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On the way down?

The home for all non-political Coronavirus (Covid-19) discussions on The Lemon Fool
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This is the home for all non-political Coronavirus (Covid-19) discussions on The Lemon Fool
onthemove
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Re: On the way down?

#431739

Postby onthemove » July 31st, 2021, 6:26 pm

Itsallaguess wrote:But eventually that pre-19th-July surge in Delta cases, mostly school-term and Euro-induced in it's latter stages, came up against the strong wall of, by then, vaccine-imposed UK resistance, as well as against the wall of 95% of people that are still voluntarily behaving themselves properly in the appropriate social situations anyway...

And here we are...

I don't think it's correct to say that the post-19th-July improvements show that people 'could always be trusted', given that we're in a completely different vaccine-induced situation in the UK now.
.


The school term and Euros were well flagged in advance. The modellers knew about them. Yet their models did not predict the drop in infection from around the 19th July. Quite the opposite!

The vaccine status of the UK hasn't changed that significantly over the past few weeks, and anyway, like the schools and euros, it's something the modellers will already have been well aware of to take into account in their models - certainly the SAGE modellers should have access to the expected delivery dates and what appointments there are in the system (I couldn't book my first jab without also booking my second at the same time; albeit the NHS have now cancelled my second jab and the only new appointment I could get is now a few weeks later :( ).

And those models were predicting, iirc, something like 100's of thousands of cases going into august. I would hope and presume the modellers making those assumptions were well aware of the efficacy and roll out of the vaccines.

Itsallaguess wrote:I think it's fairer to perhaps say that given the vaccine-induced situation in the UK now, there's enough trust in the general population that much of their COVID-protocol behaviour can now *be* voluntary, rather than written in law, because it makes much less of a difference now, when it is voluntary, than it did when it needed to still be written in law....


But the problem you've got is that infection rate declined over the space of a few weeks from when Boris made it clear he was going ahead and relaxing restrictions anyway, even as the rate of infection was already rising rapidly. This led to people believing that the government was now washing its hands of responsibility.

Here's a good example of what I mean...

"The latest numbers are terrifying, but when aren’t they? Unlock next Monday, as is now the plan, and the third wave will apparently peak in August, but it will be different from previous peaks, in that there will be no action taken to ameliorate it" https://www.independent.co.uk/voices/bo ... 83434.html


This is exactly why I believe the perception regarding responsibility shifted on to the public, compared to earlier in the pandemic.

I believe that that - the shift of responsibility from government to individuals - is the primary driver as to why infection rates made such an abrupt about turn for the better.

Clearly the models being touted prior to the 19th warning of 100's of thousands of cases going into August, have been considerably off.

And these are models from the scientists who the government (up until this point) had allegedly been following when deciding to implement mandatory lockdowns, etc.

I think it's a very valid question to ask - how did they get it so wrong?

These same modellers were almost being treated like rock stars at the beginning of the pandemic ... their names and predictions front page news, and being used to justify a whole host of legally mandated restrictions on people's liberties.

I will acknowledge the Prof Ferguson did actually agree with the 19th July opening up ... at the same time, he was predicting up to 200,000 cases per day... though that was precisely because he had factored in the vaccine take up, and modelled that those cases wouldn't translate into a high number of deaths. ( https://www.standard.co.uk/news/politic ... 44295.html )

But in the earlier lockdowns (pre-vaccine), where the number of cases was determining the number of deaths, I feel it's very important that we now understand why this latest model was so dramatically wrong footed after 19th July in terms of number of cases....

What was missing from their models - clearly something very substantial was, and likely still is, missing from their models.

And that something clearly led to an unexpected, but very welcome fall in cases seemingly paradoxically at a time when restrictions have been lifted, and which would have been expected, according to the models, to increase, rather than decrease the rate of infections.

If some as-of-yet-unknown / unexpected factor could not just slow down, but completely reverse the rise of infections, wouldn't we want to fully understand this in case of future pandemics?

If it wasn't, paradoxically, the removal of restrictions that led to such a dramatic fall in cases, then whatever it is would not only need to explain how it caused such a dramatic fall in cases, but also how it has managed to do so at a time when relaxing of restrictions would then (so the argument goes) have been presumed to be driving a rise in cases at the same time. That's quite an (alleged) head wind for that factor to have come up against.

That must be one heck of a unknown factor, if it wasn't paradoxically the removal of restrictions (human behaviour) that itself caused the unexpected drop vs the expectations from the models.

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Re: On the way down?

#431742

Postby Itsallaguess » July 31st, 2021, 6:48 pm

onthemove wrote:
Clearly the models being touted prior to the 19th warning of 100's of thousands of cases going into August, have been considerably off.


Not as 'considerably off' as the one predicting 1 million cases per week....

