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Covid (ctd) Since the plotting thread is full

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I was just read the Independent (!) 

https://www.independent.co.uk/news/health/covid-nhs-omicron-hospital-admiss...

One of the Professors on Nervtag is quoted as saying: 

"The people currently who are very sadly dying of Covid were probably infected on average about 35 days ago, so this was really before Omicron really started to transmit."

So how does 'on average' death 35 days after infection square with a death reporting criteria of 'within 28 days of a positive test'.

I'm guessing I'm missing something and it isn't quite this bad but maybe somebody can tell me what?

1
 wintertree 31 Dec 2021
In reply to tom_in_edinburgh:

The test is a few days after infection which is something you might need to factor in, but if the longitudinal estimates really are 35 days that’s not enough to pull them in to the 28 day criteria.

Data is available from the dashboard api under a 60-day cutoff as well; this will obviously include more “with covid” as well as some more “from covid” deaths.  Historically there’s not been much difference in the measures - except perhaps a longer tail in the 60-day data.

The API key is “newDeaths60DaysByPublishDate”

I’ll run off a comparative plot later today when the laptop is out…

If there is a big discrepancy that needs a bit more attention than a small comment in a news story…. Generally the 28 days measure has not held any surprises when compared with others, but these are strange times.

 Jenny C 31 Dec 2021
In reply to skog:

>> Aren’t restrictions a back door way to compulsory vaccinations

>I suppose it depends how far you're willing to stretch the definition of 'compulsory', but that's not how I'd use it.

>I'm against people being required by law to be vaccinated; I'm fine with vaccination being required for them to participate in activities (including certain jobs) where the unvaccinated are a significant risk. If they have the choice to e.g. just not get on a plane, or even to get a different job, it's then up to them whether they think it's worth it.

>I wouldn't want to see unvaccinated people e.g. banned from the supermarket, that wouldn't be proportionate.

Agreed.

Incentivising people is fine by me and restricting the activities of the unvaccinated (unless genuinely medically justified) is also ok.

But actually forcing people to have the jab is a step too far for me, even as a staunch supporter of vaccination.

Post edited at 13:02
2
 elsewhere 31 Dec 2021

Various news coverage of falling cases in South Africa, but SA waves look spikier or cases go back to near zero quicker than our waves do.

Fingers crossed but don't get too excited yet.

https://ourworldindata.org/explorers/coronavirus-data-explorer?facet=none&a...

Post edited at 13:13
 Andy Hardy 31 Dec 2021
In reply to Offwidth:

Jesus Christ. What the hell have those tossers been smoking?

 wintertree 31 Dec 2021
In reply to tom_in_edinburgh:

Plot of the 28- and 60-day measures.  I've put them through a 7-day rolling average but otherwise raw data.

The black lines show actual values on the left axis.  Solid is 60 days, dashed is 28 days.

The red lins show ratios.

  • The solid line is the ratio between the 60-day and 28-day measures.  It looks to have floated around the range 1.3 ± 0,1 for the duration of the delta wavel
  • The dash line shows 2.14 which is equal to 60/28.  This is the ratio we would expect if Covid had no association with lethality - that is it didn't make people any more likely to die, and it didn't preferentially infect people who were anyway close to death.
    • Clearly Covid is still strongly associated with lethality!

So, at the moment there's about 20 people a day more dying within 60 days of a test than within 28 days.

The occasional plot I've done of all cause mortality gated by +ve Covid tests suggests at most 10% of the 28-day deaths are "with Covid" not "of Covid", which would explain about half of that discrepancy I think

  • But, this is an analysis to take with a pinch of salt as I'm not well qualified to do more than poke at those numbers with a blunt stick.
  • Still, there's good reason to think less than half of infections are being detected as cases in the general population, which is the dataset used to estimate the deaths "with Covid" in my noddy analysis.  However, the deaths will mostly be from hospitals, and so will have a much higher ratio of infections to detected cases, so this could close the gap.

Plotting the API key newDailyNsoDeathsByDeathDate (Daily numbers of deaths of people whose death certificate mentioned COVID-19 as one of the causes. Data are reported by date of death. There is a lag in reporting of at least 11 days because the data are based on death registrations.) shows a line (dashed blue) much closer to the 28-day measure than the 60-day measure.

It doesn't seem to me like we're being deceived by the 28-day measure; how to square that with the quote you linked?  I wonder how many unvaccinated people get their first test at home when the coughing starts, and how many wait until they go to hospital?  If the later, that would put the time from first test to death well within the 28-day measure for 35-day old infections.  Bit wooly and data-free as straw clutching goes, but given the anecdotes from a couple of posters who have the privilege of helping people go to hospital over the last few months...


1
 The New NickB 31 Dec 2021
In reply to wintertree:

I was looking at the gap between peak infection and peak death during January 2021, granted this was based on 28 day data, it was only 15 days (10th January - 25th January).

 wintertree 31 Dec 2021
In reply to elsewhere:

>  but SA waves look spikier or cases go back to near zero quicker than our waves do.

Hospital admissions have also stopped rising there which is notable.

Then again, they've had about 0.5% excess deaths on a much younger population than us; if we'd lost people at the same vulnerability thresholds perhaps we'd be going in to this wave with 2 million less vulnerable people.  That would make quite a difference to how things would go...

> Fingers crossed but don't get too excited yet.

A related and open question to me is "has London peaked or are things just suspended for Christmas?".  Hard to tell from the data, but if the former, that's a promising sign too....

In reply to Andy Hardy:

> Jesus Christ. What the hell have those tossers been smoking?

The Internet.  Twitter, Facebook, Telegram and god knows what else.

I'm amazed Piers Corbyn hasn't croaked of Covid, given his stated attitude to vaccination, masks and anything else.  No surprises he's a long term climate change denier too...

In reply to TheNewNickB:

Indeed; peaks and troughs in cases and deaths normally come less than 4 weeks apart; there can be "long tail" effect however in a rapidly decaying phase.  

Post edited at 14:02
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 summo 31 Dec 2021
In reply to wintertree:

I wouldn't be surprised if many anti vaxers have secretly been vaxed, just to hedge their bets. Protesting seems as much a hobby or pastime to them, leaping from cause to cause. 

1
 elsewhere 31 Dec 2021
In reply to wintertree:

I suspect we may have a UK shaped waves  rather than SA shaped waves for cases/admissions/deaths. I have no idea why the waves look different as there are so many differences between countries and so many similarities within homo sapiens. Hence I just look at shapes!

Null hypothesis - 2.14 - excellent point.

Post edited at 14:41
 Offwidth 31 Dec 2021
In reply to Andy Hardy:

Something strong? Here's another incident 'serving legal documents' earlier this year (listen out for what the Pope did!!??):

https://www.mirror.co.uk/news/uk-news/anti-vaccine-activists-storm-nhs-2526...

Post edited at 17:21
 Offwidth 31 Dec 2021
In reply to wintertree:

Latest ONS infection survey. 1 in 25 in England (2 million) with covid, 1in 40 elsewhere in the home nations. 1 in 15 in London.

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/con...

 wintertree 31 Dec 2021
In reply to Offwidth:

Yup, there's a lot of Covid about by now.

Updated plot below with the ONS random sampling estimates and the pillar 1+2 results.

Given the differences in the data source (live infection vs new infection) they still seem to be tracking pretty well; PCR only data looks to be dropping down in relation to the other measures; tallies with an observation from Si dH on the full thread.

Big news today over Paxlovid being approved in the UK.  Potentially a massive transformation - 90% reduction in hospitalisations from trial data.

Real world problems include....

  • The need to rapidly diagnose vulnerable infected individuals to get them on the compound - set against reports of PCR capacity not keeping up.  Another reason - on top of preserving capacity for health and care staff - to stop PCR testing on younger, low risk adults and go with properly administered LFTs only?
  • Complex drug-drug and potentially  drug-food (I,e. herbal supplement) interactions with the Ritonavir component [1].

Fingers crossed...

[1] https://www.covid19treatmentguidelines.nih.gov/therapies/statement-on-paxlo...


 Moacs 31 Dec 2021
In reply to tom_in_edinburgh:

> I was just read the Independent (!) 

> One of the Professors on Nervtag is quoted as saying: 

> "The people currently who are very sadly dying of Covid were probably infected on average about 35 days ago, so this was really before Omicron really started to transmit."

> So how does 'on average' death 35 days after infection square with a death reporting criteria of 'within 28 days of a positive test'.

> I'm guessing I'm missing something and it isn't quite this bad but maybe somebody can tell me what?

I suspect it's as prosaic an explanation as that they went to hospital and never came out...and had Covid throughout so that's what got recorded as cause.  Longer than 28 days from first PCR.

And a small aside: it grinds my gears when people suggest thta being run over by a bus 28 days after infection would be in the numbers. The doctors writing the death certificates are not idiots.

1
 fred99 31 Dec 2021
In reply to Offwidth:

> Moron watch:

My immediate reaction when hearing of this was that I wanted to do some serious hurt to one and all of them. Particularly as the Police are now actively looking for one of them who has apparently stolen something from the location - presumably either something vital for its' operation, or worse, details of those working there.

These people are no longer in the "misguided" bracket - they are now plain bloody dangerous.

I can only hope that nobody at the centre has ended up catching Covid off these criminals.

 bruxist 31 Dec 2021
In reply to wintertree and thread (follow-on from #58):

I suppose what I'm getting at is that, at varying points over the last two years, we've puzzled over what strategy Gov is following. At times, Gov cleaved to SAGE advice closely, and we didn't have to theorize. At other times, Gov action was clearly at odds with SAGE advice, and at those points we tried to work out what other unpublished advice Gov might be favouring over SAGE (it usually turned out to be some form of Barringtonism).

To me, the last point at which we had to have a discussion and come up with a viable explanatory theory was the point in July just before Whitty announced that we needed to relax NPIs over the autumn in order that pressure on the NHS be relieved over winter. As I recall, this made sense to most of us: we accepted the logic of a combination of the vaccine programme and natural immunity in the young ought to result in some inevitable deaths not being deferred but greater future hazard being avoided - a manageable loss in the autumn in order to achieve a kind of hybrid herd immunity by the winter. It clearly meant significant increased hazard for groups such as teachers, but the vaccine would prevent serious damage in those groups. Our thinking and Whitty's stated logic matched at that point.

But since then, things have turned, and it's not solely the emergence of omicron. There is, once again, a very clear divergence from SAGE's plans: its advice on NPIs is ignored; symptom eligibility for PCR testing is still restricted to a now extinct variant; modelling is being weaponized in a culture war fashion familiar from Brexit. We don't see much of the CMO or CSO anymore, and the last time we did, on 15 Dec, Whitty seemed angry and uncharacteristically undiplomatic, as he has in the few public statements he's made since. We can see quite clearly that the strategy has failed: high rates of infection in autumn haven't prevented a winter wave. That's mainly down to omicron, but it could easily and equally well have been a resurgence of flu, i.e. something that contingency plans must have been in place for.

So once again I'm failing to fit the facts of the matter to the theory. I quite take your point, Wintertree, that Gov has kept trying the same thing again and again until they get lucky, and I think you're right to observe that - but it is a gambler's logic, not a public health strategy, and much as I think Johnson is an inveterate gambler I doubt that the machinery of government permits dice-rolling in lieu of strategy, even if the strategy is paper-thin.

