The Lemon Fool

swill453 wrote:

Bouleversee wrote:Yes, I noticed that as well. I expect it's because in some cases they don't know why because they haven't the capacity to do tests before or post mortems after.

It's not really that, because it's always been the case, nothing's changed.

You get knocked down by a bus within 28 days of a first positive Covid test in England - you're in the numbers.

You get reinfected with Covid for a second or subsequent time in England and die of Covid - you're not in the numbers.

Scott.

The somethings that have changed are the facts that Omicron is less fatal, and more testing positive for it, but dying of that something else (your bus). In addition vaccinations (and treatments) are producing better outcomes where infections, which show up in tests, aren't leading to the same rate of fatalities, but doesn't provide protection against those "buses". Offsetting that though are the number of people getting Covid for the second (or third or fourth ...) time and dying of it, but not captured by the "28 days ... first positive test".

It could be the former two are a larger distortion than the third, but it's surely the case it isn't right to believe "nothing's changed". I would say for certain the numbers are "noisier" and less accurate. The BBC caveat isn't a clear way of saying that, but is perhaps understood by its audience to reflect that, despite its poor scientific accuracy.

I think it's likely that the deaths with covid, as apposed to because of covid will be having a greater effect now. It's very noticeable that the numbers in mechanical ventilation bed figures are right down (they've been falling steadily since early November) and are now the lowest they've been since July last year when Delta hit us. So the higher deaths figure seems out of kilter with other healthcare figures.

Gersemi wrote:I think it's likely that the deaths with covid, as apposed to because of covid will be having a greater effect now. It's very noticeable that the numbers in mechanical ventilation bed figures are right down (they've been falling steadily since early November) and are now the lowest they've been since July last year when Delta hit us. So the higher deaths figure seems out of kilter with other healthcare figures.

Excess deaths in UK currently negative: https://app.powerbi.com/view?r=eyJrIjoiYmUwNmFhMjYtNGZhYS00NDk2LWFlMTAtOTg0OGNhNmFiNGM0IiwidCI6ImVlNGUxNDk5LTRhMzUtNGIyZS1hZDQ3LTVmM2NmOWRlODY2NiIsImMiOjh9

NotSure wrote:

Gersemi wrote:I think it's likely that the deaths with covid, as apposed to because of covid will be having a greater effect now. It's very noticeable that the numbers in mechanical ventilation bed figures are right down (they've been falling steadily since early November) and are now the lowest they've been since July last year when Delta hit us. So the higher deaths figure seems out of kilter with other healthcare figures.

Excess deaths in UK currently negative: https://app.powerbi.com/view?r=eyJrIjoiYmUwNmFhMjYtNGZhYS00NDk2LWFlMTAtOTg0OGNhNmFiNGM0IiwidCI6ImVlNGUxNDk5LTRhMzUtNGIyZS1hZDQ3LTVmM2NmOWRlODY2NiIsImMiOjh9

Brilliant.

Next, we'll have people in here claiming that catching covid must be good for you as excess deaths have gone negative!

Mike4 wrote:Brilliant.

Next, we'll have people in here claiming that catching covid must be good for you as excess deaths have gone negative!

It's just data (or rather datum at the moment). But it supports the case that some, maybe many of the current covid-positive deaths are with rather than from.

Mike4 wrote:

NotSure wrote:

Gersemi wrote:I think it's likely that the deaths with covid, as apposed to because of covid will be having a greater effect now. It's very noticeable that the numbers in mechanical ventilation bed figures are right down (they've been falling steadily since early November) and are now the lowest they've been since July last year when Delta hit us. So the higher deaths figure seems out of kilter with other healthcare figures.

Excess deaths in UK currently negative: https://app.powerbi.com/view?r=eyJrIjoiYmUwNmFhMjYtNGZhYS00NDk2LWFlMTAtOTg0OGNhNmFiNGM0IiwidCI6ImVlNGUxNDk5LTRhMzUtNGIyZS1hZDQ3LTVmM2NmOWRlODY2NiIsImMiOjh9

Brilliant.

Next, we'll have people in here claiming that catching covid must be good for you as excess deaths have gone negative!

Is that a bit like saying you can get rid of the boiler cos it's currently 30 degrees (at half 9 at night)?

Or is it because given omnom probably half the population would currently test positive on a PCR?

Gersemi wrote:I think it's likely that the deaths with covid, as apposed to because of covid will be having a greater effect now. It's very noticeable that the numbers in mechanical ventilation bed figures are right down (they've been falling steadily since early November) and are now the lowest they've been since July last year when Delta hit us. So the higher deaths figure seems out of kilter with other healthcare figures.