Government modellers predicted that cases could hit one million a week in a last-minute warning ahead of "Freedom Day".

Documents released by the Scientific Advisory Group for Emergencies on Friday show that scientists forecast increasing numbers of cases and said they expected July 19 to bring "further waves of infections, hospitalisations and deaths".

The statement of "concerns" from the Scientific Pandemic Influenza Group on Modelling (SPI-M) subgroup on July 14 also reveals that the modellers believed the ending of restrictions may have to be reversed.

Yet daily cases have dropped dramatically since peaking the next day, July 15, at around 60,000 – less than half the number the group was predicting.

Infection numbers fell again on Friday to 29,622 after a slight rise earlier in the week, less than a quarter of the forecast. The seven-day average is now down 36 per cent.


https://www.telegraph.co.uk/politics/2021/07/30/modellers-warned-1m-cases-week-even-third-wave-subsiding/

So it looks like some of these models aren't as robust as we'd like them to be - which is to be expected with a novel virus, of course, but if we accept that some of the forward-looking models can be wrong, then it's perhaps likely that we're not going to know the full story as to what's currently going on until some time in the future, when we get chance to look back a bit as well....

If I were a betting man, then my money would be on us currently miscounting previous asymptomatic infections in youngsters, and I wonder if there's enough of them that have gone undetected to be affecting the herd-immunity figures in a non-visible but beneficial way, especially now that many of them are getting vaccinated as well recently....

Still, I expect it makes a nice change for some of these scientists to get shouted at as to why we're doing so damned well, instead of getting a load of flack for how badly we've done previously....

Nice problem to have, I suppose...

Cheers,

Itsallaguess

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Re: On the way down?

#431756

Postby dealtn » July 31st, 2021, 7:43 pm

zico wrote:
Pure speculation, but I wonder if the initial steep rise in cases was caused by the "Unvaccinated Unworried" as typified by football crowds


Typified by who?

Your description of a typical football crowd is considerably different to the labels I would use.

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Re: On the way down?

#431768

Postby onthemove » July 31st, 2021, 8:15 pm

Itsallaguess wrote:If I were a betting man, then my money would be on us currently miscounting previous asymptomatic infections in youngsters, and I wonder if there's enough of them that have gone undetected to be affecting the herd-immunity figures in a non-visible but beneficial way, especially now that many of them are getting vaccinated as well recently....


I nearly suggested something along those lines as a possible alternative, though stopped short because it wouldn't fit with the evidence that I presented earlier that scientists say the current pattern isn't consistent with reaching herd immunity.

What I had in mind wasn't necessarily children, but that just potentially the R ratio had perhaps been even higher than realised such that more people have been infected than realised.

And potentially the reason this isn't showing up in the surveys of antibodies, is perhaps because low level infection might only result in a T-cell response (which is already believed to be the case in some infections) and that alone may be enough to deal with a very low initial infection.

The other week I provided a link to research which did point to evidence that less severe or asymptomatic infections could already be due to cross immunity (not sure what the official term is) from having encountered common cold coronaviruses beforehand, which do share some of the genetic characteristics of sars-cov-2 and so the T cells can provide a some degree of protection from the worst symptoms of covid from the memory T cells rather than antibodies - I mention this as evidence that you can have a degree of protection without needing antibodies.

And I believe that it's already proven that people who have tested positive for covid don't necessarily develop antibodies... from what I understand the hypothesis is that if the innate immune response (pre-antibodies) can deal with the virus quick enough before it gets a proper foothold, then it's believed that that may be why the antibodies aren't subsequently generated.

In other words there could already be a pool of T-cell immunity in the community which isn't detectable by the antibody surveys, and that may have resulted in achieving herd immunity well before anticipated.

Like I say, I stopped short of suggesting this, because it would effectively be saying we may already be at herd immunity but the scientists say the current infection rate behaviour isn't consistent with being at herd immunity.

But if it were, then the implications would potentially be that covid isn't as severe as first thought - i.e. if there were a lot of undetected, asymptomatic infections that resulted in a T-cell only response (which can itself provide some degree of future protection without antibodies) and weren't already being captured in the surveys or estimates, but those infections (along with all the rest) have now led to 'herd immunity' well before expected, then it would mean that the risk of hospitalisation and death were much lower than currently believed.

i.e. it would mean covid isn't as serious as we've been led to believe.

But like I say though, the evidence (according to the scientists, as I linked to previously) doesn't fit with this hypothesis.

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Re: On the way down?

