it is seen to be serious, and by then it is too late - again,

Chris

I don't know if that'll work - batch testing works well to improve efficiency at a low prevalence rate, but if the React report is correct then the prevalence is possibly too high. I guess batches of ten people's swabs would be worthwhile, but batches of 100 would always test positive if the prevalence is the 1 in 78 calculated by the React report.

Perhaps batch test areas of low prevalence, individual tests for hot spots. 

I think the problem is still the unknown and the experimental nature of trying to 'live with the virus' whilst entering the unknown quantity of Europe's winter.  I guess they had predictions which say R will be a certain value with % compliance to rules a,b,&c, and those predictions are wrong (or they're ignored for personal or perceived political gain).  Governments are desperate to keep their economies going and there's the misplaced belief that the virus is impossible to eliminate and we'll have to live with it.  There was the belief that a bit of social distancing, mask use and T&T was enough to prevent a rise in cases, or that an outbreak is easily dealt with by local lockdowns. However, the reality is that it isn't, and that restrictions that cripple the economy, government, and community will be required to 'live with the virus' in winter.  I don't think that's sustainable and believe elimination and strong borders is the way forward whilst there's no guarantee of a vaccine anytime soon.

  The writing should have been on the wall for governments in August when it became obvious that the live caseload was increasing as jurisdictions gradually came out of lockdown and the knowledge that the virus was going to be easier to spread in winter when more people are cooped up inside and the weather doesn't kill it off. Even the best T&T systems in Europe (Germany) were not keeping a lid on things, so what did they miraculously expect to happen?

I've just done some maths to try to work out the UK's the 'crash the NHS' potential.
France's live caseload* a week ago was about 307k, about 0.4% (1 in 250) of their population. That caseload resulted in 50% of their available beds occupied by covid patients today, therefore their current caseload of ~425k is probably going to crash their healthcare system.

According to BBC, France has about twice the hospital bed capacity that the UK does and both countries have a similar population size.

Beds per 100k population:- Germany 800, France 591, Italy 314, Spain 297, UK 246.

..so the UK should theoretically crash the NHS at a caseload half that of France's current load - 300k live cases.

Current UK live caseload* was 268k cases yesterday, increasing by 5-7k cases per day (7 day average, peaked at over 7k per day for a week solid in mid october, now down to 5.8k yesterday).  Assuming everything is equal between UK and French healthcare and likelihood of cases needing hospital treatment, the UK should expect a national lockdown in about a week's time and actually needs one now :-/.

I believe it has to be a national lockdown because the areas 'locked down' can't be unlocked whilst locking down other areas due to the likely slow decline in prevalence in the 'locked down' areas, but am happy for anyone keener to look at the rate of decline in the number of people in lockdown versus the rate of growth in number of people not locked down to give a better idea of the overall rate of decline / growth.

* I'm assuming it takes 2 weeks on average to get over an infection from onset of symptoms and thus calculate live cases as being total cases today minus total cases 2 weeks ago.

Yes, it needs some intelligent use of capacity.

France appear to have more than double the number of hospital beds and ICU beds than the UK.

A different approach to asking the asme question you are...  The number in hospital in the UK is about one doubling period away from hitting the same peak as back in March/April, and that doubling period is currently about 14 days - this is looking at the second plot in [1].

That wasn't quite "crash the NHS" levels before but it was damned close.  There's been a lot of reconfiguration since then so presumably the "crash" level is higher, but it would be madness to deliberately hold cases anywhere near that level as one loss of control and ka-boom...

So yes, if we want to wind things back from the brink we need to act immediately given the lag from lockdown to peak hospital occupancy due to the lag between infection and hospitalisation, and the time it takes for cases to burn through a typical household.  Last time hospital occupancy increase for ~ 3 weeks after lockdown; with our new doubling rate that would see us close to the crash level if we locked down today.

Tentatively the growth rate in everything (cases, hospitalisations, admissions) are all slackening which if actual, buys maybe another week or so, but that slackening could disappear as the south takes the lead. 

I imagine the people advising the government have spelt all this out with access to far more compelling data than you and I, so I wonder what their plan is?  I don't think they're going to lock down but try another round of finessing restrictions with a Tier 4, leaving us approaching "crash the NHS" Zeno's Paradox style.  

[1] https://coronavirus.data.gov.uk/healthcare

They'll obviously want to lockdown at some point in order to 'save Christmas', the question is when is the best time? I'd suggest sooner rather than later (because that's normally the best idea), but if they don't lockdown hard or long enough they won't get the caseload down low enough and unlocking for xmas will risk an instant caseload rise and xmas lockdown.  Do we have any idea how effective the Welsh lockdown has been?

Yep, their healthcare system is much bigger due to their socialist attitude to health. But their Covid situation is also about twice as bad as ours - growth in cases has been higher for some time (months) - 3.7% versus 2.6% yesterday (7 day average)) for example; and their live caseload is 425k compared to the UK's 268k.

Let's run the numbers for Germany:-

Germany has 1.35 times the French bed numbers, so  should theoretically crash their healthcare at 575k live cases.

Current Germany live caseload was 130k cases yesterday, increasing by 7k cases per day (7 day average and showing no signs of peaking yet).  Assuming everything is equal between German and French healthcare and likelihood of cases needing hospital treatment, Germany should expect a national lockdown in about 2 months time, however the new restrictions are likely to extend that, and thus they will probably just manage to 'save Christmas' without a prior lockdown.  At that point though, the prevalence level will be much higher and harder to control. I think they'll end up with a defined circuit-breaker lockdown of sorts to retain some breathing space if they're not able to retain control.  The imminent UK lockdown and French lockdowns will focus their minds and they'll do well.

I'm not really sure what'crash the NHS' means. It seems to me that talking in national terms is a waste of time because the prevalence is highly variable and so will remain the hospital load for some time. If someone needs intensive care in Newcastle you can't give them a spare bed in Newquay. I'm not sure how much flexibility the system actually does have to shift capacity around, and I'm not sure how much use the Nightingales are. So in conclusion I think trying to predict when NHS overload will occur, based on public data, is a mug's game. But in some areas we surely can't be far off.

To *some* extent you can.  Some patients will be stable enough to put in a helicopter, or you can do what the French did and convert a train to a mobile ICU for moving people around the country.

Best summary I've seen for Wales: https://www.bbc.co.uk/news/uk-wales-52380643 

The above seems to updated regularly. There's also the Public Health Wales dashboard for finer detail but there aren't the same comparison charts. https://phw.nhs.wales/topics/latest-information-on-novel-coronavirus-covid-...

To me, though the numbers are a bit jittery, it looks like in North Wales most counties started levelling off or heading down when the county lockdowns started at the beginning of October, and the further lockdown has kept the rates low or pushed them lower. Anglesey is currently on the up - it was the county least restricted until a week ago. Overall, it looks as if despite our grousing there is some positive effect from being shut in and perhaps the Welsh govt. don't deserve all the scorn heaped on them...

Don't know what support is on offer for struggling people and businesses - if only they can get that right.

The picture in South Wales looks different, I'm not sure why as I haven't been following. They do have the disadvantages of greater population density, including more students. And perhaps more mixing (e.g. commuting) over greater distances?