May I suggest that ventilation has reduced because Omicron attacks in a different way from previous variants. We know it generally doesn't have such serious effects on the lungs but attacks the upper respiratory system and that it affects those whose immune systems have been affected for various reasons, including affecting the nervous system and brain and treatment for this would be different (and I don't know how available or effective that is) so ventilation stats. would be irrelevant. My impression is that doctors are only beginning to wake up to this judging by the length of time it is taking to diagnose serious exacerbations of existing conditions due to covid infection. I now understand why MS patients were included in the list of those eligible for antivirals if infected. Whether their infection is discovered in time and they get them is another matter.

NotSure wrote:It's just data (or rather datum at the moment). But it supports the case that some, maybe many of the current covid-positive deaths are with rather than from.

Probably just suggests that death from other causes such as flu is lower than average at the moment, partly because some of those who would "normally" be dying of flu in 2022 have already died of Covid in 20/21, partly because flu has been suppressed by Covid measures (and some flu lineages have even apparently died out).

Also deaths are a lagging indicator, since it takes ~28 days from infection to death, so we will only this week be seeing the transition from delta to omicron deaths.

As an aside - this thread and the statistics thread seem to have switched roles at the moment?

Bouleversee wrote:... I now understand why MS patients were included in the list of those eligible for antivirals if infected. Whether their infection is discovered in time and they get them is another matter.

That's a big issue with these new antivirals such as Molnupiravir and Paxlovid(*). They need to be given within 5 days of symptoms emerging in order to be most effective (https://www.fda.gov/news-events/press-a ... t-covid-19). Especially now with Omicron the symptoms can be mild or even non-existent and when they are there can often be mistaken for a common cold so for people with a serious pre-existing condition, hence potentially with symptoms from their conditions and maybe also from side effects of drugs being taken to manage those conditions, I can see why early symptoms of a SARS-CoV2 infection might be missed. Although inconvenient that would suggest to me that where possible very regular lateral flow testing of the particularly vulnerable would be sensible in order to spot the need for rapid administration of an anti-viral before it's too late. Maybe that is happening and is already government advice? If it isn't I would have thought that it should be now that these new and seemingly very effective antivirals are available.

- Julian

(*) In general antiviral drug names end in vir, e.g. Molnupiravir or Oseltamivir (branded as Tamiflu that got famous when the UK government stockpiled it ages ago during the 2005 bird flu scare). The reason that Pfizer's Paxlovid seems to break that convention is because it is not actually the name of the new Pfizer antiviral, it is the name for a combination therapy that co-packages an existing antiviral (ritonavir) with the new antiviral (nirmatrelvir). It is nirmatrelvir that is the new one that specifically targets a protein in order to slow down SARS-CoV2 replication. Ritonavir is there to stop the nirmatrelvir from being metabolised away too quickly so that it stays around in the body long enough to do its job (as explained in the link I already gave).

P.S. I have no connection with Pfizer, it's just that Paxlovid looks to me to be a particularly exciting drug based on the clinical trial data; more effective than Molnupiravir from what I've read.

Two different approaches to Covid.

France currently has 5005 cases per million and is about to reopen nightclubs.

Hong Kong currently has 1 case per million, and is contact-tracing pet hamsters.

Julian wrote:

Bouleversee wrote:... I now understand why MS patients were included in the list of those eligible for antivirals if infected. Whether their infection is discovered in time and they get them is another matter.

That's a big issue with these new antivirals such as Molnupiravir and Paxlovid(*). They need to be given within 5 days of symptoms emerging in order to be most effective (https://www.fda.gov/news-events/press-a ... t-covid-19). Especially now with Omicron the symptoms can be mild or even non-existent and when they are there can often be mistaken for a common cold so for people with a serious pre-existing condition, hence potentially with symptoms from their conditions and maybe also from side effects of drugs being taken to manage those conditions, I can see why early symptoms of a SARS-CoV2 infection might be missed. Although inconvenient that would suggest to me that where possible very regular lateral flow testing of the particularly vulnerable would be sensible in order to spot the need for rapid administration of an anti-viral before it's too late. Maybe that is happening and is already government advice? If it isn't I would have thought that it should be now that these new and seemingly very effective antivirals are available.