#431789

Postby Itsallaguess » August 1st, 2021, 7:16 am

onthemove wrote:
The other week I provided a link to research which did point to evidence that less severe or asymptomatic infections could already be due to cross immunity (not sure what the official term is) from having encountered common cold coronaviruses beforehand, which do share some of the genetic characteristics of sars-cov-2 and so the T cells can provide a some degree of protection from the worst symptoms of covid from the memory T cells rather than antibodies - I mention this as evidence that you can have a degree of protection without needing antibodies.

And I believe that it's already proven that people who have tested positive for covid don't necessarily develop antibodies... from what I understand the hypothesis is that if the innate immune response (pre-antibodies) can deal with the virus quick enough before it gets a proper foothold, then it's believed that that may be why the antibodies aren't subsequently generated.

In other words there could already be a pool of T-cell immunity in the community which isn't detectable by the antibody surveys, and that may have resulted in achieving herd immunity well before anticipated.

Like I say, I stopped short of suggesting this, because it would effectively be saying we may already be at herd immunity but the scientists say the current infection rate behaviour isn't consistent with being at herd immunity.

But if it were, then the implications would potentially be that covid isn't as severe as first thought - i.e. if there were a lot of undetected, asymptomatic infections that resulted in a T-cell only response (which can itself provide some degree of future protection without antibodies) and weren't already being captured in the surveys or estimates, but those infections (along with all the rest) have now led to 'herd immunity' well before expected, then it would mean that the risk of hospitalisation and death were much lower than currently believed.

i.e. it would mean covid isn't as serious as we've been led to believe.

But like I say though, the evidence (according to the scientists, as I linked to previously) doesn't fit with this hypothesis.


If there was a single, stand-out reason for the current discrepancies between ONS-level infections and current case numbers, I think it would have been highlighted by now, so I think any discrepancy is perhaps likely to be related to a larger number of smaller, but aggregating processes, which by their nature might well be difficult to pin down within the current noisy, country-level data...

Those processes may well contain some level of T-cell immunity, but it's also likely to contain some level of previously uncounted asymptomatic immunity, some level of social-refusal to get 'triggering' PCR tests done, and some level of localised 'push-back' in some areas of the country, where herd-immunity levels might be getting reached before some other areas.

I could never really understand why such a diverse country as the UK, where that 'diversity' touches on so many different levels, such as geographical, social, religious, diversity in population density, etc., might be expected to all reach some magical level of 'herd immunity' at exactly the same time, and I've always thought it would make sense for some areas of the country to start showing signs of herd-immunity earlier than others, with some areas catching up at a later time, and if that's the case then there's likely to be some noise in the latter parts of that process that might hide the fact that some areas have actually reached a much higher level of localised herd-immunity than others...

The coming weeks and months are likely to be really interesting for the UK in relation to these types of details coming out, which will hopefully explain the current scratching of heads, but I think we're coming to the point now where the more relevant figures are the ones related to hospitalisations, and with those figures looking like they've plateaued now, with relatively low levels of hospitalisations, as well as many of those being hospitalised staying in for much shorter recovery periods, then hopefully we're well on the road to a brighter future ahead of us...

Cheers,

Itsallaguess

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Re: On the way down?

#431841

Postby Julian » August 1st, 2021, 12:52 pm

Itsallaguess wrote:... but I think we're coming to the point now where the more relevant figures are the ones related to hospitalisations, and with those figures looking like they've plateaued now, with relatively low levels of hospitalisations, as well as many of those being hospitalised staying in for much shorter recovery periods, then hopefully we're well on the road to a brighter future ahead of us...

Cheers,

Itsallaguess

And to add to the positive note I saw I think it was 3 expert commentators yesterday mentioning something that I had been wondering about for a week or two now - the possibility that when compared with the first and second wave peak in hospitalisations this third peak, if indeed we are at the peak, might be artificially high because with lower numbers of Covid-19 patients in hospital now the threshold of disease severity for a hospital to admit someone as a Covid-19 inpatient might be lower now due to the fact that the hospitals are less overloaded. One commentator went on to extend that same concept to ICU which isn't something that I hadn't thought of but I can see that if ICU beds are no longer at 100% capacity then someone might not need to be in quite such a on-the-edge situation before getting a bed on ICU.