So once again I'm left wondering, what is the theory that fits the current facts? SAGE 99 minutes indicate that they know why they're being sidelined but not what the actual policy is; it's reminiscent of that time when Cummings was pulling the strings. It seems clear that they knew the course of action to be taken would involve testing becoming broken to the point of flying blind, tracing becoming pointless, and hospitals being overwhelmed, but were unable to disclose or discuss the rationale. This is why I say I don't think there's a rationalizable public health strategy behind our current course of action: whatever SAGE were averting to, it wasn't within their official remit.

1
In reply to bruxist:

What would be the alternative to the current course of action though?

I can’t see a viable alternative.

9
In reply to VSisjustascramble:

> What would be the alternative to the current course of action though?

> I can’t see a viable alternative.

It obviously isn't the only viable alternative because it is hard to find another 'advanced' country which is doing it this way.

The most obvious viable alternative would be mask mandates, 'work from home where possible', a few weeks of shutting down nightclubs etc, and possibly delaying the start of school term by a week or two.  That would be enough to slow it down, spread it out, give more time for vaccination and some chance of reacting before it is too late if it turns out to be worse that the Tories think it is going to be.

Too many of this government have a financial services background, they are thinking in the short term and their attitude to risk is like people who take risks with other folks money and get a nice bonus when things go well but don't lose their own cash when they go badly.

Post edited at 19:46
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 AJM 31 Dec 2021
In reply to bruxist:

> We can see quite clearly that the strategy has failed: high rates of infection in autumn haven't prevented a winter wave. That's mainly down to omicron, but it could easily and equally well have been a resurgence of flu, i.e. something that contingency plans must have been in place for.

I would have thought it's almost entirely down to Omicron?

- WTs analysis seemed to suggest Delta was being squeezed by boosters and immunity into an ever shrinking pool. 

- I guess it depends on whether you count having to resort to Plan B as "failed", but it was still there as a (in my view, obviously not that of the CRG!) fairly unobtrusive set of control measures that could have been used to relieve the pressure had the combined impacts of flu and covid proved too much (views obviously differ on whether that point had already been reached!).

I guess you could have deferred the summer/autumn wave by retaining mild restrictions from July onwards, but would that have led to any better an outcome when Omicron arrived? I tend to think unless you've geared your planning around a vaccine/immunity escape (how does one plan for that?!), then a vaccine/immunity escape is going to break your plan.

 wintertree 31 Dec 2021
In reply to bruxist:

I pretty much agree with your interpretation of the current government/advisory split - but I disagree with a part of your assessment building up to that.  To go through that disagreement before returning to the advisory angle...

> We can see quite clearly that the strategy has failed: high rates of infection in autumn haven't prevented a winter wave.

I don't think it has failed.  

  •  I've said a few times over the last six months that raising broader spectrum immunity (than the spike protein) is one of the ways we become more robust against intangible future variants; now one of those has become very tangible and I think post-vaccination delta infection is going to have done a lot for those people when it comes to resisting omicron, which could be a much worse "first breakthrough infection" than delta, given how it evades neutralising immunity and so delivers a larger effective viral load during infection, even putting aside other questions over its intrinsic properties.
  • We know vaccines don't prevent spread indefinitely - antibodies do this, and they fade through physical/chemical degradation, and their efficacy fades as it only takes a few small mutations to break their "fit" that neutralises the virus.  We expect spread after vaccination, but...  I say "we know" this; I'm not sure it's a point that's made it far beyond the immunologists; there's a kind of quasi-peace between many viruses and humans, our immune system lets them in every so often to get a good look at them and update the inner defences; perhaps our outer defences weaken over time for this specific reason.  It prevents genetic divergence between the inner defences and a mutating virus from recharging the pandemic potential.  But the prevalent view of vaccination seems to be that it stops infection.  That was never the expectation when they were being developed, it was something of a bonus that almost certainly helped save our bacon in early 2021.
  • We know that the T-cell immunity in particular is much less broken by variation, and provides enduring protection from severe illness - those inner defences - whilst not doing so much to prevent infection. 
  • For me the expectation has long been that we end up with a lot of spread of the virus, but with health protection through broad immunity, T-cells in particular.

We're going in to an omicron winter with far more immunity across our population than nations that took the other road; that immunity will almost certainly make a material difference to the effects of omicron on our population - a beneficial difference.  It's far from clear to me if this was worth the cost on healthcare or not over the last six months, and other intangibles remain - how much difference is Paxlovid going to make?   Will an omicron adapted vaccine land in time to make a big difference?

This "move to endemic spread" process was already happening with delta - antibodies were fading and a more gradual equilibrium could have been established, bunched up by seasonality.  Omicron shoves the accelerator down on the next round of infection, but it's still the direction we should be moving in if we believe endemic circulation with periodic reinfection and enduring health protection through standard immune responses is the best available outcome.

Of course, if that is the appropriate endpoint needs to be continuously questioned; I haven't seen any real support for alternatives from credible experts...?  But we still need to keep in mind the "boiling a lobster" analogy.

I don't really see it as  "hybrid immunity" - more as moving towards the kind of immunity we will have in a fully endemic situation.  A stable endemic situation can only exist with immunity-against-severe-disease moderating infections; the current vaccines take a lot of the pain out of the first steps to that immunity but they do not deliver the same level of protection an adult who has lived a life of endemic circulation would have.  The problem is, the part of the virus current vaccines target is the part undergoing the most rapid variation - likely as it adapts to us, its new host.  This means that neutralising immunity can disappear in the blink of an eye, as with omicron.  There are a couple of other targets mooted for sterilising immunity IIRC, and they would undergo less host adaption driven selective pressure than the key bits of the spike (the RBD).

We don't know if our strategy has failed or not yet, the proof of that will be in the levels of vaccinated individuals going in to healthcare, and their length of stay and length of stay in intensive care as well as their outcomes. If we are moving towards endemic-level immunity we should see a marked reduction in consequences compared to previous waves.  I'm setting aside the unvaccinated as that's a strictly limited duration problem - it limits our rate going forwards by consuming healthcare capacity, but the issue of vaccinated or not is rapidly being replaced by net total immunogenicity.

>  I quite take your point, Wintertree, that Gov has kept trying the same thing again and again until they get lucky, and I think you're right to observe that - but it is a gambler's logic, not a public health strategy, and much as I think Johnson is an inveterate gambler I doubt that the machinery of government permits dice-rolling in lieu of strategy, even if the strategy is paper-thin.

I didn't really close out my thinking there; having got lucky the last time around, it's going to re-enforce that gambler's logic, if that's what's at play when it comes to a growing disconnect between cabinet and the advisory machine, that's bad news.  Well, any driver of disconnect is bad news.

There's clear "WFT" moments for me in what's going on - it's been obvious for some time that cases were going to skyrocket and it's maddening to see nothing apparently done in terms of advance decisions to protect PCR capacity for where it makes the most difference for example.  These don't inspire any confidence in a holistic, well thought out and check-pointed plan.

Very worrying times; a big unknown for me remains why cases in London are turning to decay from the youngest adults rising through the ages.  To return to your gambler's analogy - that's  quite the lure that we could be almost there, but I don't think the numbers add up and it would not be appropriately precautionary to assume that this is the case right now.

Post edited at 19:55
1
 wintertree 31 Dec 2021
In reply to VSisjustascramble:

> What would be the alternative to the current course of action though?

Two-to-three week circuit breaker to wait and see how the recent infections progress through healthcare to calibrate the new variant and figure out how much prevalence we can actually accommodate to keep following this route safely, and to allow an informed discussion about if we wish to consider following this route or not once the calibration is done.

4
 bruxist 31 Dec 2021
In reply to AJM:

> I would have thought it's almost entirely down to Omicron?

Oh yes - it's entirely down to omicron; influenza incidence is very low again, as last year, according to UKHSA's monitoring:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/...

My point about that was simply that a contingency plan would have been in place for a possible winter resurgence of flu. That resurgence hasn't happened but something else has i.e. omicron. I don't think there's a great deal of difference between the social systemic effects of a new variant and the same of an simultaneous flu outbreak but, given that we monitor so carefully for the latter, we surely had some public health plan in place to deal with it if it did happen, and I'm wondering why that plan isn't now in action.

I'm not at all trying to criticize the July plan - quite the opposite! I'm trying to understand what plan we're following now, if there is one.

In reply to tom_in_edinburgh:

What would that do though?

Cases would likely still increase with the measures you’re advocating.

I’ll grant that increasing vaccination might slow this increase, but the total space under the curve will almost certainly be the same.

I’m now completely convinced that the government is following the right course of action. There’s no benefit to suppressing cases anymore. Let’s catch it, feel a bit iffy for a few days and future proof our immunity against the variants to come.

I say this as self isolating on New Year’s Eve - happy new year by the way.

12
 wintertree 31 Dec 2021
In reply to VSisjustascramble:

> I’m now completely convinced that the government is following the right course of action. There’s no benefit to suppressing cases anymore. Let’s catch it, feel a bit iffy for a few days and future proof our immunity against the variants to come.

We're seeing a lot of people going in to hospital - today's update is quite the belter as hospitalisations land with force in more regions.  We're not currently seeing people come out of hospitals at the same rate, and we haven't figured out what fraction of those people are going to end up in intensive care.

Get it wrong and we overwhelm healthcare.  Take more than another week to pull the circuit breaker and we'll be learning heavily on luck to not completely overwhelm healthcare.

> but the total space under the curve will almost certainly be the same.

Only if we don't overwhelm healthcare.

> I’m now completely convinced that the government is following the right course of action.

I once followed the right course home.

 Down a flight of stairs from a flat, out the front door, through the estate, along a mile of deeply rutted dirt track downhill, [censored] and in through the front door of my house.

The only problem is that I was in such a rush (and possibly pissed as a fart) that I did all this on my bicycle at 3 am without any lights.

As it turns out I got home without any harm, but in retrospect taking things a bit more slowly would have been sensible, as then I'd still be alive now but without having leant heavily on a limited supply of luck.

More haste, less speed.

In reply to wintertree:

I understand the point. And I have a track record of advocating speed (which in hindsight was correct).

However what you’re suggesting isn’t cheap. You’re looking at c.£30bn+ to do 2 weeks. And the cash spend has a public health impact.

Healthcare can be pushed harder (it’s not nice and some exhausted person who works for the NHS will probably tell me I’m a tw@t, but it can be).

I appreciate the difference in demographics with South Africa, but even the number crunching insurance companies are publishing data that people don’t deteriorate in the same way they did with delta. 

Time to put in a final push and end the pandemic.

12
 wintertree 31 Dec 2021
In reply to VSisjustascramble:

But if we gamble and get it wrong, it’s twice that cost and twice as long.  Which has twice the public health impact.  Which is what we’ve seen several times in the past, which is why I find your confidence in the government to get it right this time utterly incompressible; what’s it built on?

> I appreciate the difference in demographics with South Africa, but even the number crunching insurance companies are publishing data that people don’t deteriorate in the same way they did with delta. 

I’d be interested in any links you can share.  The intensive care plot I posted at the end of the full thread sure hints that way (again with today’s data) but I wouldn’t want to believe it for another week, and if it’s bad news then…

The issue remains that if we move too fast, even with milder, shorter hospital stays with less intensive care time, move to fast and we end up having to lock down harder and longer than if we take two weeks now to figure out exactly where we stand.