- Julian

(*) In general antiviral drug names end in vir, e.g. Molnupiravir or Oseltamivir (branded as Tamiflu that got famous when the UK government stockpiled it ages ago during the 2005 bird flu scare). The reason that Pfizer's Paxlovid seems to break that convention is because it is not actually the name of the new Pfizer antiviral, it is the name for a combination therapy that co-packages an existing antiviral (ritonavir) with the new antiviral (nirmatrelvir). It is nirmatrelvir that is the new one that specifically targets a protein in order to slow down SARS-CoV2 replication. Ritonavir is there to stop the nirmatrelvir from being metabolised away too quickly so that it stays around in the body long enough to do its job (as explained in the link I already gave).

P.S. I have no connection with Pfizer, it's just that Paxlovid looks to me to be a particularly exciting drug based on the clinical trial data; more effective than Molnupiravir from what I've read.

But the only ones being offered here, so far as I am aware, are those referred to in this NHS document:

https://www.nhs.uk/conditions/coronavir ... ronavirus/

NotSure wrote:

Mike4 wrote:Next, we'll have people in here claiming that catching covid must be good for you as excess deaths have gone negative!

It's just data (or rather datum at the moment). But it supports the case that some, maybe many of the current covid-positive deaths are with rather than from.

I think of it this way. If the first wave in 2020 had caused the same amount of hospitalisations and deaths as Omicron is now doing, the world mught not have panicked but rather just considered it to be a bad flu year.

Hallucigenia wrote:Two different approaches to Covid.

France currently has 5005 cases per million and is about to reopen nightclubs.

Hong Kong currently has 1 case per million, and is contact-tracing pet hamsters.

I know which country I would rather be in, and I don't even like the French very much.

Lootman wrote:I think of it this way. If the first wave in 2020 had caused the same amount of hospitalisations and deaths as Omicron is now doing, the world mught not have panicked but rather just considered it to be a bad flu year.

Except the lower impact of omicron is mostly down to vaccines rather than less inherent nastiness of omicron. So it's a hypothetical that doesn't work.

As an aside, I've posted on the other thread some papers about the neurological effects of Covid, it's obviously going to take time before we work out all the mechanisms by which it affects people in the long term, but possible dementia is a nasty one.

Bouleversee wrote:

Julian wrote:

Bouleversee wrote:... I now understand why MS patients were included in the list of those eligible for antivirals if infected. Whether their infection is discovered in time and they get them is another matter.

That's a big issue with these new antivirals such as Molnupiravir and Paxlovid(*). They need to be given within 5 days of symptoms emerging in order to be most effective (https://www.fda.gov/news-events/press-a ... t-covid-19). Especially now with Omicron the symptoms can be mild or even non-existent and when they are there can often be mistaken for a common cold so for people with a serious pre-existing condition, hence potentially with symptoms from their conditions and maybe also from side effects of drugs being taken to manage those conditions, I can see why early symptoms of a SARS-CoV2 infection might be missed. Although inconvenient that would suggest to me that where possible very regular lateral flow testing of the particularly vulnerable would be sensible in order to spot the need for rapid administration of an anti-viral before it's too late. Maybe that is happening and is already government advice? If it isn't I would have thought that it should be now that these new and seemingly very effective antivirals are available.

- Julian

(*) In general antiviral drug names end in vir, e.g. Molnupiravir or Oseltamivir (branded as Tamiflu that got famous when the UK government stockpiled it ages ago during the 2005 bird flu scare). The reason that Pfizer's Paxlovid seems to break that convention is because it is not actually the name of the new Pfizer antiviral, it is the name for a combination therapy that co-packages an existing antiviral (ritonavir) with the new antiviral (nirmatrelvir). It is nirmatrelvir that is the new one that specifically targets a protein in order to slow down SARS-CoV2 replication. Ritonavir is there to stop the nirmatrelvir from being metabolised away too quickly so that it stays around in the body long enough to do its job (as explained in the link I already gave).

P.S. I have no connection with Pfizer, it's just that Paxlovid looks to me to be a particularly exciting drug based on the clinical trial data; more effective than Molnupiravir from what I've read.

But the only ones being offered here, so far as I am aware, are those referred to in this NHS document:

https://www.nhs.uk/conditions/coronavir ... ronavirus/

I know. That’s why I specifically compared Paxlovid (not on the list) to Molnupiravir at the end of my post. They are both antivirals which sort of do the same thing, interrupt the replication cycle of the virus, albeit by different mechanisms of action. All that I said in the main post applies to a both Molnupiravir and Paxlovid. The other drug on the list, Sotrovimab, is a monoclonal antibody so is somewhat different but is also best administered within 5 days of onset of symptoms (https://www.nhs.uk/medicines/sotrovimab ... otrovimab/).

