Coronavirus Health - Health and Wellbeing

[johnhemming]

than tested positive cases which are leading indicators of hospitalisations and then deaths.

This is an interesting question. I personally am not sure that PCR positive tests are actually leading indicators of hospitalisations. People carrying the virus can be PCR positive for quite a bit of time (definitely over 3 weeks, but it varies). Depending upon how the test is done it can pick up viruses that have been inactivated. Hence apart from the fact that PCR positive tests are skewed by sampling and test the prevalence whilst we want the first derivative in respect of time, they may actually lag hospitalisations or be around the same time and do not necessarily lead.

The daily variations in percentage prevalance in the tests recently do not seem statistically significant as they are moving by too much in a day. It appears also that a high proportion of the testing is of cohorts of students and school children. Once that has stabilised one would expect to see a drop in new "case" numbers. That, however, would be meaningless.

[GoSeigen]

Hi,

I apologize if this issue has already been discussed.

If we accept that most of the new cases of Covid do not lead to hospital visit, not to speak of death, then why create panic and shut down economic and social activities, schools, colleges etc? Today's total number of new cases is 12,594 and of new deaths is 19. Comparing the plots of daily new cases and daily new deaths from https://www.worldometers.info/coronavirus/country/uk/ shows the daily death curve is almost flat and remained flat for the last three months compared with that for daily new cases. 19 deaths in a population of more than 67 million should not be a reason to shut down a country. If infected persons do not show any serious symptoms and get normal with over-the-counter medication then why not accept this as a feature of this virus at this late stage and be prepared to live with it?

alpha

Completely in agreement alphab1. From July or so it was quite obvious that this virus is not particularly deadly. IMO opinion it is over bar the Fat Lady. I have invested accordingly.

Governments have bought their time, now it is appropriate to normalise economies, give people their liberty back and get things moving again. Indeed where we do business we have noticed a strong pick-up in the past few weeks.

GS

[Lootman]

Completely in agreement alphab1. From July or so it was quite obvious that this virus is not particularly deadly. IMO opinion it is over bar the Fat Lady. I have invested accordingly.

Governments have bought their time, now it is appropriate to normalise economies, give people their liberty back and get things moving again. Indeed where we do business we have noticed a strong pick-up in the past few weeks.

Yes it almost feels like we have defeated the virus without really understanding how we did it.

If we had had the current hospitalisation and death rate back in April/May, with the same infection rate, we would probably have just dismissed this as a bad dose of flu.

But at this point the government may be a little too much in love with a crisis and the special powers it gives them, making a return to normality more difficult. Every political leader hopes, prays and dreams for a good crisis. It is also a handy thing to blame for anything else that goes wrong. Imagine what Corbyn would have done with this!

[alphab1]

https://nypost.com/2020/10/06/medical-e ... -720629484

"Medical experts: Lockdowns do more harm than good"
On Oct. 4, 2020, three preeminent experts — Dr. Martin Kulldorff, professor of medicine at Harvard University; Dr. Sunetra Gupta, an epidemiologist at Oxford University; and Dr. Jay Bhattacharya, a physician and epidemiologist at Stanford University — delivered the following declaration, calling for a different approach to dealing with the novel coronavirus than the lockdown model:
(snip)

Retired people living at home should have groceries and other essentials delivered to their homes. When possible, they should meet family members outside, rather than inside. A comprehensive and detailed list of measures, including approaches to multigenerational households, can be implemented and is well within the scope and capability of public-health professionals.

Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as handwashing and staying home when sick, should be practiced by everyone to reduce the herd immunity threshold.

(snip)
Since the declaration was published, more than 2,000 public-health scientists and more than 2,000 medical practitioners have signed it, as have nearly 40,000 members of the general public. You can add your signature to the declaration online at https://gbdeclaration.org.


It is difficult to understand why newspapers are concerned about thousands of missing contact tracing data of people not needing hospitalization but not about the very limited number needing treatment. If this number can be controlled then the spread of covid with no serious effect could be treated as a 'new normal' and the enormous effort and cost of tracing and controlling the virus brought to an end, urgently.