2
 kipper12 31 Dec 2021
In reply to wintertree:

Not just drug-herbal supplement, think grapefruit juice, which is contains a good cyp 3A4 inhibitor, lots of dietary components are good sources of interaction.  Add in possible workplace exposure and interactions there.  The world of drug-environmental interactions is varied and complex, and we are not anywhere close to understanding them 

In reply to wintertree:

https://www.discovery.co.za/corporate/news-room

Not quantified, but a key quote from their takeaways is: “Furthermore, hospitalised adults currently have a lower propensity to be admitted to high-care and intensive-care units, relative to prior waves.”

It mirrors what SA doctors were saying in the first 2 weeks of the disease when the news channels were still trying to speak to them.

If they don’t need ICU beds we can push even harder. If the current round of therapeutics are even half as good as claimed and the SA data is semi-accurate we don’t need masses of medical resources to deal with a worse case scenario - we just need lots of beds. Beds can be made.

9
 Maggot 31 Dec 2021
In reply to VSisjustascramble:

> Beds can be made.

https://www.kingsfund.org.uk/blog/2021/04/nhs-nightingale-hospitals-worth-m...

"– but unfortunately, there is no magic NHS staffing tree to shake."

 summo 31 Dec 2021
In reply to VSisjustascramble:

> we just need lots of beds. Beds can be made

and extra doctors,  nurses, cooks, cleaners... etc.. 

In reply to summo:

Do we need NHS staff or squaddies at this point?

If you need an ICU bed you really need an ICU consultant.

If you need a bit of oxygen and a couple of pills why can’t Wayne Jones from the Welsh infantry do it?

Push hard - mitigate against future waves. SA are done with this nonsense - let’s not forget they’re out of the pandemic now.

19
 wbo2 31 Dec 2021
In reply to VSisjustascramble:

Healthcare can be pushed harder (it’s not nice and some exhausted person who works for the NHS will probably tell me I’m a tw@t, but it can be). 

That , I think, is a very easy thing to say.  But I don't think it can be pushed harder if you want a health service functioning in 3,6, 12, 24 months as you completely ignore the effects of staff burnout.   To be blunt, do you have any experience in your job handling people in a very high stress enviroment?

Currently I'm waiting for a facility to start work again.  We've had an infection blow up, and when it blows up, it seems to go fast.  People aren't very sick, but they're too sick to work,and they'll certainly be too sick to work in a hospital.  Push this hard and you run a real risk of having a partially non functioning healthcare for a few months as people recover and new ones get sick.  By partially non functioning I mean imagine A and E with 50% staffing for a few months.  I can get new staff.,  A hospital can't

In reply to wbo2:

I get your point. One of the reasons I want to push hard is that I think it’s better for healthcare over a 12-24 month window.

Let Omicron go beserk and there’s a small risk that we overwhelm healthcare.

Suppress Omicron now and we’re still in the pandemic phase next year. Would you rather be rushed off your feet for a month or slogging it out for the next 18 months.

If we want the NHS to survive we need to stop kicking the can down the road.

18
In reply to VSisjustascramble:

I think we are going to be slogging it out for the foreseeable irrespective of choices about how we manage omicron. 
 

The idea that there’s an option for the NHS to have a month where we roll up our sleeves and put in a few late nights, after which we can kick back and relax, is not one anyone who has any direct connection with the service will recognise. 
 

and that “small risk” comment is doing a lot of heavy lifting. 

 MG 31 Dec 2021
In reply to no_more_scotch_eggs:

From a staff perspective is a short mega peak worse than a prolonged moderate one? Warwick models suggest there is a choice. E.g. Fig 8

https://warwick.ac.uk/fac/cross_fac/zeeman_institute/new_research/combattin...

In reply to MG:

Interesting link, thanks. Fig 8 suggests the ship has sailed though. Plan B vs step 1 introduced on Jan 3 curves are pretty much the same. Looks like 1.7k to 4.7k deaths a day by mid Jan are baked in now. 
 

If there was a choice- the one where rationing lifesaving treatment as capacity is outstripped doesn’t happen. 
 

edit: I hope that modelling is wrong. The peak in hospital admissions is 8k to 22k per day. The peak in previous waves was less than 4,000 per day. There are only c100,000 acute beds in the NHS. The second half of January isn’t looking very pleasant.

Post edited at 22:59
 wintertree 31 Dec 2021
In reply to no_more_scotch_eggs:

I agree on your interpretation of the ship already sailing on that model.

> edit: I hope that modelling is wrong

If I read figure 8 right that’s predicting about 5,500 admissions/day and 500 deaths/day on Jan 1st for England.  Deaths figures look pretty provisional over the week up to Dec 30th but are on the order of 100/day.  Admissions on dec 29th are 2.370.

It could be that the 50% severity of delta is not a good match to reality and that we’re closer to 25%, or if could be that it’s a few days ahead of reality, exponential growth and all that.  If one leans towards the timeline being off, then by this model the ship hasn’t sailed in the real world just yet, but it’s about to.

I find the approach of a single “severity vs delta” a poor fit as we’ve got very different severities for the susceptible pools represented by mainly non-elderly immunonaive and for breakthrough mainly elderly infections, and I think the former is very hard to quantify in terms of size, but we know it must be a rapidly decreasing pool.

When looking at admissions and comparing to the alpha wave, keep in mind that two doses have been shown to reduce length of stay; data obviously not in on three doses and omicron, but hopefully still reduced.  So occupancy for breakthrough admissions shouldn’t scale like it did in alpha wave with regards admissions.

I’m a bit surprised at some of the parameters in table 1 - in opposing directions.

This model came up in an earlier thread I think, interesting that by its dynamics moving too soon in control measures is also bad; I don’t get the feeling masterminds are sat in data central waiting for the Goldilocks moment, and I don’t have enough faith in the models that I think they could predict the moment well enough. 

Iggy_B 31 Dec 2021
In reply to Maggot:

I mentioned this in a thread a couple of month's ago but worth repeating now just for how unbelievable it is.

 My OH is a German MD, we worked in the Humanitarian sphere for the last decade. Settling in West Cumbria since March, she has a job offer here and applied to the GMC to get her qualifications recognised in July. The GMC outsources this to an American company who after five months have still not verified her documents. Hundreds of expensive phone calls later, her visitor visa has expired and she is working in Africa again and it looks likely that I'm off to join her soon.

 It's barely the tip of the iceberg, but there are medics trying to work in this country who are being hampered by the system.

In reply to wintertree:

Hopefully it’s the lower severity rather than the few days ahead on the curve option. I agree with your comments up thread, a few weeks greater restrictions should be put in place, while we work out which of these scenarios is correct, and take the last chance to avoid the worst of the damage if the severity modelling turns out to be accurate. 
 

Anyway, time to charge my glass ready for the bells, happy new year when it comes…!

 wintertree 31 Dec 2021
In reply to no_more_scotch_eggs:

> Anyway, time to charge my glass ready for the bells, happy new year when it comes…!

Indeed - happy new year to you and to all!

I hope to be asleep by the bells; a hard day's work on the drainage in the lower field followed by watching "Don't Look Up" - not the cheerful end to the year we'd been hoping for!  Probably should have read the spoilers...  

In reply to VSisjustascramble:

> Beds can be made.

Not hospital beds.

But hospice beds. Where people go to die, out of the public eye. That appears to be the role of the new 'Nightingale' hospitals.

Which, given the actual results of Florence Nightingale's crimean hospital (for which she never forgave herself), is about right.

2
Andy Gamisou 01 Jan 2022
In reply to no_more_scotch_eggs:

> I think we are going to be slogging it out for the foreseeable irrespective of choices about how we manage omicron. 

>  

> The idea that there’s an option for the NHS to have a month where we roll up our sleeves and put in a few late nights, after which we can kick back and relax, is not one anyone who has any direct connection with the service will recognise. 

>  

> and that “small risk” comment is doing a lot of heavy lifting. 

And it's funny how the people who suggest that approach tend not to be the ones "putting in a few late nights".  (Not sure what they think staff have been doing for the last 20 months).  My wife's already onto her 10th day in a row (including a few double shifts), with her next day off tentatively penciled in as the 6th (but with an oncall, so not really a day off).  And this is before the effects of the current wave hit.

Seems like a comfory option from your sofa with your brain disengaged. 

In reply to MG:

I was wondering if someone was going to post that paper. I deliberately didn't because it's had a hard ride in a lot of the other discussion 'forums'. 

As we can clearly see, it was already overtaken by events even before the day it was released. But also nobody seems to have read this part on p14:

"Throughout we have assumed that Omicron has the same generation time distribution as Delta -essentially the same latent and infection periods. However, the rapid increase of Omicron relative to Delta could partially be due to a shorter generation time; Omicron would still need to have a competitive advantage over Delta but this would be magnified by a shorter generation time. As such,if the generation time of Omicron was half that of Delta (so around 2.5-3 days instead of approximately 5-6 days), once the model is recalibrated to match the growth of SGTF, this would approximately halve the predicted peak outbreak sizes."

Post edited at 07:58
 Offwidth 01 Jan 2022
In reply to Longsufferingropeholder:

I agree. Also I don't see the high deaths predictions as being at all likely given SA data. However, what those supporting the government 'non-plan' don't want to hear (la la laing with fingers in ears) is this is as much about other factors as it is about covid hospitalisations. Staff off sick and self isolating is top of those pops currently and as much as the govenment might seek to change this you can't have infected staff at work (aside from the fact many are too ill to do so) is the risk of infect other staff and patients and making things even worse. The Feb 3rd deadline on first jabs for a few percent of unvaccinated NHS front line staff is the next looming disaster waiting to happen (the government could still delay this).

Like bruxist says, I could still see a coherent plan in July and was optimistic then. I can't see one now and that's all about government inaction and mistakes since then.....we could have been in a much better state without these errors, such that we might have been able to cope with omicron.  I'm not sure what actual logical strategic option we have now other than restrictions short of a full lockdown.

The public are simply not being told how bad things are in hospital trusts and all sorts of other NHS services. When the omicron wave ends what happens next if another covid problem arises? Even when covid has gone we have years of NHS work clearing backlogs that will need staff who are not broken.

Many cost estimates of restrictions are exaggerated and even the more accurate predictions are party a mirage in my view. Business is being hit hard but unfairly unsupported at present by what amounts to a zombie lockdown in England. Unless we want to lose a huge amount of viable business, financial support is essential and a good investment. As an aside on finance, the cost of repairing severe damage to the NHS alone will likely be a significant lump of the accurate estimates, if not even larger.

5
 wintertree 01 Jan 2022
In reply to Offwidth: (and VS)

>  Also I don't see the high deaths predictions as being at all likely given SA data. 

I think we need to look to our own data - and to give ourself buffer time to evaluate our own data - rather than lean on the SA data.

I think it's dangerous to look to SA for a bunch of related reasons.

  1. De-mo-gra-phics
    • SA has a far smaller  post-retirement age population - about 3% over 70 vs about 13% in the UK 
    • Hospitalisation and fatality risk increase about exponentially with age
    • SA data simply can't speak to one of our most vulnerable cohorts
  2. Loss of vulunerable
    • SA has had excess deaths of perhaps 0.5% - this reduces their pool of vulnerable
    • To affect a similar reduction to the UK's pool, we'd probably have needed to loose about 2.5% of our population to Covid over the last 2 years;  thankfully we haven't
  3. Different immune status
    • SA has had several waves that basically amount to uncontrolled rip; they have a high level of population immunity from natural infection with a range of variants
    • We have a signifiant reservoir of immunonaive vaccine refusers, and much of our immunity comes from vaccines.

> The public are simply not being told how bad things are in hospital trusts and all sorts of other NHS services.