The UK government has placed orders for both Molnupiravir and Paxlovid (and Sotrovimab of course since that is already on the list) but Merck got approval for Molnupiravir earlier than Pfizer’s Paxlovid. The UK has placed big orders for both (https://www.bloomberg.com/news/articles ... on-spreads). As and when Paxlovid is available in the UK I am sure it will be added to the list.

- Julian

Hallucigenia wrote:

Lootman wrote:I think of it this way. If the first wave in 2020 had caused the same amount of hospitalisations and deaths as Omicron is now doing, the world mught not have panicked but rather just considered it to be a bad flu year.

Except the lower impact of omicron is mostly down to vaccines rather than less inherent nastiness of omicron. So it's a hypothetical that doesn't work.

As an aside, I've posted on the other thread some papers about the neurological effects of Covid, it's obviously going to take time before we work out all the mechanisms by which it affects people in the long term, but possible dementia is a nasty one.

I thought the observation of weak effect in South Africa where vaccinated folk are relatively low in number was definitive evidence that omicron is inherently weaker than say delta. Is this no longer a tenable deduction?

Regards,

odysseus2000 wrote:I thought the observation of weak effect in South Africa where vaccinated folk are relatively low in number was definitive evidence that omicron is inherently weaker than say delta. Is this no longer a tenable deduction?

The trouble with South Africa is that there's a lot of immunity from previous infection, and that can be hard to quantify. This paper is probably the best one at compensating for that :
https://www.medrxiv.org/content/10.1101 ... 22269148v1

They suggest that although eg they saw a 73% reduction in deathrate during the omicron wave versus their delta wave, when you adjusted for vaccination and known infection that went down to 59%, and if you assume that only 15% of infections are actually detected (based on excess mortality and seroprevalence) it drops to 28% less inherent severity. And if you assume 12% of infections are detected, then there's no difference at all between omicron and delta.

But some reduction seems plausible based on what we know from epidemiology elsewhere and mechanisms, it's just that immunity plays at least as big a part.

In SA the Delta wave ended in October 2021. In the UK the Delta wave did not end until it was overwhelmed by Omicron. It is at least plausible (probably likely) that immunity (from all sources) was higher in SA in October than in the UK in December. If (partial) immunity to Delta blunts Omicron, it could happen in SA.

My 24 year old daughter tested positive for Covid back in September. No symptoms apart from loss of taste and smell on about day six.

She had her booster about three weeks ago then went on holiday for two weeks to the Caribbean.

On her return she did not need a test to fly into the UK as a fully vaxxed individual.

She did need a day two lateral flow test though. She did a lateral flow test on her return and every day since for her job, now day four, all have been negative.

We also did a PCR test for her on day two, it came back this morning positive, we confirmed it with our in house same day PCR machine and again positive.

She has no symptoms whatsoever and the PCR tests were not legally required for her, if we hadn't done them she would now be mixing with hundreds customers through her job.

She is now going to isolate for five days.

Could the government be wasting their and our money time with lateral flow tests?

John

redsturgeon wrote:My 24 year old daughter tested positive for Covid back in September. No symptoms apart from loss of taste and smell on about day six.

She had her booster about three weeks ago then went on holiday for two weeks to the Caribbean.

On her return she did not need a test to fly into the UK as a fully vaxxed individual.

She did need a day two lateral flow test though. She did a lateral flow test on her return and every day since for her job, now day four, all have been negative.

We also did a PCR test for her on day two, it came back this morning positive, we confirmed it with our in house same day PCR machine and again positive.

She has no symptoms whatsoever and the PCR tests were not legally required for her, if we hadn't done them she would now be mixing with hundreds customers through her job.

She is now going to isolate for five days.

Could the government be wasting their and our money time with lateral flow tests?

John

I don't think so.

ISTR LFTs have a false negative rate of about 30%, but approaching zero false positives. This means if you get a positive LFT result, it is almost certainly correct and you are infected. Very useful to know as you can now decide to self isolate. (Or not, depending on your politics or personal ethics.)

On the other hand if you are actually infected there is also a 1 in 3 chance your LFT will be telling you you're negative. This is still useful from a public health PoV, as it still means 2 in 3 infections in people testing themselves are caught, whereas with no LFTs these would all remain undetected.

That to me, does not seem a waste of time and money.