This is not a layman's view but that of respected and accomplished experts in the field.

[JohnB]

The purpose of contract tracing is to keep the replication number R, the number of new cases each infected person generates, below one. Its not a matter of the severity of the cases, its the number. If R > 1 the number of cases is exponential, and whatever small fraction of people do need hospitalization exceeds the number of ICU beds, and they die in corridors.

No-one has found a good symptom mitigation strategy that would allow people to accept they should catch it like a cold.

If immunization doesn't work, I'd be inclined to take my chances at 52, but for the sake of 91yo mum, I'm prepared to let them have a go first, but then play Russian Roulette with her.

With only 500,000 cases putting the NHS under stress, I can't imagine 25 million, unless we all agree to suffer (and some to die) at home.

[dealtn]

With only 500,000 cases putting the NHS under stress, I can't imagine 25 million, unless we all agree to suffer (and some to die) at home.

Can you explain how you think 25million cases is possible, as I too can't imagine it?

[neversay]

This is not a layman's view but that of respected and accomplished experts in the field.

There are equally respected and accomplished experts that take the opposite view. Such is science for establishing concensus on the 'knowns' whereas the very many 'known unknowns' are still a matter for informed speculation on the relative probabilities.

These include whether being able to shield the vulnerable is realistic, plus the many possible consequences of 'Long-Covid' the latest of which appears to be possible impact on sperm counts.

In other words, their views are based on informed guesses on probabilities rather than established facts. The majority of scientific advisors to Governments around the world have made a very different assessment of those probabilities.

Those who are not vulnerable should immediately be allowed to resume life as normal.

That represents one hell of an experiment and not without massive social and economic consequences if it goes wrong. @JohnB neatly explained the numbers.

It is difficult to understand why newspapers are concerned about thousands of missing contact tracing data of people not needing hospitalization but not about the very limited number needing treatment. If this number can be controlled then the spread of covid with no serious effect could be treated as a 'new normal' and the enormous effort and cost of tracing and controlling the virus brought to an end, urgently.

I totally agree on the misplaced sensationalisation by the newspapers. The inadequacy of many so-called 'journalists' has been a low-point in this crisis. As I mentioned before, we are not currently seeing the level of hospitalisations because the current pool of those infected is still low (but rapidly growing), affecting a younger demographic, and we do have many lockdown measures in place.

[dealtn]

Those who are not vulnerable should immediately be allowed to resume life as normal.

That represents one hell of an experiment and not without massive social and economic consequences if it goes wrong. @JohnB neatly explained the numbers.

Do you think the current situation is not also "one hell of an experiment and not without massive social and economic consequences"?

[neversay]

Those who are not vulnerable should immediately be allowed to resume life as normal.

That represents one hell of an experiment and not without massive social and economic consequences if it goes wrong. @JohnB neatly explained the numbers.

Do you think the current situation is not also "one hell of an experiment and not without massive social and economic consequences"?

Quite. It's a balance between societal cost whatever policy is pursued. If the experts are divided on the topic, the laymen are clearly picking sides according to their political preferences, personal risks and value they place on the different potential outcomes.

The UK response is broadly in-line with other nations around the world:

https://ourworldindata.org/policy-responses-covid

The public opinion and dialogue in different countries vary according to many factors:

https://www.pewresearch.org/global/2020 ... economies/

Most countries are having similar debates and being similarly highly-charged by politics and wreckless 'journalism'.

[dealtn]

That represents one hell of an experiment and not without massive social and economic consequences if it goes wrong. @JohnB neatly explained the numbers.

Do you think the current situation is not also "one hell of an experiment and not without massive social and economic consequences"?

Quite. It's a balance between societal cost whatever policy is pursued. If the experts are divided on the topic, the laymen are clearly picking sides according to their political preferences, personal risks and value they place on the different potential outcomes.

The UK response is broadly in-line with other nations around the world:

https://ourworldindata.org/policy-responses-covid

The public opinion and dialogue in different countries vary according to many factors:

https://www.pewresearch.org/global/2020 ... economies/

Most countries are having similar debates and being similarly highly-charged by politics and wreckless 'journalism'.

