Omicron variant

[Lootman]

Whereas you have done what? Put forward the usual array of strawman 'arguments'. How does that ever help anyone?

The difference is that I am happy with government policy.

You claim to not be happy with it and yet you have no credible alternative.

You don't even know what I "claim"! It's just more imaginary and made up stuff.

OK, so you admit to not claiming that any alternative policy would be better? QED.

[redsturgeon]

Moderator Message:
FAO Lootman and XFool . No more posts from either of you on this thread for the next 24 hours please.

[servodude]

Moderator Message:
FAO Lootman and XFool . No more posts from either of you on this thread for the next 24 hours please.

Aww!

I'm not getting to a panto this year and it was a fun substitue

- sd

[mc2fool]

Moderator Message:
FAO Lootman and XFool . No more posts from either of you on this thread for the next 24 hours please.

Aww!

I'm not getting to a panto this year and it was a fun substitue

- sd

Oh no it wasn't!

[Julian]

So, this massive surge in positive tests cases must, in the majority, be Delta.

Data up to 18h00 15 December 2021



The data is up to 6pm on 15th December 2021.

I remind you of the warning from Mr Javid




40% of the cases are in London.

I’m not convinced your conclusion is correct. My eye is drawn towards the phrase “confirmed omicron cases”. I assume here that confirmed means a positive swab has actually been sequenced as opposed to simply displaying S-gene dropout which wouldn’t merit “confirmed” but rather “strongly suspected” or “very likely”. Next I am making a big assumption that swabs are not sent directly for sequencing immediately, they actually do the PCR test on the swab first to see if it is positive and then some percentage of the positive samples are sent on for full sequencing which sounds reasonable to me. If I am correct then from various stuff that I have heard I get the impression that the free NHS PCR tests are running at a 3-5 day backlog at the moment and the additional delay to get the sequence required for an definite omicron confirmation is another week or so. Assuming for now that my delay numbers are right(*) that means that any case number data based on date-reported rather than date-of-sample is always looking back into the past but critically the confirmed-Omicron subset of those cases is looking about a week further back into the past than the not/not-yet-confirmed subset of the total case numbers so trying to get an accurate Omicron/other-variant data from a recent (less than 10 days ago) data is not possible.

- Julian

(*) I did ask in another post if anyone actually had some reliable data on current PCR turnaround time, time to sequence, and if my assumption that all samples sent for sequencing would have first been PCR tested. If anyone can supply numbers better than my “I think I read somewhere” almost guesses I would love to know what the actual turnaround times are and if my assumption of PCR-then-sequencing is correct.

[Wizard]

Another option could be to stop treating anyone who has not had the vaccine (without good medical reason). That may at least buy some time.
I recall recently hearing that in Scotland 40% of admissions and 60% of intensive care patients with COVID were unvaccinated. If it gets anywhere near as bad as predicted we are going to be choosing who to let die. I would suggest that the first to go should be those that have brought it on themselves.

I've suggested as much myself here before
- or at least charge them for it

- sd

Really? And would you withdraw treatment from or charge overweight diabetic patients? Or smokers? Or people who crash when going above the speed limit? Those injured when drunk? Practitioners of dangerous sports? Overly adventerous ladder users?

And this kind of divisive suggestion is made on the basis of an anecdote that suggests 60% of those in hospital with COVID are vaccinated!

Quite possibly yes, if any of the examples you give were clogging up the NHS, possibly having a massive impact on the health others in society and causing huge economic damage to the country. It is Darwinian, we should let the unvaccinated bear the consequences of their choices and not the rest of society.

[servodude]

I've suggested as much myself here before
- or at least charge them for it

- sd

Really? And would you withdraw treatment from or charge overweight diabetic patients? Or smokers? Or people who crash when going above the speed limit? Those injured when drunk? Practitioners of dangerous sports? Overly adventerous ladder users?

And this kind of divisive suggestion is made on the basis of an anecdote that suggests 60% of those in hospital with COVID are vaccinated!

Quite possibly yes, if any of the examples you give were clogging up the NHS, possibly having a massive impact on the health others in society and causing huge economic damage to the country. It is Darwinian, we should let the unvaccinated bear the consequences of their choices and not the rest of society.

Let me be really clear

I am not suggesting that we deny treatment for the obese, or those who smoke, or vape, or do hard drugs, or avoid vaccines BECAUSE they do those things

I am suggesting that when it comes to triage in the case of a resipiratory pandemic, where resources are limited, that these factors need to be considered
- that choosing to have not taken the vaccine will be a deprioritising factor if someone presents at hospital needing respiratory care
- that where there is competition that machine will go to a patient who did have the vaccines

Surely that's not too controversial?
It's the kind of ethical decision we have to make all the time when triage is necessary; you prioritise the resources based on the chance of positive outcomes
- if there's one bed available and it comes down to a choice between a 20 year old vaccinated otherwise fit non-smoker and an obese non-vaccinated 75 year old smoker - who do you think gets the ventilator?

Now.... what if that "20 year old vaccinated otherwise fit non-smoker" caught it from his "20 year old UN-vaccinated otherwise fit non-smoker" flatmate who also needs treatment in the single available ventilator?
- toss a coin?

I'd prefer to have a health system that doesn't require that kind of consideration
- but that's not the case

- sd

[Mike4]

I am suggesting that when it comes to triage in the case of a resipiratory pandemic, where resources are limited, that these factors need to be considered
- that choosing to have not taken the vaccine will be a deprioritising factor if someone presents at hospital needing respiratory care
- that where there is competition that machine will go to a patient who did have the vaccines

Surely that's not too controversial?

I'm sure that will become endlessly controversial, if and when the meeja twigs that must be what happens.