I also saw an interview with someone pretty senior in the NHS maybe a week ago raising a point that I hadn't considered at all, and that is that the Covid-19 disruption for a hospital does not increase linearly with number of patients admitted, it's more of a step function and that is more accute with relatively few patients. The issue apparently is that with one or two patients a hospital can probably find isolation rooms for a few beds but once the patient count gets above a very few patients then they need a ward and at that point they can't say "well, the orthopaedic ward has a spare bed so we'll put patient 5 there" because Covid-19 is highly infectious so at the point when that 1 extra patient comes in that is too much for the odd isolation bed they've got here and there then in order to house that patient they actually have to clear out an entire orthopaedic ward (for instance) and consolidate all the Covid-19 patients there. And when that now-a-Covid-19 ward fills up they potentially get to the same breakpoint again when another dedicated ward is needed. One beneficial consequence of this that occurs to me though, and I'm don't mean this literally because staff and meds etc costs money, but in a way once a new Covid-19 ward does have to be created simply because there is 1 more patient than can be accommodated with the existing isolation beds, then that newly created Covid-19 ward is unlikely to be particularly full so at least for a while there are some "free" beds (free as in the hospital doesn't need to do any extra bed juggling because they are already sitting empty). That "we currently have unused Covid-19 beds" effect might, for hospitals that any given time are at that point in their step function, be what's driving the lower threshold for admitting someone for a few days who might only be showing moderate to severe disease as opposed to severe disease to get them on oxygen and monitor them since a bed is free to do that whereas such a person might not have been admitted during one of the previous peaks.

I can imagine however that hospitals are a bit more protective of ICU beds so maybe when you (itsallaguess) suggest that "we're coming to the point now where the more relevant figures are the ones related to hospitalisations" perhaps of those hospitalisation figures the most indicative now is the one that reports on the number of people on mechanical ventilation. That is certainly the one that I am paying most attention to now, that and daily deaths figures. With so much confusion and uncertainty around the case numbers I look at those figures daily but they are the ones I react to the least.

- Julian

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Re: On the way down?

#431854

Postby Itsallaguess » August 1st, 2021, 2:02 pm

Julian wrote:
I can imagine however that hospitals are a bit more protective of ICU beds so maybe when you suggest that "we're coming to the point now where the more relevant figures are the ones related to hospitalisations" perhaps of those hospitalisation figures the most indicative now is the one that reports on the number of people on mechanical ventilation.

That is certainly the one that I am paying most attention to now, that and daily deaths figures.


Thanks Julian, I think you're quite right, and that also touches on a related point that I was reading about a few days ago, which was highlighting that many of those currently being identified as COVID-hospitalisations are actually being initially admitted for other reasons -

More than half of Covid hospitalisations are patients who only tested positive after admission, leaked data reveal (26th July 2021) -

The figures suggest vast numbers are being classed as hospitalised by Covid when they were admitted with other ailments, with the virus picked up by routine testing.

Experts said it meant the national statistics, published daily on the government website and frequently referred to by ministers, may far overstate the levels of pressures on the NHS.

The leaked data – covering all NHS trusts in England – show that, as of last Thursday, just 44 per cent of patients classed as being hospitalised with Covid had tested positive by the time they were admitted.

The majority of cases were not detected until patients underwent standard Covid tests, carried out on everyone admitted to hospital for any reason.

Overall, 56 per cent of Covid hospitalisations fell into this category, the data, seen by The Telegraph, show.

Crucially, this group does not distinguish between those admitted because of severe illness, later found to be caused by the virus, and those in hospital for different reasons who might otherwise never have known that they had picked it up.


https://www.telegraph.co.uk/news/2021/07/26/exclusive-half-covid-hospitalisations-tested-positive-admission/

Now it's probably important to also highlight that at least some of those 'non-COVID' issues that cause these initial hospitalisations might actually be 'COVID-related' or 'COVID-induced' (think breathing difficulties etc...), but given the testing regime discussed in the Telegraph article above, it seems that there is also bound to be at least some level of hospitalisations that might well not have warranted taking up a bed if it weren't for some of those 'other' non-COVID issues as well, given that they're in the hospitals at the time of that later COVID test already, so I think your point about focussing on ventilation-figures is also a good one in direct relation to this potential 'over-counting' issue as well, given that it's likely to focus on those in greatest need of high-level COVID-related medical intervention, and will help to remove some of that more 'noisy' data, as well as the important point that you've made earlier, related to the obvious flexibility in admittance-triaging that can be made between a hospital that's having to only accept the most poorly patients due to bed-availability pressures, and one that can afford to admit people further down the 'necessity curve', simply because they perhaps aren't having to operate under such pressures at that time, and can afford to triage across a much wider spectrum of need....

Cheers,

Itsallaguess

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Re: On the way down?

#431868

Postby servodude » August 1st, 2021, 3:01 pm

Itsallaguess wrote:I think your point about focussing on ventilation-figures is also a good one in direct relation to this potential 'over-counting' issue as well, given that it's likely to focus on those in greatest need of high-level COVID-related medical intervention,


Do you know what's classed as "ventilation" for the figures these days?

The traditional "vent", as was originally recorded, fell out of favour for treating COVID cases because it was working much less than it did for the normal types of thing it's used for; bear in mind it requires the patient to be in an induced coma so even with non COVID respiratory cases it's a coin toss if you'll come off it (with the first tranche of covid patients it was closer to 20% success)

It would be interesting to know whether NIV is considered "ventilation" for the figures these days (I doubt it though given it can be easily done outside ICU - thought maybe I'm mixing up how the figures are reported in different regions now).