Please, please start a thread on this.  It'll get far more readers and input than it will in a data thread.

 wintertree 01 Jan 2022
In reply to neil_h: (from full thread)

> That’s not what my German friends are saying. Only time will tell. either way it’s a long  winter before you can laud it that Germany has “escaped”.

Cases look to be turning to rise in Germany on the OWiD data explorer, and omicron is now rising up its share in their sequencing data (available under the "metric" button).  If omicron sets R>1 despite their stringent lockdown...

On the OWiD front, worth looking at cases then deaths for France and the UK.  What're you doing France?  

https://ourworldindata.org/explorers/coronavirus-data-explorer

In reply to wintertree:

COVID figures in Germany may be much higher than reported https://p.dw.com/p/450s4

also, "sky blue" says leading research team.

> What're you doing France?  

Vaccinating loads of young people and then pointing at the headline percentage and pretending they're in as robust a position as certain other nations.

https://nitter.pussthecat.org/flodebarre/status/1475891948938530816 (I know, but, for those who haven't seen it yet)

Irt Offwidth:

Yes, the NHS is on the bones of its arse. We know. We don't need telling again.

Post edited at 09:56
 wintertree 01 Jan 2022
In reply to Longsufferingropeholder:

What a strange parallel universe that link is where some people in another, comparable country are pointing at the UK and asking “why aren’t we doing as well as them?”.

> also, "sky blue" says leading research team.

For today’s research I am mainly going to be testing if rocks are still hard and water is still wet.  I’m starting to regret not hiring a mini digger.

In reply to Longsufferingropeholder:

> Yes, the NHS is on the bones of its arse. We know. We don't need telling again.

'We' might. The government and the rest of the country seem pretty oblivious.

In reply to VSisjustascramble:

> I’m now completely convinced that the government is following the right course of action. There’s no benefit to suppressing cases anymore. Let’s catch it, feel a bit iffy for a few days and future proof our immunity against the variants to come.

The South Africans caught it and it didn't stop them getting it again.  The whole 'let's catch it have a rough week and after that it'll be over' thing is dangerous wishful thinking.  Maybe you'll catch it, get seriously ill and in six months catch another variant.  

We don't know how long it will take or how many mutations there will be before our immune system and a new virus that's jumped from another species will come into equilibrium but it is a fair bet that the amount of time it takes is absolutely unrelated to when we feel that it 'should' be over.

If you have a large computer program and you keep finding bugs in it that is not a sign that you've nearly got rid off all the bugs.  It is a sign that there are a f*ckton of bugs left to find.  You start to think you've got most of the bugs when you go a long time without finding one.  With Covid, when it is obviously finding more potent/transmissible mutations every few months we should take that as a sign that it has plenty of scope left for mutation, not a sign that we are getting towards stasis where it is 'just the cold'.  

 neilh 01 Jan 2022
In reply to wintertree:

Thanks. I had also read that Germany’s reporting had been lax over the Christmas period.This surprised me. Let’s give it a few more days and see what happens. 

 fred99 01 Jan 2022
In reply to VSisjustascramble:

... we just need lots of beds. Beds can be made.

And just who is going to make these beds (and look after the people in them) ??

 wintertree 01 Jan 2022
In reply to captain paranoia:

> > Yes, the NHS is on the bones of its arse. We know. We don't need telling again.

> 'We' might. The government and the rest of the country seem pretty oblivious.

Which is why I think Offwidth should start a thread specifically on that angle.  There’s been lots of insight from people scattered over many threads, Iggy_B’s mad example above being one - a thread of its own would probably engage more readers than the data threads, and would be worthwhile.

 bruxist 01 Jan 2022
In reply to wintertree:

I fully agree with all of your points about the benefits of raising broad spectrum immunity, and agree too that it's unclear whether it was worth doing given the costs from July to now. I don't think we can usefully measure the latter: we know there were some 20,000 deaths in that period, but these are the deaths we were assured were merely being brought forward from winter to autumn.

[As an aside, I was never comfortable with the moral logic behind that temporal displacement - if followed though to its logical conclusion it leads somewhere quite genuinely horrifying - but accepted it as a pragmatic short-term strategy in an extreme emergency. But a conversation about that would be too much of a digression...]

However, the premise of the argument Whitty was put forward to voice was not that the autumn strategy was part of a longer-term immunogenicity plan, but that it would preserve NHS functionality in the short term, over this winter. I'm judging the success of the plan on its own stated grounds, and on these it is most certainly a failure. That's not to say that it might not have longer-term benefits, but those incidental benefits aren't the measure by which the plan can or should be judged.

Nonetheless, we find ourselves where we are now (as you've often said, with a view to working out where to go now rather than working out how we got here), and where we are is NHS overload. If we're still following the July plan, well, its aim must have changed. What is the aim now? If we stick with it for the time being, must we not necessarily acknowledge that its immediate consequence is the acceleration of healthcare collapse? And surely that single consequence radically changes the calculus of any longer-term plan?

I'm genuinely puzzled about the rationale behind our current approach. The last-known strategy openly stated by Gov can't explain what we're doing now.

(& btw, yes, fully agree with you WT: Offwidth, a running thread on NHS capacity seems to me like it could become critical info, as useful if not more than WT's plotting threads. It's already starting to happen on other social media at a local level.)

2
In reply to captain paranoia:

Just looking at the BBC covid stats page. Hospitalisations are starting to ramp sharply in most regions. It's lucky we're able to track numbers on a daily basis during this critical period of growth. Oh, hang on...

1
 wintertree 01 Jan 2022
In reply to bruxist:

Good discussion, thanks.  Thought provoking.

> However, the premise of the argument Whitty was put forward to voice was not that the autumn strategy was part of a longer-term immunogenicity plan, but that it would preserve NHS functionality in the short term, over this winter

To my understanding, these aren't really separable intents, as raising broad immunity is the way to preserve healthcare capacity by mitigating against peak loads so far as possible, and that's true if a new variant upsets the applecart or not, and it also protects against immune escape variants.

Omicron mainly looks like an accelerator, not a turn for the worse; the obvious way to maintain the plan is to bring in restrictions sufficient to slow omicron back to put us on the path we were on.

> I'm judging the success of the plan on its own stated grounds, and on these it is most certainly a failure.

If we judged the plan against a parallel world where we'd kept control of cases until winter, and then had omicron break through lockdown-level control measures and set R>1, would it be a failure?  

  • Germany looks perilously close to being in that position now - with more stringent measures than us in the autumn they went in to uncontrolled exponential spread, and rapidly started to locally overload healthcare and produce significantly higher death rates than us; they're now in lockdown level measures and omicron looks like it might be beating those.  

I agree with you that the plan is no longer looking likely to deliver its stated goals in the face of omicron, but nature has moved the goalposts; and I think the plan is likely to have left us well placed for that change in goal.

We can't see that parallel universe, and it's a month to soon to see how this is going to pan out for other nations; perhaps there will turn out to be an intrinsically lower fatality for omicron and waiting will retrospectively be proved the better choice, perhaps not. 

You're right that it was never stated that the plan would leave us better placed for variants; I've certainly suggested that before and take it as a more-or-less automatic consequence of the plan. 

>  What is the aim now?

It would be nice to know, wouldn't it.  I have this daft idea that government works for us and so should report accountably to us.  I know, I know...

> If we stick with it for the time being, must we not necessarily acknowledge that its immediate consequence is the acceleration of healthcare collapse? And surely that single consequence radically changes the calculus of any longer-term plan?

To me, the immediate consequence is the acceleration of the path we were on with massively compressed demands on healthcare, raising peak demand potentially above any sane limit.

It's not clear that omicron will bring about healthcare overload, but that many people are seriously considering such a collapse is all we need to know when it comes to putting the brakes on to counter the acceleration of omicron.

A two week circuit breaker now gives time to figure all this out, and there's enough omicron in the system now to measure everything the needs measuring and calibrate the models in towards reality.  If all the stars don't align in our favour, we're going to need that slowdown in spread pretty much immediately.

I don't think it does change the longer term plan substantially; the larger genetic changes might mean updated spike-protein vaccines and updated MAB therapeutics are needed for the more vulnerable, and it raises the importance of getting "Valneva as a booster, efficacy against severe disease" data, as well as raising the motivation to produce some DNA / mRNA vaccines with other targets, again primary for the more vulnerable, but the long term outlook doesn't feel substantially different to me.  Assuming we don't break everything in the short term...

> [As an aside, I was never comfortable with the moral logic behind that temporal displacement - if followed though to its logical conclusion it leads somewhere quite genuinely horrifying - but accepted it as a pragmatic short-term strategy in an extreme emergency. But a conversation about that would be too much of a digression...]

The maths of a pandemic are pretty bad, however you look at it.

Another way of looking at the temporal displacement is the role of symmetry breakers - probabilities don't remain invariant of time.

  • The lethality of covid increases exponentially per year of age, at about +16.5% per year of age.  People are getting older since the pandemic started - displacing their exposure in to the future increases their risk through their increasing age.  You might say "Huh - you broke the maths" because the mean age of the population does't change, so how can net consequences?  The answer there is that Covid's lethality mechanism relies it seems on people not having had broad and enduring immunogenic events when they were young, so the consequences flowing through the age pipeline will change as we get children and young adults experiencing a truly endemic exposure to the virus becoming old people.
    • Bringing exposure forwards reduces the risk to the exposed, because they are younger enough to translate in to measurably reduced risk 
  • Variants - to date these have been more lethal.  We wait to see on the intrinsic lethality of omicron.  We know SARS-nCov-1 and MERS-nCov have society ending lethality if they spread like this virus; it gives a clue about what might be accessible.  Or lethality could decrease; almost certainly not as much as it could increase.
    • This is all really intangible - bringing exposure forwards broadens immunity before the intangible - good or bad.  It's a hard call and hindsight won't judge the wrong one kindly, but at the time nobody knows the right call.
  • Therapeutics - these strongly favour temporal displacement to later on - but again they're intangible.  One promising anti-viral is looking like a damp squib and the other is going to be limited by drug-drug interactions; no obvious sign of the MAB therapeutics making a difference to top level data.  

The only tangible point is delaying exposure increases risk through age; the rest are intangible and could swamp the age factor in either direction.

> (& btw, yes, fully agree with you WT: Offwidth, a running thread on NHS capacity seems to me like it could become critical info, as useful if not more than WT's plotting threads. It's already starting to happen on other social media at a local level.)

Yup, and Offwidth is very well placed to frame that thread and bring a lot of referenced evidence to start it off.  Lots of informed, engaged and sensible people hang out on UKC and will I am sure contribute.

Post edited at 20:48
In reply to wintertree:

> the obvious way to maintain the plan is to bring in restrictions sufficient to slow omicron back to put us on the path we were on.

Unfortunately, Javid doesn't seem to think it's obvious...

 wintertree 01 Jan 2022
In reply to captain paranoia:

> > the obvious way to maintain the plan is to bring in restrictions sufficient to slow omicron back to put us on the path we were on.

> Unfortunately, Javid doesn't seem to think it's obvious...

One starts to understand why he was made health minister.  

In reply to tom_in_edinburgh:

> The South Africans caught it and it didn't stop them getting it again.  The whole 'let's catch it have a rough week and after that it'll be over' thing is dangerous wishful thinking.  Maybe you'll catch it, get seriously ill and in six months catch another variant.  

> We don't know how long it will take or how many mutations there will be before our immune system and a new virus that's jumped from another species will come into equilibrium but it is a fair bet that the amount of time it takes is absolutely unrelated to when we feel that it 'should' be over.

