UKC

Professor Johan Giesecke, a senior Swedish epidemiologist gives a very straight talking explanation of the Swedish approach and why they have not applied a lockdown: https://unherd.com/thepost/coming-up-epidemiologist-prof-johan-giesecke-sha...

It's about 35 minutes but worth watching to the end. 

The UK Covid Symptom Tracker estimates that more than 2 million people have been infected in the UK, down to 580,000 as of April 15th: https://covid.joinzoe.com/data, which supports the professor's estimate of the death rate. 

Finally, is lockdown killing people? This BBC report (https://www.bbc.co.uk/news/health-52278825?fbclid=IwAR1b-PohQf7BkI6sfU_booG...) summarises ONS statistics that show C19 caused 3500 of the deaths out of the 6000 above the normal 10,000 for this time of year.

It's worth reflecting: we have seen the reports of the sad C19 deaths, but the ONS figures show something like 2500 people have died during lockdown over the usual 10,000.  The BBC report is right to say this is a shocking figure: an increase in death rate of 25% irrespective of the virus. It's not clear why. 

It appears that lockdown is not simply saving lives. Rather it seems to be a factor in a spike in deaths that are not directly due to the virus. 

www.youtube.com/watch?v=lADB9Qu53CY

Depends how many Covid19 deaths are identified as Covid19 deaths. There's certainly been stories about that. What do you reckon?

Also unless the lockdown caused non-covid19 deaths grow exponentially like an infectious disease (seems unlikely) the unconstrained growth of Covid19 would have outstripped them even more.

Yes we should be in lockdown. Most of the unexplained extra deaths will be Covid-19 deaths but where people have died without a positive test results (we are doing very little testing): our Covid-19 death statistic is only for people dying in hospital after a positive test. Also, you have to be very careful with mulitplicative hazards which grow exponentially: dying due to DIY accidents during lockdown is not contagious and is therefore linear and a much smaller threat than a new virus which is in the early stages of exponential spread.

https://twitter.com/EWErickson/status/1251113801384185858

PS the death rate in Sweden is much higher than in any of the other Nordic countries.

That made me chuckle

The ONS deaths are from death certificates signed by GPs who attribute the death to C19  even if the patient was not tested but was judged by the GP to have C19 at the time. They include deaths in the home, care homes, hospitals and elsewhere. Consequently the ONS C19 deaths will include patients who were not included in test results

Partly because people are dying from the virus in care homes and partly because people are avoiding hospitals for treatable diseases.  Both of which would also happen if we removed lockdown.  There are probably other sources of excess deaths, I don’t think the situation without lockdown would be any kinder to those people.  I think it would likely be worse for everyone.

The ONS figures don't give any clue to that. I've no idea if anyone is looking at that.

In a lot of cases, care homes for example, are the when the doctor is called to a deceased, un-tested and frail old person are they going to spend precious time working out of it was Covid? Also there is this aspect:

https://www.mirror.co.uk/news/uk-news/nhs-doctors-told-dont-need-21882792 (sorry it's the Mirror I hope you have advert blockers (I'm not allowed to say a d b l o c k on UKC))

And https://www.homecare.co.uk/news/article.cfm/id/1624501/Coronavirus-left-off...

I'm not saying it's a conspiracy but are rushed doctors going to do detective work on every deceased person?

Also the population density for Sweden as a whole and for Stockholm are so completely different to the UK that comparisons of lockdown and its effects between the two countries are difficult, possibly even pointless.

That's exactly why I was comparing Seden to other Nordic countries (you even quoted it). I never mentioned the UK which isn;t a nordic country. Norway and Sweden for example have simiral demographics and densities but hugely different death rates (norway locked down early).

This is the best thing I have read on the subject.

http://ftalphaville.ft.com/2020/04/15/1586943153000/Why-are-we-really-in-lo...

So this excess non-covid deaths due to lockdown might not exist or it could even be saving non-covid deaths for all we know due to fewer accidents or something.

If the non-covid excess deaths grow in the same way as covid deaths that would be an incredible coincidence of timing between covid and multiple other causes. That would be an interesting analysis.