The accuracy of the counting on admissions with/because of covid has always been very difficult to gauge.
Taking a step back I'd probably try to consider the prevalence in the population vs those being admitted. If you expected 1% of the population to test positive and 10% of the admissions do; it would be hard to suggest covid wouldn't be a factor?

Or looking at it another way 50% of "admissions with COVID" testing positive once admitted to hospital really only suggests that half of people don't get tested when they should?

-sd

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Re: On the way down?

#431875

Postby Sorcery » August 1st, 2021, 3:45 pm

servodude wrote:
Itsallaguess wrote:I think your point about focussing on ventilation-figures is also a good one in direct relation to this potential 'over-counting' issue as well, given that it's likely to focus on those in greatest need of high-level COVID-related medical intervention,


Do you know what's classed as "ventilation" for the figures these days?

The traditional "vent", as was originally recorded, fell out of favour for treating COVID cases because it was working much less than it did for the normal types of thing it's used for; bear in mind it requires the patient to be in an induced coma so even with non COVID respiratory cases it's a coin toss if you'll come off it (with the first tranche of covid patients it was closer to 20% success)

It would be interesting to know whether NIV is considered "ventilation" for the figures these days (I doubt it though given it can be easily done outside ICU - thought maybe I'm mixing up how the figures are reported in different regions now).

The accuracy of the counting on admissions with/because of covid has always been very difficult to gauge.
Taking a step back I'd probably try to consider the prevalence in the population vs those being admitted. If you expected 1% of the population to test positive and 10% of the admissions do; it would be hard to suggest covid wouldn't be a factor?

Or looking at it another way 50% of "admissions with COVID" testing positive once admitted to hospital really only suggests that half of people don't get tested when they should?

-sd


Or worse, say 1% of patients admitted to hospital have Covid, the other 49% catch it in hospital.

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Re: On the way down?

#431878

Postby Itsallaguess » August 1st, 2021, 4:00 pm

servodude wrote:
Itsallaguess wrote:
I think your point about focussing on ventilation-figures is also a good one in direct relation to this potential 'over-counting' issue as well, given that it's likely to focus on those in greatest need of high-level COVID-related medical intervention


Do you know what's classed as "ventilation" for the figures these days?

The traditional "vent", as was originally recorded, fell out of favour for treating COVID cases because it was working much less than it did for the normal types of thing it's used for; bear in mind it requires the patient to be in an induced coma so even with non COVID respiratory cases it's a coin toss if you'll come off it (with the first tranche of covid patients it was closer to 20% success)

It would be interesting to know whether NIV is considered "ventilation" for the figures these days (I doubt it though given it can be easily done outside ICU - thought maybe I'm mixing up how the figures are reported in different regions now).


For the UK figures, they say that it means 'patients currently in mechanical ventilation beds' -

Image

Source - https://coronavirus.data.gov.uk/details/healthcare

I think that's a ventilation process above and beyond a simple oxygen mask, and is a 'forced' mechanical ventilation similar to the one shown here -

https://www.sciencemag.org/sites/default/files/styles/inline__450w__no_aspect/public/Longterm_coronavirus_1280x720.jpg

Without getting into the weeds too much, I suppose they are figures of 'mechanical ventilation bed occupancy', and don't go into detail as to the use or actual requirement of that mechanical ventilation, but I think for the sake of these types of discussions and comparisons, then it might be fair to say that if the triage decides that a mechanical ventilation bed is either required 'now', or might well be required 'at some point', then if they're in one of those beds, I think we might as well assume they're actually needing to be...

With that said, the good news as far as the UK is concerned is that ventilation-bed usage seems to have plateaued at the moment too..

Cheers,

Itsallaguess

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Re: On the way down?

#431893

Postby zico » August 1st, 2021, 5:42 pm

Itsallaguess wrote:More than half of Covid hospitalisations are patients who only tested positive after admission, leaked data reveal (26th July 2021) -

The figures suggest vast numbers are being classed as hospitalised by Covid when they were admitted with other ailments, with the virus picked up by routine testing.

Experts said it meant the national statistics, published daily on the government website and frequently referred to by ministers, may far overstate the levels of pressures on the NHS.

The leaked data – covering all NHS trusts in England – show that, as of last Thursday, just 44 per cent of patients classed as being hospitalised with Covid had tested positive by the time they were admitted.

The majority of cases were not detected until patients underwent standard Covid tests, carried out on everyone admitted to hospital for any reason.

Overall, 56 per cent of Covid hospitalisations fell into this category, the data, seen by The Telegraph, show.