You have a very odd understanding of immunity and the computer bug analogy is nonsense.

Every immunity increasing event (whether that be vaccination or infection) will reduce the risks of adverse outcomes against future infections.

When the virus is endemic everyone will eventually catch it. Unless we go for elimination you’re eventually going to catch it.

The pandemic is over in South Africa now. Yes a lot of them caught Omicron, but it had no significant adverse healthcare consequences. We can’t follow the SA route out due to our demographics, but we can use an initial round of vaccinations to tip the odds in our favour and then follow their strategy.

The vaccination only strategy (with our current vaccines) is risky as it’s always going to be more vulnerable to immune escape variants.

7
 Kalna_kaza 01 Jan 2022
In reply to fred99:

The government could classify all hospitals and covid related buildings as protected sites under the serious organised crime legislation for the duration of the pandemic. It makes trespassing a significantly more serious offence, similar to breaking into a royal residence or a nuclear site. 

Post edited at 22:32
In reply to wintertree:

> One starts to understand why he was made health minister.  

Surely you're not suggesting this is a deliberate plan to discredit & f*ck up the NHS...? I mean, what possible reason could this government have to do that...?

1
 wintertree 01 Jan 2022
In reply to captain paranoia:

You might think this is part of why I want Offwidth to start a dedicated thread for this discussion. There’s a surprising number of HCPs on from a wide range of areas.  Been an eye opener for me this last 18 months.  

Post edited at 22:48
 Toerag 01 Jan 2022
In reply to Longsufferingropeholder:

> "However, the rapid increase of Omicron relative to Delta could partially be due to a shorter generation time."

This would correlate with the massive difference in bronchial counts - Omicron multiplies much more rapidly in the bronchial tissue, and thus the person becomes more infective, faster.

 wintertree 01 Jan 2022
In reply to Toerag:

> This would correlate with the massive difference in bronchial counts - Omicron multiplies much more rapidly in the bronchial tissue, and thus the person becomes more infective, faster.

Is this finding coming from people yet, or still from rodents?

The signs are lining up but I’m not sure it’s proven yet for humans?  It’s all tentatively promising  including hinting at potential lower intrinsic lethality but I didn’t think it was determined yet for humans?

Still….

 Stichtplate 01 Jan 2022
In reply to VSisjustascramble:

> Do we need NHS staff or squaddies at this point?

NHS staff.

I could explain why. I could explain why in detail, with examples, evidence, anecdotes, graphs and legislation.

I could but it'd be a lot of effort, I'm very tired and I really can't be arsed.

You are spouting off from such a ridiculously high level of ignorance that I'm afraid dunning kruger doesn't even cover it.

1
 Michael Hood 02 Jan 2022
In reply to Stichtplate:

Squaddies would of course be ok if we accepted that every patient in that situation who deviated from whatever was considered the "normal" disease recovery path would be leaving in a body bag.

But then we might have a body bag shortage - however I'm sure the government could sort out contracts with suitable suppliers to at least avoid that ☹

 Toerag 02 Jan 2022
In reply to wintertree:

> Is this finding coming from people yet, or still from rodents?

I've no idea

 jonny taylor 02 Jan 2022
In reply to wintertree:

> People are getting older since the pandemic started - displacing their exposure in to the future increases their risk through their increasing age.  You might say "Huh - you broke the maths" because the mean age of the population does't change, so how can net consequences?  The answer there is that Covid's lethality mechanism relies it seems on people not having had broad and enduring immunogenic events when they were young, so the consequences flowing through the age pipeline will change as we get children and young adults experiencing a truly endemic exposure to the virus becoming old people.

I can't decide if you're writing this paragraph as a good thing or a bad thing. "displacing... increases the risk" seems like you're saying it's a bad thing. On an individual level, yes, but on a population level they're mostly filling "dead mens shoes" (where many of those deaths are from other causes). Doesn't that make it a broadly net positive thing in terms of population-level risk? (Can explain more what I mean if you reckon differently...)

Post edited at 12:33
 wintertree 02 Jan 2022
In reply to jonny taylor:

It's a brain melter this one, isn't it...  I'm tempted to think you're right, partly...

The population must get more robust as time goes on and people with better (broader and from a younger age) become older, so yes the population level risk reduces over time.  I agree to that.

 But for individuals, their risk increases.

I think what's missing from my earlier thinking that you got is that  it's a leaky pipeline, and that us people age and have their personal risk from Covid raise, their risk from life itself also raises and life itself (post vaccination) is pruning way more people from the pipeline than Covid, and so keeping the societal level risk from monotonically growing.

In terms of Bruxist's point I think the individual risk is the appropriate lens mind; if we're going endemic, the later someone's first breakthrough infection is postponed, the worse it's going to be due to their personal risk increasing with age (and with increased genetic divergence from the vaccines breaking more T-cell epitopes, starting to become notably significant with the longer chain ones for Omicron...).  This increasing risk is sometimes countered by further vaccination which muddies the waters; thankfully we've rolled out a fresh dose to many of the more vulnerable (by age) just about before omicron slams through; holding off for a few more weeks could have probably made a material difference there - but then we also think the omicron additional protection is leaning heavily on a very high level of antibioses to counter their poor match to the variant, and this is going to wane very quickly.

Where I can't square the circle - those individuals who are at lower risk by not holding out against infection for years - they represent the major risk to healthcare as they're the vulnerable cohort; as they move through the pipeline, they're replaced by people with a far more endemic experience (younger exposure) who will never reach the same risk.  So, absent any other changes.  There are two opposing forces here - one is the risk of this cohort who got their first immunity late in life ageing and becoming higher risk, and the other is the leaky pipeline removing those higher risk individuals from the population through all cause mortality.  What happens to the net risk to healthcare depends on the balance of those forces; the apparent fatality risk of one Covid infection post vaccination is surprisingly close to that of all cause mortality for one year, and we don't yet really know (I think) how the risk increases with personal ageing for those first vaccinated in later life.  So who knows which way the societal risk goes...

I hope that's all clear....? 

Post edited at 13:01
 bruxist 02 Jan 2022
In reply to wintertree:

> Good discussion, thanks.  Thought provoking.

Equally! I'm going to respond from my angle rather than point-by-point, as I know we're coming at this from very different backgrounds and (at least for me) that's part of the usefulness of the conversation (though I'm unsure whether to continue on this continuation thread or on the discontinuation of it...)

> > However, the premise of the argument Whitty was put forward to voice was not that the autumn strategy was part of a longer-term immunogenicity plan, but that it would preserve NHS functionality in the short term, over this winter

> To my understanding, these aren't really separable intents, as raising broad immunity is the way to preserve healthcare capacity by mitigating against peak loads so far as possible, and that's true if a new variant upsets the applecart or not, and it also protects against immune escape variants.

I suspect this is the point at which we butt up against those unmeasurable costs. Raising broad immunity is one way to preserve healthcare, I agree - but it isn't the only mitigation available, and not all mitigations have commensurable costs. Some mitigations have a higher public health cost, but a lower individual cost - or vice versa (the old idea that public health is everyone's friend, but it is very much not *my* friend...)

I think such a strategy asks something rather unusual of broad immunity, though. We wouldn't normally use herd immunity primarily to protect a healthcare system from overload; rather, we would hope to reach a threshold at which the unprotected (the elderly, the immunocompromised, the generally vulnerable) are protected from the likelihood of contracting a disease in the first place, because it cannot spread among the rest of the population. I'm assuming that was the logic behind the July strategy - spread now, lower the ability to spread later. That seemed reasonable, if infection with delta conferred some natural immunity to delta; and the consequence of preservation of healthcare capacity would have been a secondary effect.

In that light, I could even make sense of some of the most apparently nonsensical parts of Gov's approach - doing nothing about ventilation, blathering anti-mask pseudoscience (Robert Halfon MP wins my 'Twunt of the Day' award today for his outstanding efforts), refusing to update the testing criteria, denying airborne transmission, insisting schools are safe and so on - as artificial accelerationism. Unfortunately, a variant that displays both vaccine escape and reinfection potential doesn't just take over that job of accelerating population level immunity. Rather it means the logic of raising spread now in order to reduce it later is broken, the infection control measures available to us are rendered insufficient, the vulnerable groups in society are placed in greater hazard, and healthcare capacity breaks down.

Here's where I must return to Whitty's initial logic of deaths merely being brought forward. I don't think this can hold true anymore if we persist with the same strategy under these changed conditions, for a number of reasons. Firstly, the 1000 or so deaths a week we saw from July to now were ostensibly those we would otherwise have seen from October 21- March 2022. Difficult to judge with the very incomplete deaths data we have over Xmas/NYE, but unless these decline dramatically very soon, we've just let ourselves be nudged into accepting a very high level of non-seasonal mortality, as the deaths we're seeing now have been brought forward from April and onwards, which cannot make sense given normal levels of mortality at that time of year. Secondly, healthcare: rationing of emergency care, Cat 1 + 2s not being reached in effective times, NHS staffing decimated (in the literal sense, classical scholars) cannot fail to have a knock-on effect on both non-covid excess deaths and population morbidity: a lot of progress made over the last few decades against all sorts of urgent life-threatening conditions will go into reverse. Thirdly (and this is related to point 2 and, I think, the most hazardous likelihood), widespread infection increases, by a nontrivial factor, the number of people living with a new pre-existing condition who previously were healthy, and so they join the ranks of the vulnerable, with the difference that their potential deaths have been brought forward not just by a couple of months: in effect, their age-based risk has been accelerated. Follow such a policy of temporal displacement of death in full consciousness of its implications and things start to go all Logan's Run rather quickly...

[btw, what sources are you using for Germany? What I see from the RKI - Xmas reporting lag aside - and hear from friends there is very different.]

1
 MG 02 Jan 2022
In reply to Stichtplate:

The government is resorting to using tbe army far too regularly (floods, HGVs Covid etc.) It's not what they are for. But...

They do seem good at organizing stuff quickly and doing tasks efficiently.  I was vaccinated by a soldier, and the centre was run by other soliders. Very smooth all round. So, I dont think its entirely unreasonable to think they could help out for a few weeks in the NHS generally.

In reply to bruxist:

Your logic leads to elimination as being the only correct course of action. It doesn’t make sense.

4
In reply to Stichtplate:

Explain please.

The army is an effective tool for assisting with other civilian agencies then capacity becomes an issue. They’re even assisting with the ambulance service at the moment I believe.

What makes non-ICU Covid care so difficult that more non-skilled bodies couldn’t be useful.

3
 wintertree 02 Jan 2022
In reply to bruxist:

I think there's one bit of your approach to this that I disagree on, so I'll dig in to that first:

> We wouldn't normally use herd immunity primarily to protect a healthcare system from overload; rather, we would hope to reach a threshold at which the unprotected (the elderly, the immunocompromised, the generally vulnerable) are protected from the likelihood of contracting a disease in the first place, because it cannot spread among the rest of the population.

I think the conventional idea of "herd immunity" has been out of the window since the Alpha variant came along; this disease is just too transmissive for elimination through very high uptake with current vaccine efficacies.  We can't achieve that level of herd immunity, certainly not with the fraction of people not engaging with vaccination.

The future with this virus to me looks like periodic re-infection as antibodies fade, sometimes compounded by genetic drift breaking the neutralising power of antibodies faster.