I agree , for now we need lockdown to stop overwhelming the NHS. However, the vast number of patients who would have normally presented to front line services ( chest pains , headaches , infections , abdominal pain etc) have not done so. There will likely be a vast population with decompensated heart failure , strokes , infections and so on who will either present too late to be able to have meaningful help or will die at home . 
 This lockdown will likely contribute to a significant spike in none Covid deaths. 
The figures for Covid deaths themselves are going to be hard to get right testing is just getting underway. Furthermore, we are seeing a huge range of conditions present as none Covid , but they turn out to be Covid positive. It’s a pernicious disease. Possibly responsible for peripheral vascular disease , heart attacks , strokes , kidney failure and many elderly fallers who have fractures , and likely did so because of Corvid infection ( it does not take much to augment frailty ) 

 Lock  down will cause huge mental health and material wealth problems which will cause further ongoing problems. It’s release will be a compromise between new infections and morbidity associated with social , medical and economic isolation . 

 Lockdown will casue many problems, but crucially these are mostly linear. Sooner or later we will have to un-lockdown and try and manage the spread but not yet. Hopefully we can do that what Covid-19 becomes less exponential and more steady-state (r0 close to 1 due to more people with immunity?).

As far as I'm aware with Sweden, their measures have been similar to lots of other countries but because the population tends to follow advice, they haven't felt the need to implement things legally. Their death rate from Covid-19 is still 2.5x that of Denmark, 5x that of Norway and 10x that of Finland.

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Sweden

We couldn't avoid more stringent measures as we didn't follow advice- remember the "avoid non-essential travel" period when all the national parks were overrun? 

If we hadn't locked down the doubling would have continued and there would be far more Covid casualties in the hospitals.   People having these symptoms would not be going to hospital under that scenario either.   Not locking down would free up hospitals to save them, it would wipe them out because, like everyone else, they would catch Covid but they'd be unlikely to survive.

The other side of it is that there are classes of disease and health problems which will be reduced by the lock down:

a. there was an extrapolation of a vast reduction in deaths caused by air pollution in China due to industry being shut down.   It won't be as bad in the UK but London in particular has an air pollution problem.

b. things like traffic accidents are reduced by fewer people driving.

c. there may be other infectious diseases e.g. flu getting suppressed by the lockdown.

d. possibly many people are less stressed without commutes and long hours at work and getting more sleep and more exercise.

Like I said , I agree we absolutely need to lock down now as we have done but it’s far more complex than that. Cases are not on the exponential increase now. They are slowing ( as far as we can tell ) . 
 We are seeing a slow but defined rise in non Covid cases of serious disease but nothing like our standard numbers. Agree a small decrease in trauma but this is a tiny proportion of morbidity and mortality compared to general medical conditions. Disagree  that lockdown is good for people with reduced stress and increased exercise. The economic and social fall out will be huge.  I never once said it is not necessary now but it will have to be thought about in depth. No one knows the level of immunity previous infection gives you or the role of co infection in the pathological process we now call Covid disease. 
Creating a vaccine may or may not be possible within a time frame of 6 months to years . Testing is by no means accurate. The swabs have a sensitivity of 70%, I don’t have data for the newer rapid tests. 
It is a complex and uncertain time. We have no idea the figure for the general population infected since it started. Immunological tests have so far had poor accuracy. 

Yes they are, but the rate has just lowered from 35% per day increase to ~5% per day.

Peter Capaldi was in my favourite film ever - Local Hero.

There appears to be an undercount of 2000 covid deaths in care homes in same time period.

https://www.bbc.co.uk/news/uk-52341403

There's most of the non-covid discrepancy of 2500 gone already with just one correction.

What a surprise that daily headline figure is an undercount rather than an overcount.

Case closed

In our area of France (Ariège), which has one of the lowest incidence of covid-19 in the whole of France (just 2 deaths) but is locked down like all of the others, I saw a statistic last week which identified the overall death rate in Ariège during the last month was over 20% down on the same period last year.

If more people are apparently dying during lockdown in the UK, I wouldn't be in a hurry to blame the lockdown itself.