Crucially, this group does not distinguish between those admitted because of severe illness, later found to be caused by the virus, and those in hospital for different reasons who might otherwise never have known that they had picked it up.


https://www.telegraph.co.uk/news/2021/07/26/exclusive-half-covid-hospitalisations-tested-positive-admission/

Itsallaguess


I had a look at the source data to check this out, using the next to last Excel file at the bottom of the page for the link below.
Latest NHS England data (27th July) shows that out of 5,021 hospital patients with Covid 3,855 are being treated primarily for Covid.
3,855/5,021 = 77% of Covid patients are treated primarily for Covid.
The NHS report also suggests that some people being treated for other illnesses such as strokes may have had their illness caused by Covid.

How do we reconcile the Telegraph statement of "More than half of Covid hospitalisations are patients who only tested positive after admission"?
One possibility is that Telegraph figure excludes those who were hospitalised with Covid, but didn't have a Covid test before being hospitalised.

The majority of inpatients with Covid-19 are admitted as a result of the infection. A subset of those who contract Covid in the community and are asymptomatic, or exhibited relatively mild symptoms that on their own are unlikely to warrant admission to hospital, will then be admitted to hospital to be treated for something else and be identified through routine testing. However these patients still require their treatment in areas that are segregated from patients without Covid, and the presence of Covid can be a significant co-morbidity in many cases. Equally, while the admission may be due to another primary condition, in many instances this may have been as a result of contracting Covid in the community. For example research has shown that people with Covid are more likely to have a stroke (Stroke Association); in these cases people would be admitted for the stroke, classified as ‘with’ Covid despite having had a stroke as a result of having Covid.

The headline published numbers in publications to date have been “inpatients with confirmed Covid” without differentiating between those in hospital “for” Covid and those in hospital “with” Covid. Recognising the combination of high community infections rates, with the reduced likelihood of admission for those who contract Covid in the community and are fully vaccinated, the Covid SitRep was enhanced to add a requirement for providers to distinguish between those being primarily treated ‘for’ Covid and those ‘with’ Covid but for whom the primary reason for being in hospital was non-Covid related. In practice this distinction is not always clear at the point of admission when the patient’s record has not been fully clinically coded. In light of this trusts have been asked to provide this “for” and “with” split on a ‘best endeavours’ basis.


https://www.england.nhs.uk/statistics/s ... -activity/

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Re: On the way down?

#431936

Postby servodude » August 2nd, 2021, 1:49 am

zico wrote:How do we reconcile the Telegraph statement of "More than half of Covid hospitalisations are patients who only tested positive after admission"?


I honestly think it's just as simple as people avoiding getting tested until it is mandated in hospital
Haven't the symptom tracking data streams generally suggested the prevalence would be about double that suggested by "testing"?

I've only had one Covid test as a result of symptoms vs about a dozen that were required for work
- if I had had every possible bout of symptoms checked those probably would be about even (given the plethora of symptoms and their overlap with every other seasonal sniffle, allergy, respiratory gripe etc)
- I can't imagine I'm that unusual (at least in that regard ;) )

- sd

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Re: On the way down?

#431938

Postby servodude » August 2nd, 2021, 2:08 am

Itsallaguess wrote:Without getting into the weeds too much, I suppose they are figures of 'mechanical ventilation bed occupancy', and don't go into detail as to the use or actual requirement of that mechanical ventilation, but I think for the sake of these types of discussions and comparisons, then it might be fair to say that if the triage decides that a mechanical ventilation bed is either required 'now', or might well be required 'at some point', then if they're in one of those beds, I think we might as well assume they're actually needing to be...


Thanks for the explanatory link!
From that it sounds like they would be considering NIV (non-invasive ventilation) along with the more traditional "intubation"

Which is good news as it means a lot more of those included in the data will recover
- but still a shite thing to spend your time wired up to (as you can see from the photo you linked to)

- sd

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Re: On the way down?

#431996

Postby murraypaul » August 2nd, 2021, 11:15 am

1nvest wrote:Is it not now just comparable to catching a cold? Covid 30,000/day contractions, 60/day deaths, for 1 in 500 contracting a cold might lead to subsequent complications/death?


Care to offer any evidence at all for that figure?

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Re: On the way down?

#432109

Postby ursaminortaur » August 2nd, 2021, 7:18 pm

Julian wrote:
AWOL wrote:...
... of course the biggest impact danger on the UK's national Risk Register before COVID19 was pandemic flu, and there is no reason we couldn't get a Flu pandemic too in which case it would be face masks, social distancing, vaccines etc. A flu pandemic would be handled in the same way. Part of the problem here is that we semi-prepared for a flu pandemic, and were not prepared for a non-flu pandemic.
...