  • Herd immunity no longer protects the vulnerable from this, because people are going to get repeatedly re-exposed, and their protection against infection fades over time.  The re-infection rate goes on to be determined by the immune wanning timescales, not the level of immune protection in the population.
  • We could aggressively vaccinate every year to keep transmission down, but it's not possible to predict the next variant, and it takes time from emergence to validation and at scale production of a vaccine. I think it's only by the skin of our teeth that a 3rd dose of current vaccines has efficacy against infection for Omicron - it's taking an incredibly high antibody level to deliver what we got for much less with Delta; and that level is going to fade.
  • There'll be some sort of phase-locking behaviour to seasonality most likely.  Properly timed boosters that track the genetics, or that rely on producing very high antibody levels to overcome poor binding affinity when not up-to-date with the variant (where we are now with omicron) cold give brief periods of protection slowing down transmission, which will help safeguard the most vulnerable through the peak periods in the infectious cycle (likely beating to the seasonal drum?).  New MAB cocktails could do likewise for those with poor immune response.
  • The important immunity here is not protection against infection/transmission but protection against severe disease.  This is where we are with "common cold" causing viruses, including a coronavirus (OC43) that may have made its entrance in to our nuisance-level viral pantheon through a pandemic.  As far as I can divine this is what policy is actually taking us towards.

For a thought experiment, imagine we stayed in global lockdown for a decade. Omicron breaks between 15% and 30% of various T-cell epitopes (pattern recognition to target the virus) from the current vaccine.  That's changes that have happened in the 21 months since vaccination work started.  Over a decade we might see almost no remaining T-cell immunity given ongoing mutation.  When we come out of that lockdown, there's no T-cell affinity left and when it lands, it's a brand new pandemic.

  • For a stable endemic situation, the virus - or well matched, broad spectrum vaccines - have to go in to people to re-stimulate and refresh the T-cell immunity, so that it tracks variations over time.
  • The longer we take to do this - with all the unpleasant consequences it involves - the worse the intangible but rising pandemic potential risk.

> I'm assuming that was the logic behind the July strategy - spread now, lower the ability to spread later. 

To a point yes; it should lower the spread during the winter months, but then that ability to spread recovers as antibodies fade - but enduring protection from severe illness remains.  

> Here's where I must return to Whitty's initial logic of deaths merely being brought forward. I don't think this can hold true anymore if we persist with the same strategy under these changed conditions, for a number of reasons. Firstly, the 1000 or so deaths a week we saw from July to now were ostensibly those we would otherwise have seen from October 21- March 2022.

It's worth keeping in mind that a disproportionate chunk of those are people who have declined vaccination, a bit under half of under 70 years olds to have died.

Harsh, but I'm going to set the unvaccinated aside when it comes to considering losses.

> Difficult to judge with the very incomplete deaths data we have over Xmas/NYE, but unless these decline dramatically very soon, we've just let ourselves be nudged into accepting a very high level of non-seasonal mortality, as the deaths we're seeing now have been brought forward from April and onwards, which cannot make sense given normal levels of mortality at that time of year.

The majority of vaccinated deaths - about 90% I think - are coming from people aged 70+; one Covid infection looks to be on the order of as lethal as a year or two of life at that point.  If we move to endemic circulation, it's clearly - at present - a significant rising factor for mortality rates in the over 70s.

What isn't clear to me is if this is a sustained risk going forwards, or if the majority of vaccinated older people who survive their first breakthrough Covid infection go on to have a better chance with their next one - partly through selective losses and partly through broader immunogenicity.  

This is where I see the meaning in Witty's comment - moving to endemic circulation everyone is going to have to roll the dice on their first breakthrough infection, and delaying that raises the risks through getting older without broader priming of T-cell immunity (likely more related to the exponential-with-age mortality risk of Covid), and it raises the risks through immune wanning from the vaccines, and it raises the risks through increasing genetic divergence of the virus and immunity (if we held out until son-of-omicron with as many mutations again emerges, T-cell immunity could be much more significantly at risk...?)

If elimination is off the cards, everyone has to roll the dice. Not once, but every 1 to 3 years or so. Lots of tangible and intangible risks to delaying that (I'd argue we're not really bringing deaths sooner, we're no longer deferring them as much as we were by the way)

Of course there are intangible benefits to continuing to defer exposure as well - therapeutics. Nothing is really certain until data is in on their real world use.  

> Secondly, healthcare: rationing of emergency care, Cat 1 + 2s not being reached in effective times, NHS staffing decimated (in the literal sense, classical scholars) cannot fail to have a knock-on effect on both non-covid excess deaths and population morbidity: a lot of progress made over the last few decades against all sorts of urgent life-threatening conditions will go into reverse.

Totally agree.  I'm still hoping Offwidth starts a thread on this.  In terms of myself and my young family, I'm much more worried about what's happening to the NHS than about Covid now. That's what has warring for our future. 

> Thirdly (and this is related to point 2 and, I think, the most hazardous likelihood), widespread infection increases, by a nontrivial factor, the number of people living with a new pre-existing condition who previously were healthy, and so they join the ranks of the vulnerable, with the difference that their potential deaths have been brought forward not just by a couple of months: in effect, their age-based risk has been accelerated.

But if we can't eliminate the virus, what's the alternative?

> Follow such a policy of temporal displacement of death in full consciousness of its implications and things start to go all Logan's Run rather quickly...

To put a different perspective of this; these are deaths displaced from April/May 2020 to late summer 2021; displaced through the use of lockdowns and control measures short of lockdowns and through vaccination.  We're still displacing an awful lot of deaths through control measures and many older people being very careful.

> In that light, I could even make sense of some of the most apparently nonsensical parts of Gov's approach - doing nothing about ventilation, blathering anti-mask pseudoscience (Robert Halfon MP wins my 'Twunt of the Day' award today for his outstanding efforts), refusing to update the testing criteria, denying airborne transmission, insisting schools are safe and so on - as artificial accelerationism.

I can't make sense of some of these - whilst I think everyone has to roll the dice eventually if elimination is off the cards, we can stack the odds in people's favour.  High viral load situations are a result of bad building designs that don't give people a healthy environment.  Nobody should be getting particularly high viral load exposure and the barrier to addressing a lot of this has been embarrassingly low.

> Unfortunately, a variant that displays both vaccine escape and reinfection potential doesn't just take over that job of accelerating population level immunity. Rather it means the logic of raising spread now in order to reduce it later is broken, the infection control measures available to us are rendered insufficient, the vulnerable groups in society are placed in greater hazard, and healthcare capacity breaks down.

I still see it is an acceleration; I still see the goal as moving us on to an endemic circulation pattern as fast as safety possible to mitigate against significant breakage of antibody and T-cell epitopes from S-protien vaccines, and just because that's all we can do now - delaying the inevitable opens up a wider gap from all sources of immunity to the inevitable.  This is why I was so agog at the Valneva decision because a well adjuvanted inactivated virus vaccine that they claim (no published data last I looked) to have a good T-cell response to multiple viral proteins is the obvious next step in taking the pain out of our transition from a pandemic to a truly endemic pattern.

I think I'm as stymied by you by the current response and by many events over the last 12 months, but coming at it from a different side.    

> [btw, what sources are you using for Germany? What I see from the RKI - Xmas reporting lag aside - and hear from friends there is very different.]

The OWiD data explorer - https://ourworldindata.org/explorers/coronavirus-data-explorer

It'd worth looking at the 7-day moving average and at raw cases; there are day-of-week effects and a festive sampling low; the case rate has stopped falling and may or may not be rising; the "Omicron share" metric shows it landing significantly in the last week - against a trend of falling cases and coming from a share of 0% this means omicron cases must be rising unless their measurement is highly targeted.   Give it another week... ???

Post edited at 21:18
In reply to bruxist:

> Here's where I must return to Whitty's initial logic of deaths merely being brought forward.

That ignores the development of therapeutic drugs, the rollout of vaccines, the ability to provide better treatment when not overwhelmed, the ability to treat non-covid conditions when not overwhelmed.

In one sense, all deaths may be 'brought forward'; we all have to die at some point...

 Stichtplate 02 Jan 2022
In reply to VSisjustascramble:

> Explain please.

> The army is an effective tool for assisting with other civilian agencies then capacity becomes an issue. They’re even assisting with the ambulance service at the moment I believe.

> What makes non-ICU Covid care so difficult that more non-skilled bodies couldn’t be useful.

Isn't it blindingly obvious to anyone with a passing grasp of the issue?

We aren't short of unskilled labour. We're short of skilled clinicians.

In reply to Stichtplate:

No. I’ve been in an ICU ward and realise that ICU care can’t be given without large teams of skilled professionals.

What goes on in a Covid ward post admission that someone with basic training couldn’t do?

10
In reply to wintertree:

Thanks for rehashing my “Your logic leads to elimination as being the only correct course of action. It doesn’t make sense.”. In a slightly more articulate way.

1
 wintertree 02 Jan 2022
In reply to captain paranoia:

>That ignores the development of therapeutic drugs, the rollout of vaccines, the ability to provide better treatment when not overwhelmed, the ability to treat non-covid conditions when not overwhelmed.

I totally agree on therapeutics but they are intangible at the point the decisions are made - just like the intangible risks from delaying spread/exposure.

If (and I accept it's an open question) omicron's intrinsic lethality is in a ballpark between that of alpha and delta, it's likely people who got exposed and needed treatment during the summer got better treatment then than they might in a week or two's time, and certainly than they would have got if it was all bunched up in to another giant winter peak without spread in the summer/autumn.  That view I think can work in both directions.

We effectively opted for a broad, shallow peak in the late summer vs a tight one in the winter. Of course, we could use lockdown to control the winter peak as we've seen across much of Europe, but lockdown comes with very real effects for many people.   We've seen how seasonality ends up pushing the required level of control measures right up the scales in winter without sufficient population level immunity.

If Omicron forces a lockdown shortly, it would I think have forced a much bigger one without the spread during the late summer and the autumn.

There was no doubt in my mind at all that lockdown was entirely appropriate in Spring 2020, and again for Winter 2020/2021.  How anyone could argue otherwise still troubles me.

But now?  It's far from clear to me.  

The arithmetic of a pandemic is harsh and inhuman; that arithmetic says that most of the vaccinated deaths are in the over 70s now.   Order of 80% to 90%.

Do we spread those out over the summer/autumn, or do we carry them forwards in to winter and then end up having to lock down young families, close businesses, and disrupt everyone's lives to get through those deaths in a healthcare-risking winter spike?  

This is something of a taboo subject given the utter insanity of the "but the economy" arguments early on in the pandemic, but it has to be addressed.

I don't profess to know which is the better outcome for society as a whole.  I do know that we expect government to weigh such issues.  What bothers me - if I had the job of listening to the evidence, the cost of each side and of making a decision, it would haunt me.   My eye would twitch like Former Chief Inspector Dreyfus in The Pink Panther Strikes Again, I'd have bags under my eyes, I'd be a mess.  No sign of our leadership carrying those decisions with them.

The biggest failure I see of "learning to live with the virus" is of not resourcing healthcare sufficiently to function "as normal" with the extra load placed on it.  One might almost suspect the ERG/CRG don't like the partial-Brexit-reversing look of some decisions that are needed for staffing.

 wintertree 02 Jan 2022
In reply to VSisjustascramble:

> Thanks for rehashing my “Your logic leads to elimination as being the only correct course of action. It doesn’t make sense.”. In a slightly more articulate way.

There is a big middle ground however.  For example (by no means conclusive), these apply regardless of if elimination is desirable/achievable or not, and are areas I think we could and should do more.