Not quite sure from what you said, do you think ariege should be locked down or not?

The claim of extra non-covid deaths is not based on the official headlines figures, it's based on death certificates, which includes care homes. 

(Of course GPs might be under-reporting covid in care-home death certificates, but that's a different issue.)

Absolutely, yes of course. Otherwise we could confidently expect a lot more deaths, and why would we want to choose that option?

Cheers 😁

On a potentially worrying note,I have decided that Spain may not be the place for me to buy a house, and will be looking at France, with Ariege on the list, you have been warned 😂

That's because infection is being held in check by lockdown... The fact that, even with lockdown measures, the infection rate has only really flattened off, and has not fallen to zero, shows just how widespread the infection must be. Relax the lockdown now, and watch the infection rate explode again.

It would be interesting to see who is being infected now; is it people adhering to lockdown, or is it those who are having to continue to work in public-facing roles?

I read this earlier and it implies some people are now questioning the approach.

https://time.com/5817412/sweden-coronavirus/

“Sweden has a relatively high case fatality rate: as of April 8, 7.68% of the Swedes who have tested positive for COVID-19 have died of the virus. Neighboring countries, like Norway and Denmark, have case fatality rates of 1.46% and 3.85% respectively. (The U.S. case fatality rate is 3.21%.) While Sweden’s elevated case fatality rate could be a result of its low testing rates compared to its neighbors, experts say Sweden’s laissez-faire approach could also be to blame.”

I don't see how death rates have anything to do with infection rates, assuming treatment can still be given at the equivalent level. Differences in death rates can be due only to differences in testing, or differences in the virus; has it mutated into a more lethal form in Sweden, or are Swedes more susceptible?

No. Undercounting of Covid19 rather than extra non-covid appears to be the issue.

I would hope that the doctor would already be aware of a deterioration in the health of a frail old person with symptoms that indicate a likely Covid 19 infection.

Do you think that GPs are under-reporting covid19 on death certificates?

Sweden now counts all care home deaths, test positive or suspected. 

When Belgium started doing the same, or adjusted their figures last week, their statistics over took Italy. 

Every country counts differently, tests differently is at a different stage in the virus's procession, so drawing conclusions compare data is likely full of errors. 

It's a distinct possibility given that it's been in the news. C4, Guardian and FT I think.

https://mobile.twitter.com/C4Ciaran/status/1250814898973655043

Of some concern, there is apparently no science available that proves that re-infection is not possible.  On that basis, the possibility of herd immunity has no grounding until those that have contracted it, could be safely said to be immune. 
Sweden’s approach appears to be premised upon:

herd immunity

no re- infection possibility

with no notion about what % herd immunity is achieved for *this* virus.

(there is no standard rate for herd immunity, that percentage depends upon the virus).

That Tweet is about *official figures* not including care-home deaths. The official figures are NOT coming from death certificates. 

So that Tweet does *not* suggest that GPs are under-reporting covid19 on death certificates.

Perhaps read through some of those Ciaran Jenkins @C4Ciaran tweets  (my emphasis added below).

A whistleblower has told

@Channel4News

they fear Coronavirus is sometimes entirely left off death certificates in care homes and in the community, meaning the true number who die from the virus may never be properly recorded.

Whistleblower told Channel 4 News they felt: *GPs were under too much pressure sometimes taking “the easy option” in omitting Coronavirus from death certificates *GPs were not putting the “actual cause” of death on some certificates *GPs on occasion resorting to “guesswork”

GP whistleblower: “I know GPs writing bronchopneumonia or frailty of old age on death certificates when they strongly suspect Covid, to avoid running into problems."

Different population. Totally unable to validate extrinsic validity. 
 UK has a VERY unhealthy population, especially in deprived areas. Believe me. We are waiting for this ticking time bomb ! 

Well , I’m a front line NHS consultant. Plenty of my colleagues and juniors have tested positive . So far I’ve dodged it , for now !😀

That really doesn't surprise me, sadly.

What does surprise me is you're actually getting tested...

Hope you and your colleagues get the PPE you deserve, and manage to dodge the bullet.