I've heard that said many times by seemingly credible experts since pretty much the beginning of this pandemic. What I still don't understand to this day is how the response to the two would have been different. In what way is/was the flu pandemic play book inadequate for the coronavirus pandemic that we have encountered? One thing I imagine might have been a key difference is an assumption that there would be a high probability that one or more acceptably effective vaccines would be available in significant volume reasonably early on in the pandemic since I assume that the assumption was(*) that the existing flu vaccine knowledge and manufacturing capacity would deliver a suitable pandemic-appropriate vaccine fairly quickly but in what other ways was the flu pandemic response significantly different to the coronavirus (ideal) response? (I do note your use of "semi-prepared" re our prior flu pandemic preparations which of course is a whole other issue in itself.)


One other major difference between Coronavirus and flu was that with flu we had a large number of antivirals which we knew were effective. For Coronavirus we had none. Hence, as well as expecting a vaccine to be developed quicker for a flu pandemic, planning for that flu outbreak also foresaw less need for Intensive Care and ventillators since most would be expected to respond to the antivirals.

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Re: On the way down?

#432141

Postby servodude » August 3rd, 2021, 2:58 am

ursaminortaur wrote:
Julian wrote:
AWOL wrote:...
... of course the biggest impact danger on the UK's national Risk Register before COVID19 was pandemic flu, and there is no reason we couldn't get a Flu pandemic too in which case it would be face masks, social distancing, vaccines etc. A flu pandemic would be handled in the same way. Part of the problem here is that we semi-prepared for a flu pandemic, and were not prepared for a non-flu pandemic.
...

I've heard that said many times by seemingly credible experts since pretty much the beginning of this pandemic. What I still don't understand to this day is how the response to the two would have been different. In what way is/was the flu pandemic play book inadequate for the coronavirus pandemic that we have encountered? One thing I imagine might have been a key difference is an assumption that there would be a high probability that one or more acceptably effective vaccines would be available in significant volume reasonably early on in the pandemic since I assume that the assumption was(*) that the existing flu vaccine knowledge and manufacturing capacity would deliver a suitable pandemic-appropriate vaccine fairly quickly but in what other ways was the flu pandemic response significantly different to the coronavirus (ideal) response? (I do note your use of "semi-prepared" re our prior flu pandemic preparations which of course is a whole other issue in itself.)


One other major difference between Coronavirus and flu was that with flu we had a large number of antivirals which we knew were effective. For Coronavirus we had none. Hence, as well as expecting a vaccine to be developed quicker for a flu pandemic, planning for that flu outbreak also foresaw less need for Intensive Care and ventillators since most would be expected to respond to the antivirals.


A random hail of thoughts...

The incubation period for a flu is typically 2 days; if any "plan" involved a critical timing component SARS-COV2 blew that way out with its crazy time constants
- any stockpiles of Tamiflu etc were pretty useless

One serious risk from a flu infection is subsequent bacterial pneumonia; the mitigations for which don't really overlap with COVID (it generally gives you pneumonia itself not as a conduit for a bacterial infection)

But its true that the NPI for both would be the same (aside from the timing required)
- and we can see how effectively flu has been run to ground in the face of the COVID restrictions

- sd

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Re: On the way down?

#432195

Postby Nimrod103 » August 3rd, 2021, 10:09 am

ursaminortaur wrote:
Julian wrote:
AWOL wrote:...
... of course the biggest impact danger on the UK's national Risk Register before COVID19 was pandemic flu, and there is no reason we couldn't get a Flu pandemic too in which case it would be face masks, social distancing, vaccines etc. A flu pandemic would be handled in the same way. Part of the problem here is that we semi-prepared for a flu pandemic, and were not prepared for a non-flu pandemic.
...

I've heard that said many times by seemingly credible experts since pretty much the beginning of this pandemic. What I still don't understand to this day is how the response to the two would have been different. In what way is/was the flu pandemic play book inadequate for the coronavirus pandemic that we have encountered? One thing I imagine might have been a key difference is an assumption that there would be a high probability that one or more acceptably effective vaccines would be available in significant volume reasonably early on in the pandemic since I assume that the assumption was(*) that the existing flu vaccine knowledge and manufacturing capacity would deliver a suitable pandemic-appropriate vaccine fairly quickly but in what other ways was the flu pandemic response significantly different to the coronavirus (ideal) response? (I do note your use of "semi-prepared" re our prior flu pandemic preparations which of course is a whole other issue in itself.)


One other major difference between Coronavirus and flu was that with flu we had a large number of antivirals which we knew were effective. For Coronavirus we had none. Hence, as well as expecting a vaccine to be developed quicker for a flu pandemic, planning for that flu outbreak also foresaw less need for Intensive Care and ventillators since most would be expected to respond to the antivirals.