  • Mitigating peak viral loads through proper air handling 
  • Allowing the more vulnerable sufficient legal and practical means to protect themselves
  • Properly resourcing healthcare for the tasks involved
  • Accurate messaging that doesn't lead to people getting heavily optimistic views of the risks

I think I'm in 100% agreement with Bruxist on everything in the middle ground, and in terms of what the stable endemic situation looks like, I'm reaching my own interpretation based on a lot of lay reading in immunology and some selective brain picking here and there...

 Stichtplate 02 Jan 2022
In reply to VSisjustascramble:

> No. I’ve been in an ICU ward and realise that ICU care can’t be given without large teams of skilled professionals.

You've been in an ICU and realise it needs skilled clinicians. Well done.

> What goes on in a Covid ward post admission that someone with basic training couldn’t do?

Dunno? I'm a paramedic I don't work in a covid ward. Maybe if you spend time in a covid ward you'll reach the level of enlightenment you acquired after seeing the inside of an ICU.

 wintertree 02 Jan 2022
In reply to Stichtplate:

I think a better question is where the army can be deployed to reduce pressure on the NHS.

If the inability to discharge patients in to care is still a problem, then every bed in a care home opened up by army assistance in the care home frees up a bed and some (smaller) quantity of staff time to the NHS.

From what I can tell, the time required to qualify for care home work is significantly less than that for clinical roles.  I think it would need a sensitive approach to choosing people based on aptitude.

There may be other less-obvious ways resources can be shuffled along a chain with forces going in one end and clinical staff coming out of the other?

If only we'd had six months to plan for the possibility of a bad Covid spike in winter...

In reply to wintertree:

Just on your lockdown points. There are still people coming out against it. This from todays guardian for example:

https://amp.theguardian.com/world/2022/jan/02/britain-got-it-wrong-on-covid...

I’m 50:50 now. We’ll never know if we made a mistake in hindsight. 

I might post this on the anti-vax/ conspiracy thread, but lockdowns (and other Covid restrictions e.g. social distancing) cause huge harms, which I don’t think is widely appreciated. Are we sure that those calling for lockdowns now aren’t acting in the same bad faith as those pushing anti-vax stuff. There are certainly some people in Indy-SAGE with very dubious political views - economic warfare?

15
 Andy Hardy 02 Jan 2022
In reply to VSisjustascramble:

Who is calling for a lockdown now? (Bear in mind that I'm not on tw@tter)

There are many many lots of things we could do before lockdown - for instance, for the same cost as half a royal yacht, every classroom could be equipped with a HEPA filter...

1
 wintertree 02 Jan 2022
In reply to VSisjustascramble:

>  There are still people coming out against it. 

On the other hand, healthcare got screwed.  If we'd had less control measures, would healthcare have been more or less screwed?

That's not hindsight, that's first order thinking.

If we'd embraced much more control measures a few weeks sooner, it might have bought time to figure out a way to avoid lockdown, but I'm not hopeful.

> I’m 50:50 now. We’ll never know if we made a mistake in hindsight. 

It was the only plausible action at the time with what was known at the time.  We've failed to throw sufficient protection around the more vulnerable even after the following massive improvements from the first lockdown:

  • PPE crisis addressed
  • Lack of testing capacity addressed
  • Vaccines

If we can't fully protect the most vulnerable now, the idea that we could have done so sufficiently to preserve universal healthcare back in April 2020 is cloud cuckoo land.

 Stichtplate 02 Jan 2022
In reply to wintertree:

> I think a better question is where the army can be deployed to reduce pressure on the NHS.

The army excels at logistics...focus them on making ambulances ready and stocked and you'd save thousands of clinical man hours and relieve untold extra stress on staff who currently have 10 minutes to check a vehicle, it's kit and restock before going live at the start of a shift.

Instead they stick them out as drivers. This just puts more stress on the clinicians teamed up with them as their clinical work load has doubled. 

> If the inability to discharge patients in to care is still a problem, then every bed in a care home opened up by army assistance in the care home frees up a bed and some (smaller) quantity of staff time to the NHS.

> From what I can tell, the time required to qualify for care home work is significantly less than that for clinical roles.  I think it would need a sensitive approach to choosing people based on aptitude.

The bigger choke point is the many thousands of elderly with chronic health problems who are too sick for care homes but aren't getting any healthier on hospital wards. There's very little out there for these patients.

> There may be other less-obvious ways resources can be shuffled along a chain with forces going in one end and clinical staff coming out of the other?

When you replace clinical staff with non-clinical staff, patients get less clinical care and the clinical staff on duty are lumped with a hugely increased workload at a point where many are already at breaking point.

 wintertree 02 Jan 2022
In reply to Andy Hardy:

> Who is calling for a lockdown now? 

Almost nobody now;  I was making the point that we hopefully avoid lockdown this winter as a result of allowing the spread of delta since the summer.  So the costs of lockdown have a relevance to evaluating the costs and benefits of the last six months.  Omicron is pushing that hope close to the wire.

>  There are many many lots of things we could do before lockdown - for instance, for the same cost as half a royal yacht, every classroom could be equipped with a HEPA filter...

Just imagine what could be done if you didn’t give money to a lab that was 100% incapable of detecting covid and presumably didn’t run any QA…

Post edited at 22:23
1
 wintertree 02 Jan 2022
In reply to Stichtplate:

Thanks for the first two replies.  Well, for all three…

> > There may be other less-obvious ways resources can be shuffled along a chain with forces going in one end and clinical staff coming out of the other?

> When you replace clinical staff with non-clinical staff, patients get less clinical care and the clinical staff on duty are lumped with a hugely increased workload at a point where many are already at breaking point.

Indeed,  but I didn’t mean replacing clinical staff directly - I mean are there other situations where a clinician is covering another job, and that other job can be covered by the forces.  Or even longer chains.  Your comment on having them preparing ambulances being an example of what I was thinking.

In reply to wintertree:

The healthcare question is a simple one. Yes - it would be in a far far better place now if we, like South Africa had gotten out of the pandemic.

In the UK it’s likely that the pandemic will still have some energy going into next winter (more if we have to lockdown). 

It’s not Covid itself that’s putting pressure on healthcare, it’s the need to dual run and deal with routine and Covid issues. Plus less vulnerable people means less demand for ongoing care.

I don’t think healthcare will look anything like normal until 2024/5 due to the path we’ve taken.

As to the wider point, I fully understand it would have been truely grim. But has the lack of schooling, the debt, the mental health issues, the healthcare issues had an impact that it will take more life years off the population than the lockdown saved? I’m convinced it has (by a significant amount).

Are there other factors that need to be considered to balance that view, of course yes. But we’ve been too quick to dismiss the “standard” pandemic response in my opinion. There’s a reason why let it rip was the default response for decades.

15
In reply to wintertree:

My sister has worked with army medics at her vaccination centre. Although their training is fairly limited, and very much directed to combat trauma injuries, she said they were very good, efficient vaccinators.

She also mentioned how crazy it was that vaccinators and those manning the covid advice lines are being paid more than ICU nurses. That's despite having worked as a hospital nurse and administrator for nearly forty years; the piss poor pay was something of a surprise.

In reply to wintertree:

> I think a better question is where the army can be deployed to reduce pressure on the NHS.

> If the inability to discharge patients in to care is still a problem, then every bed in a care home opened up by army assistance in the care home frees up a bed and some (smaller) quantity of staff time to the NHS.

As I understand it there is a lot of staff churn in the care sector because the pay is sh*t so people move into sectors like hospitality.

If there is a lot of churn then there are a lot of people out there who have experience in the sector but are not currently employed in it.  

So the simplest way to get more staff would be to push in some money to make it compelling for people who used to work there to jump back in for a couple of months.

 mondite 02 Jan 2022
In reply to wintertree:

> I think a better question is where the army can be deployed to reduce pressure on the NHS.

The military are badly understaffed  (in part due to those idiots at crapita screwing up army recruitment) and even with the drop in operations are still struggling for both retention and also keeping their training current.

I somewhat doubt the average soldier signed up to work in carehomes and I think you would start seeing increased retention problems. 

Using the military allows politicians to feel like Churchill but its going to have long term impact on their ability to do their proper job and whilst the immediate hotspots have been cut back on there are several still brewing.

Be a better idea to look at why getting carehome staff is so hard. Just possibly the crap wages and crap hours?

 wintertree 02 Jan 2022
In reply to mondite:

Like I said, it would need a sensitive approach to finding the right people.

TiE’s point about staff churn meaning there’s a lot of trained people out there is good.  Ties in with your point on crap pay.  If better pay to re-recruit and retain care staff works it’s both cheaper and faster than recruiting clinical staff but achieve the same results. 

> Using the military allows politicians to feel like Churchill but its going to have long term impact on their ability to do their proper job and whilst the immediate hotspots have been cut back on there are several still brewing.

Funny, it makes them look like people who’ve failed to prepare rather than Churchill…. Yes, defence planning is another thing that needs its own thread…

 Toerag 02 Jan 2022
In reply to Stichtplate:

> The army excels at logistics...focus them on making ambulances ready and stocked and you'd save thousands of clinical man hours and relieve untold extra stress on staff who currently have 10 minutes to check a vehicle, it's kit and restock before going live at the start of a shift.

St.Johns provide the ambulance service here, their volunteers have been doing all the ambulance cleaning.

In reply to VSisjustascramble:

> The healthcare question is a simple one. Yes - it would be in a far far better place now if we, like South Africa had gotten out of the pandemic.

> In the UK it’s likely that the pandemic will still have some energy going into next winter (more if we have to lockdown). 

> It’s not Covid itself that’s putting pressure on healthcare, it’s the need to dual run and deal with routine and Covid issues. Plus less vulnerable people means less demand for ongoing care.

> I don’t think healthcare will look anything like normal until 2024/5 due to the path we’ve taken.

> As to the wider point, I fully understand it would have been truely grim. But has the lack of schooling, the debt, the mental health issues, the healthcare issues had an impact that it will take more life years off the population than the lockdown saved? I’m convinced it has (by a significant amount).

> Are there other factors that need to be considered to balance that view, of course yes. But we’ve been too quick to dismiss the “standard” pandemic response in my opinion. There’s a reason why let it rip was the default response for decades.

That’s just not true; societies have always taken steps to protect themselves from communicable diseases by restricting movement and population mixing, on legal, societal and individual levels. There is evidence from the 1918 flu pandemic at city level in the US showing much lower death rates in cities which mandated some form of lockdown compared to those that didn’t. That’s one of the most dispiriting aspects of the current pandemic; the way to manage pandemics has been known for over 100 years, and the contingency planning had been done, but when it was needed it wasn’t used. 
 

There were for sure greater limitations on how much a society could lock down during previous pandemics, and there still are in many parts of the world. We have data now that allow comparison of excess deaths in countries which have locked down more or less strictly over the duration of the current pandemic, see below:

https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker
 

and for the number and duration of lockdowns:

https://en.m.wikipedia.org/wiki/COVID-19_lockdowns
 

it’s pretty clear that countries that chose not to, or were unable to, lockdown properly before mass vaccination was completed have fared much worse than those that did. Our excess deaths are 1/3 of those in Peru, Bulgaria, Russia, Serbia, where lockdowns have been shorter, and hard to operate effectively (in Peru refrigerators are not widely available, and people had to go to the market most days to buy food even during their first lockdown). Scaled up, we could perhaps have lost another 300,000 lives. These would not all have been pensioners in care homes.