Well I suspect many, if not most, experts are not picking extremes, nor are many laymen. It doesn't seem that way admittedly, particularly as politicians, and the media appear to be operating towards one end or other of the spectrum of opinion. Many simply wish for a more considered, and focussed on multiple inputs and effects on society than a narrowly defined "Covid", debate on the multiple issues society faces as a result of this new virus.

That was admittedly difficult in the early weeks of this new, and unknown, virus. That excuse is less credible now.

[alphab1]

(1) If thousands of people get infected but show no or only mild symptoms of the illness, then why should we worry/care if they spread the virus to many others with a positive R rate , however high?

(2) The infected people needing hospitalization (whether or not needing mechanical ventilation) require close monitoring even if their number is presently very low compared to the total affected population. It is these people on whom most of the effort to discover the reason of the severity (i.e. tracing) should be spent and lessons learnt. The relevant government department may already have and can have in a few days the relevant data from all over the country of all those hospitalized with covid and publish the information so that people can appreciate if some restrictions are put on these 'vulnerable' people. Following this approach there should be no situation when NHS will be overwhelmed as it selectively tackles the real problem at its origin.

Cheers

[Mike4]

(1) If thousands of people get infected but show no or only mild symptoms of the illness, then why should we worry/care if they spread the virus to many others with a positive R rate , however high?

One reason would be because of "long covid". Just because someone didn't die of it, doesn't mean the long term consequences of having COVID-19 are necessarily trivial.

I'm surprised you are unaware of it.

https://www.bbc.co.uk/news/stories-54106272

[Lanark]

(1) If thousands of people get infected but show no or only mild symptoms of the illness, then why should we worry/care if they spread the virus to many others with a positive R rate , however high?

Lets throw some numbers at this:

Assuming a best case where the illness is spread evenly across the year and an average illness is 10 days, some people might get better after 5 days but some are ill for months, 10 days seems a reasonable guess for an average.

365 days in the year / 10 days = 36 tranches of people getting ill spread across one year.
UK population = 66 million
Dividing the population by 36 = 1,851,389 will be ill at any one time
20% of those will require some level of hospital care = 370,277 extra hospital cases at any one time.

The rate of ICU admission among hospital patients with coronavirus varies from 3% to 100%
https://journals.plos.org/plosone/artic ... ne.0235653

If we take the lowest possible rate 3% of 370,277 = 11,108 additional ICU beds required at any one time.

However there is a flaw in this calculation, while the average illness time might be 10 days, the average time for people in hospital ICU's is about 6 weeks (42 days) so we need to multiply that number by 4 = 44,432 additional ICU beds required at any one time.

The UK currently has about 4,500 ICU beds which are 80% occupied, so about 900 free at any one time.
So that means that of the 44,432 patients who need an ICU, 43,532 of them (that's 97%) will instead be sat in a tent in the car park - getting a level of medical care you might expect in a third world country.

Lets also assume that none of the medical staff get ill.

Now while all of this might do the job of getting the country moving towards herd immunity, the reality is that with such a large amount of infection travelling through the population we would be bound to have some mutations of the virus. That could lead to us being right back at square 1 with none of the developed vaccines having any effect on a different strain.

This is why NONE of the medical professionals in ANY country around the world are advocating a policy of just letting the disease run wild.

[JohnB]

A Guardian piece refuting the herd immunity argument in the gbdeclaration, "Why herd immunity strategy is regarded as fringe viewpoint"

William Hanage, a professor of epidemiology at Harvard, likens the strategy to protecting antiques in a house fire by putting them all in one room, standing guard with a fire extinguisher but simultaneously fanning the flames.

“If the blaze outside the room were adequately controlled then maybe, just maybe, they would be able to stamp out all the embers,” he said. “But this approach is to actively encourage the fire. The risk is that too many sparks make it through and all you’re left with is ashes.”

https://www.theguardian.com/world/2020/ ... -viewpoint

[servodude]

A Guardian piece refuting the herd immunity argument in the gbdeclaration, "Why herd immunity strategy is regarded as fringe viewpoint"

William Hanage, a professor of epidemiology at Harvard, likens the strategy to protecting antiques in a house fire by putting them all in one room, standing guard with a fire extinguisher but simultaneously fanning the flames.