Surely the big difference with a flu pandemic is that with Covid19, perhaps a third of people who have caught it show no syptoms, but are still carriers and infectious. So tracking and tracing is so difficult. With flu, how many are symptomless?

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Re: On the way down?

#432203

Postby servodude » August 3rd, 2021, 10:49 am

Nimrod103 wrote:
Surely the big difference with a flu pandemic is that with Covid19, perhaps a third of people who have caught it show no syptoms, but are still carriers and infectious. So tracking and tracing is so difficult. With flu, how many are symptomless?


That would be a third of infected people
https://pubmed.ncbi.nlm.nih.gov/18230677/

The big difference between these viruses in this regard is covid is slower to present
- it takes you longer to transition from pre-symptomatic to symptomatic
- gives a bigger window for unknowingly spreading it and a bigger window to work back to work out where you've been, etc

-sd

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Re: On the way down?

#432205

Postby AWOL » August 3rd, 2021, 10:59 am

Nimrod103 wrote:
Surely the big difference with a flu pandemic is that with Covid19, perhaps a third of people who have caught it show no syptoms, but are still carriers and infectious. So tracking and tracing is so difficult. With flu, how many are symptomless?


Up to half although the transmission from asymptomatic flu carriers is greatly reduced.

I think the differences were the lack of existing immune training in the population, the lack of effective treatments when COVID first started (this has improved hence how hospitals are busy treating the seriously ill COVID patients but their death rate is lower... in the developed world).

Looking over some of the things said in the earlier discussion and apparent assumptions I suspect it may be worth reviewing some observations on Flu and Pandemic Flu versus COVID pandemic.

1. We are fooling ourselves if we think that Pandemic Flu doesn't have the potential to be as bad as COVID.
2. The details would likely be different and there is no point speculating but there is historic evidence to suggest what to expect.
3. Most of the general public don't know what infections they had when but very few of them have experienced pandemic flu and most of them have mistaken a common cold for influenza.
4. Pandemic Flu may look very different for regular influenza. Spanish Flu gives some evidence of this. It hit 25-40 year olds the worst (3-4x higher than the general morbidity rate)
5. COVID kills patients using their own immune system causing multiple organ failure whereas it's bacterial pneumonia on top of flu that kills flu patients.
6. If we were treating a flu pandemic and not seasonal flu we would expect to have face masks, social distancing, lockdowns and vaccines so the people who get upset about out temporary loss of freedoms during a time of crisis would be no happier.
7. For anyone who disagrees with 6 then the historic record shows this is what we did to tackle pandemic flu although the vaccines only came into use after the Spanish Flu but before Asian Flu pandemic, in the case of the Spanish Flu social distancing was the main weapon.

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Re: On the way down?

#432216

Postby servodude » August 3rd, 2021, 11:34 am

AWOL wrote:
Nimrod103 wrote:
Surely the big difference with a flu pandemic is that with Covid19, perhaps a third of people who have caught it show no syptoms, but are still carriers and infectious. So tracking and tracing is so difficult. With flu, how many are symptomless?


Up to half although the transmission from asymptomatic flu carriers is greatly reduced.

I think the differences were the lack of existing immune training in the population, the lack of effective treatments when COVID first started (this has improved hence how hospitals are busy treating the seriously ill COVID patients but their death rate is lower... in the developed world).

Looking over some of the things said in the earlier discussion and apparent assumptions I suspect it may be worth reviewing some observations on Flu and Pandemic Flu versus COVID pandemic.

1. We are fooling ourselves if we think that Pandemic Flu doesn't have the potential to be as bad as COVID.
2. The details would likely be different and there is no point speculating but there is historic evidence to suggest what to expect.
3. Most of the general public don't know what infections they had when but very few of them have experienced pandemic flu and most of them have mistaken a common cold for influenza.
4. Pandemic Flu may look very different for regular influenza. Spanish Flu gives some evidence of this. It hit 25-40 year olds the worst (3-4x higher than the general morbidity rate)
5. COVID kills patients using their own immune system causing multiple organ failure whereas it's bacterial pneumonia on top of flu that kills flu patients.
6. If we were treating a flu pandemic and not seasonal flu we would expect to have face masks, social distancing, lockdowns and vaccines so the people who get upset about out temporary loss of freedoms during a time of crisis would be no happier.
7. For anyone who disagrees with 6 then the historic record shows this is what we did to tackle pandemic flu although the vaccines only came into use after the Spanish Flu but before Asian Flu pandemic, in the case of the Spanish Flu social distancing was the main weapon.


All true.

We should remember also that a lot of the deaths in the Spanish flu pandemic came from secondary infections that would now be treatable (while antibiotics still work anyway;) )
- which really only means it would look a bit different if it happened today

-sd


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