And I really don’t think anyone is downplaying the damage lockdown has done. I have school age children. I fear that the psychological scarring from this, particularly on my eldest, is going to be very long lasting. But you too readily dismiss the damage failing to lock down would have had. We watched healthcare systems becoming overwhelmed in north Italy, New York, Madrid, Manaus, India. People fighting for oxygen cylinders, driving dying family members from full hospital to full hospital, mass graves being dug.  It was said repeatedly by numerous posters back in spring 2020, it is frankly delusional to think that people would continue to head into their local mall to meet friends over a latte in Starbucks, before engaging in a little light retail therapy if they no longer believe an ambulance is going to come for them if they fall ill, which is the situation we were rapidly heading towards by the end of March 2020. People take their own decisions;  and given the run on bog roll around that time while healthcare was still available, what do you think they would have done when the hospitals were full and people were dying in ambulances? What sort of damage does that do to the economy, and what sort of long term psychological scarring does that leave a country with?
 

Not that this reply will change anything. You have showed little interest over a number of threads now in engaging with people who have direct experience of some of the points you make, preferring to rehearse your existing position. I’m sure you’ll be posting that lockdown will kill more people that it saved all the way through to the next pandemic. 
 

Post edited at 00:07
1
In reply to no_more_scotch_eggs:

I get your point, but just to be clear are you counting in quality adjusted life years lost? Because that’s what I’m doing.

Therefore I’m not sure whether your point around Spanish Flu neglects the consequences of locking down.

Lockdown saved c600k lives, with c.10 life years saved per person. I.e. 6m years.

If the measures put in place to lockdown take 2 months off the life of the current UK population then we lost c.70m*1/6 = c.12m life years as a consequence of lockdown.

This is massively simplified, but which of those scenarios is worse? 

As to your point about not being willing to engage. On Covid i’ll always have a sensible conversation with people as long as they agree with the basic facts I.e.: everyone will catch it, elimination is impossible, lockdowns have a significant cost.

If people can agree on scientific fact and can keep the “oh, won’t someone think of the vulnerable” wailing to a minimal then I’m happy to discuss.

12
 wintertree 03 Jan 2022
In reply to no_more_scotch_eggs:

> But you too readily dismiss the damage failing to lock down would have had. We watched healthcare systems becoming overwhelmed in north Italy, New York, Madrid, Manaus, India. People fighting for oxygen cylinders, driving dying family members from full hospital to full hospital, mass graves being dug.

> and what sort of long term psychological scarring does that leave a country with?

What is the soul of a nation worth? How do you ever put that damage on a bean counting balance sheet?  

You can’t.  It’s far worse than the financial damage IMO, and it’s not an honest argument to pretend the decision was just one of financial costs.

1
In reply to VSisjustascramble:

You invoke “scientific fact”;  but your argument is based on the premise of QALYs (well, except it’s not, you have no adjustment for  “quality of life” as opposed to simply duration of life in your sample calculations), which are:

a) speculative- we won’t know the full quality of life impact of lockdown for generations yet

b) inevitably affected by value judgment, and 

c) have a counterfactual which is impossible to calculate. We can’t re run time with no lockdown to measure the effects and make a comparison with what we actually did.

So, I’m inclined to treat your “I’m only prepared to debate the facts” claim with a degree of scepticism.

Especially when we have plenty of real world current data for what happens when you apply different levels of disease containment. Caveated of course that no two circumstances are identical, and some degree of interpretation will always be needed; but it’s pretty obvious, and doesn’t seem to be disputed by you, that without lockdowns we would have had some hundreds of thousands of additional deaths. Your point- which you hold with, I think, unjustified certainty- is that the economic and long term health and educational costs of this will be greater.

I don’t agree, as we have evidence from across the North Sea for what happens if you take that approach. Sweden had twice the excess deaths as Denmark, and suffered the same economic hit. As per my point above, when people no longer trust the state can supply the fundamentals of civil society, they stop behaving like model consumers. Our own experience regarding panic buying provides evidence of this. 
 

The resurrection of the argument over lockdown, with a reliance on a speculative counterfactual, and the wilful disregard of plenty of real world current data as to the likely effect of failing to take adequate measures, is another dispiriting example for me over how the pandemic response has been relentlessly politicised. Perhaps it is just wishful thinking- “if the world was run more like the way I think it should be, then bad things could be avoided”; it’s pretty grim to accept we were sitting ducks for this disaster, and remain so for the next one, and there would be some comfort in thinking that we can control our fates. Unfortunately, many of the arguments that this leads to will directly undermine any useful learning from this pandemic, and make us more vulnerable when the next one comes. 

Post edited at 09:30
2
 squarepeg 03 Jan 2022
In reply to tom_in_edinburgh:

But everybody won't catch it. There's always a percentage who don't get sick. 

2
In reply to wintertree:

Absolutely. Once the illusion that a state has the power and wisdom to protect its citizens from egregious harm is shattered, it takes a long time for it to return, if it ever does.

what does that do to a society? I’d rather not find out.

 neilh 03 Jan 2022
In reply to tom_in_edinburgh:

You mean they are agency employees.There are already plenty of those in the care sector getting paid way above the standard rate.Ask any care home manager.That solution is already there and in place.

 HardenClimber 03 Jan 2022
In reply to wintertree:

Yes, there seems to have been little attempt to make long term changes to health care (even if they hadn't worked through by now we could have started). (As you suggest, perhaps driven by Brexit Apologists, who are now talking up agreements with India),

There seems to be rather little regard for healthcare staff morale.

One of our early mistakes was understanding airborne spread and the need for effective masks.  Given the potential role (even if it is principally to reduce the dose recieved) there seems to have been a very limited amount of reseach and guidance (the minimum accpetable in advice is still woefully inadequate, and politicians fail to push / lead by example).

Following on thoughts of airborne spread there seems to have been rather limited attention to environmental sollutions (buildings, ventilation), which could have more general benefits than covid. This might also help with the next pandemic (if global warming hasn't got us first).

We didn't get a (proper) grip on travel / screening of overseas travellers.

Of course the government is caugh in the thrall of the neo-liberal individualist group (which, also has support for its ideas from the far left) whose approach still seems to be of simultaneously complaining about restrictions and complaining that the NHS is busy with COVID work. In our brave new world of culture wars a graduated approach seems difficult to envisage. I can't help but fear that the final public health structures we are left with with be greatly limited.

(We did get some things right, I think eg the running hot in the summer. I do worry that we (on all sides) forget nothing and learn nothing (Talleyrand).

 neilh 03 Jan 2022
In reply to VSisjustascramble:

So what do you think to China’s and Australia/ NZ approach.

1
In reply to neilh:

> You mean they are agency employees.There are already plenty of those in the care sector getting paid way above the standard rate.Ask any care home manager.That solution is already there and in place.

My only point was that the way to get more people for a couple of months is to spend significantly more money on wages for a couple of months.  Whether that money goes through agencies or some other mechanism is up to the government.

 Michael Hood 03 Jan 2022
In reply to no_more_scotch_eggs:

> We have data now that allow comparison of excess deaths in countries which have locked down more or less strictly over the duration of the current pandemic, see below:

This is pretty interesting; it seems that in a lot of countries that although Covid has killed many, the measures taken have reduced deaths from (some) other causes so that the excess deaths is significantly less than Covid deaths. In some countries that have imposed strict measures, excess deaths is even negative.

Presumably Flu is the obvious cause where deaths have reduced in many places (measures that reduce transmission) but there must be many other causes; e.g. have road deaths reduced because of reduced travel, etc.

 neilh 03 Jan 2022
In reply to tom_in_edinburgh:

That is what happens anyway which is my point., you do this by becoming an agency employee working in the care sector and you get paid more.  It’s already there and in operation.  
 

There is a shortage of people who want to work there irrespective of the wages. 
 

it’s also why the govt backyracked before Christmas  and introduced temporary visas for the care sector to try and attract more people.Brexit took away that pool of Labour. ( an obvious downside to Brexit). 

Post edited at 11:14
In reply to neilh:

> There is a shortage of people who want to work there irrespective of the wages. 

The 'irrespective of wages' bit seems unlikely when people are leaving to take jobs in hospitality and supermarkets.   Those aren't exactly high pay industries.   I don't get the impression people doing care work are on the 'irrespective of wages' end of the pay scale.

> it’s also why the govt backyracked before Christmas  and introduced temporary visas for the care sector to try and attract more people.Brexit took away that pool of Labour. ( an obvious downside to Brexit). 

This is Tory economics.  They like free markets except when they increase employees wages.  Their goal is to hold wages down and so the c*nts that own chains of care homes and donate to the Tories make more money.  Patel wants visas for Indians because an Indian on a visa tied to an employer will work for less than an EU citizen who can swap employers.  Rishi's father in law owns a large Indian outsourcing company, very likely those outsourcing companies will make out like bandits supplying the indentured labour once they can get visas.  As usual the whole thing is corrupt AF.

Post edited at 11:45
In reply to neilh:

China’s approach will prove to be a disaster.

Personally I’m absolutely bricking the economic fallout when China accepts the inevitable. It has the potential to make 2008 look like an economic hiccup.

New Zealand has done a great job, but we aren’t New Zealand. A totally different set of circumstances.

7
 Dax H 06 Jan 2022
In reply to no_more_scotch_eggs:

> it’s pretty clear that countries that chose not to, or were unable to, lockdown properly before mass vaccination was completed have fared much worse than those that did. Our excess deaths are 1/3 of those in Peru, Bulgaria, Russia, Serbia, where lockdowns have been shorter, and hard to operate effectively (in Peru refrigerators are not widely available, and people had to go to the market most days to buy food even during their first lockdown). Scaled up, we could perhaps have lost another 300,000 lives. These would not all have been pensioners in care homes.

> And I really don’t think anyone is downplaying the damage lockdown has done. I have school age children. I fear that the psychological scarring from this, particularly on my eldest, is going to be very long lasting. But you too readily dismiss the damage failing to lock down would have had. We watched healthcare systems becoming overwhelmed in north Italy, New York, Madrid, Manaus, India. People fighting for oxygen cylinders, driving dying family members from full hospital to full hospital, mass graves being dug.  It was said repeatedly by numerous posters back in spring 2020, it is frankly delusional to think that people would continue to head into their local mall to meet friends over a latte in Starbucks, before engaging in a little light retail therapy if they no longer believe an ambulance is going to come for them if they fall ill, which is the situation we were rapidly heading towards by the end of March 2020. People take their own decisions;  and given the run on bog roll around that time while healthcare was still available, what do you think they would have done when the hospitals were full and people were dying in ambulances? What sort of damage does that do to the economy, and what sort of long term psychological scarring does that leave a country with?

What you need to remember is we didn't need mass graves, we were not fighting in the streets over food ot oxegen cylinders and our health care though stretched didn't break. Because none of this happened a lot of people think the government over reacted. 

Had the above happened the same people criticising the "over reaction" would be protesting that the government didn't do enough to protect us. 

It's like the nightingale hospitals, turns out we didn't need them, I class that as a bonus but a lot of people see it as a massive waste of money but if we had people dying in the streets people would be asking why field hospitals were not set up until it was too late. 

No matter what happenes, no matter what is said or done people like VS will always criticise. 

1
 MargieB 06 Jan 2022
In reply to wintertree:

 As regards the unknown reason for decay in London, is this  related to T-cell immunity or rather  a lack of it ? Do combination vaccinations like astra zenneca with pfizer provide better T-cell immunity? what proprotion of Londoners got this combination? What proportion just got 3 pfizer? Does the lack of combination vaccinations in London explain the decays?


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