“If the blaze outside the room were adequately controlled then maybe, just maybe, they would be able to stamp out all the embers,” he said. “But this approach is to actively encourage the fire. The risk is that too many sparks make it through and all you’re left with is ashes.”

https://www.theguardian.com/world/2020/ ... -viewpoint

Yes at times it seems like a hopeful justification for inaction

- i found this article quite well written in a similar vein: https://www.nytimes.com/2020/09/24/opin ... ccine.html

-sd

[alphab1]

As this is a very serious topic on both sides of the pond I appreciate the comments to my post as we all wish to reach an approach which is balanced.

https://www.bmj.com/content/371/bmj.m3908

This is the article I referred to early today. Some comments:

>>Kulldorff said that, with focused protection, low risk people could remain active and that this would help communities reach herd immunity sooner, which could shorten the duration and harms of lockdowns. Herd immunity, he said at a meeting in Great Barrington, Massachusetts, “is not a strategy—but a biological reality that will arrive sooner or later, either naturally or through a vaccine, or both.”

He defended the Swedish approach, saying that “schools were never closed for children aged 1 to 15, with zero covid-19 deaths . . .and the United States has now passed Sweden in terms of deaths per million inhabitants, despite Sweden having an older, more high risk population.”<<

>>However, Stefan Baral, a physician epidemiologist and associate professor at Johns Hopkins University, said he was concerned that the meeting had taken place. Baral explained that, while he generally agreed that lockdowns were causing serious harms, he had declined to sign the declaration because it did not address the concrete steps needed to assist the most vulnerable people.

Baral told The BMJ that three steps must accompany any loosening of restrictions: firstly, the removal of any barriers to accessing healthcare; secondly, paid leave for people affected by covid-19; and lastly, housing support for such people in multigenerational households.

“Sweden instituted paid leave from day 1,” he said. “You can call in sick and know that you are going to be able to eat that night. In the US, if you call in sick, you and your family may not eat.”

Bhattacharya, one of the authors, said that he welcomed such criticisms, as he hoped that the declaration would be just the beginning of an important dialogue about the benefits, and the harms, of public health interventions. <<

Let us hope a balanced approach will soon be found including taking of concrete steps to assist the most vulnerable people, which a detailed study of the hospitalized group will help to identify.

[sg31]

I believe COVID belongs to the cold group of virus infections, which means that neither herd immunity, nor a vaccine, will have any impact.

Can you give any evidence that the SARS-CoV-2 virus is a 'cold group virus' and define what you mean by that term.

I'm not aware of it being classified as such by any reputable research but I'm not upto date on the latest papers.

[Lanark]

Wired have just run an effective takedown of that very paper, the so called 'Barrington Declaration' created by a libertarian think tank.

There is no ‘scientific divide’ over herd immunity
https://www.wired.co.uk/article/great-b ... fic-divide

Whenever I see something being put out by Libertarians, I basically stop reading, you just know it's going to be presenting a completely dumb argument.

[johnhemming]

There is no ‘scientific divide’ over herd immunity

There are various views held by scientists relating to this issue. Hence that title is clearly wrong. There is a divide over whether lockdowns are a good idea.

Otherwise I am not inclined to go through the article to pick out the erroneous bits. Substantially people are wedded to particular views here. It is IMO worth bringing new actual research or new statistical information to the debate, but this particular article does not as far as I can see add anything to the debate.

[Mike4]

Dr John Campbell posted a rather scathing dismantling of the Barrington Declaration is a typically very restrained manner today too.

Two points he made jumped out at me particularly.

1) Eminent scientists such as the three authors tend not to get to the top of the tree by being good at the science, rather by being particularly good at 'working the system', by getting to know the right people and saying the right things. So he has little respect for the views or the three authors.

2) Unsupported claims. He points out they make a lot of statements and claims in the document, none of which are supported with any references or any evidence. Most unscientific and leading to lack of credibility.