When there is such a hoo-ha about 'vaccine passports' being unacceptable because they are so "divisive' (which is the whole point of them), I can't imagine triage on the basis of vaccination status turning out to be being anything less than political dynamite and uproar.

At which point, I suspect coin-tossing WILL be declared by the political animals to be the correct method of deciding.... thereby sadly encouraging the anti-vaxxers....

[Julian]

There are a few data points in this article that I found interesting …

Last winter’s wave was driven by the Alpha variant, and before the rollout of vaccines it hospitalised about 22% of cases in the 65-and-over age group. The vaccine programme slashed that rate to 6%. Chris Whitty, England’s chief medical officer, has said that his worst case scenario for Omicron is a return to those pre-vaccination hospitalisation rates. More optimistically, he said a booster might provide better protection against severe Omicron than two doses do against severe Delta.

The UK Health Security Agency expects to have reliable data on the severity of Omicron and the effectiveness of vaccines against hospitalisation in the week between Christmas and the new year, or more likely the first week of January.

The UK can perform about 800,000 PCR tests a day, though capacity rises and falls. Typically fewer than half of people who are infected get a test, but with Omicron spreading so fast, daily case numbers could swiftly become unreliable.

[ Source: https://www.theguardian.com/world/2021/ ... SApp_Other ]

- Julian

[servodude]

I am suggesting that when it comes to triage in the case of a resipiratory pandemic, where resources are limited, that these factors need to be considered
- that choosing to have not taken the vaccine will be a deprioritising factor if someone presents at hospital needing respiratory care
- that where there is competition that machine will go to a patient who did have the vaccines

Surely that's not too controversial?

I'm sure that will become endlessly controversial, if and when the meeja twigs that must be what happens.

When there is such a hoo-ha about 'vaccine passports' being unacceptable because they are so "divisive' (which is the whole point of them), I can't imagine triage on the basis of vaccination status turning out to be being anything less than political dynamite and uproar.

At which point, I suspect coin-tossing WILL be declared by the political animals to be the correct method of deciding.... thereby sadly encouraging the anti-vaxxers....

Fk I know!

This whole clustercuss could have been avoided worldwide with a little bit more education and decent leadership
- the politicising of what are basic facts for some notional gain (be it kudos, attention, money ... i don't bloody know what!) is one of the most rank displays of self defeat for our species that i've ever seen

There has ALWAYS been the possibility of needing triage - I fully expect it has been done and kept quiet throughout the past few waves
- there are a slew of factors that will be considered - when that happens its not a social judgement it's just a cold hard and difficult decision
- because when this disease turns nasty in a patient it can do so very quickly

There's no easy solution for the politicians
- down this way there was a bit of an uproar when some younger folk died at home in NSW because they were deemed "healthy enough" to cope outside of hospital and weren't being monitored sufficiently - you can guarantee that will weigh on future decisions
- it's going to be very politically "awkward" if it ever transpires that vaccinated patients die for want of resources consumed by their reluctant counterparts

- sd

[Mike4]

There's no easy solution for the politicians

My observation is their ONLY concern is to do whatever makes it more likely for them to get re-elected, never mind the death toll.

[servodude]

There's no easy solution for the politicians

My observation is their ONLY concern is to do whatever makes it more likely for them to get re-elected, never mind the death toll.

I am confident that you are correct
I am also confident that there are some among us that think that is their job
and confident also that most don't give it enough thought to make it any other way
- but this is getting a touch too political for this board

I only mentioned them because sometimes someone requires to lead

- sd

[Julian]

…
There has ALWAYS been the possibility of needing triage - I fully expect it has been done and kept quiet throughout the past few waves
- there are a slew of factors that will be considered - when that happens its not a social judgement it's just a cold hard and difficult decision
- because when this disease turns nasty in a patient it can do so very quickly
…

Details kept quiet yes (to my knowledge) but the fact of the matter not kept quiet as completely as you might think at least in the UK. I can’t remember if it was during the first or second wave but I remember seeing a news piece of the still-common inside-the-hospital variety with access to various clinical and management teams that explicitly touched open the fact that they were working on creating clinical guideInes for the front line staff on how to triage patients in the face of insufficient resources to provide everyone the care they needed. The rationale was to get ahead of the problem and make things easier for the medical staff by enabling them to be guided strongly by following pre-proscribed rules rather than having to agonise over on-the-spot personal judgements. They didn’t mention the specifics but the fact that they were trying to create formulas to follow to at least to some extent reduce the feeling of personal responsibility was definitely a thing way back whenever.

- Julian

[Mike4]

There's no easy solution for the politicians

My observation is their ONLY concern is to do whatever makes it more likely for them to get re-elected, never mind the death toll.

I am confident that you are correct
I am also confident that there are some among us that think that is their job
and confident also that most don't give it enough thought to make it any other way
- but this is getting a touch too political for this board

I only mentioned them because sometimes someone requires to lead

- sd

If only the scientists were in charge of policy. I'd have far more confidence if Prof. Whitty was running our Covid response instead of the buffoon and his sycophantic goons in the cabinet.

Oops, little bit of politics there... (to quote wossisname, standup comic from the 80s.)

[Julian]

…
Oops, little bit of politics there... (to quote wossisname, standup comic from the 80s.)

Ben Elton would be my guess.

- Julian

[Mike4]

…
Oops, little bit of politics there... (to quote wossisname, standup comic from the 80s.)

Ben Elton would be my guess.

- Julian

YES! Well done, I could not bring his name to mind!

[servodude]

they were working on creating clinical guideInes for the front line staff on how to triage patients in the face of insufficient resources to provide everyone the care they needed.

yes that's very much how it's always worded
- what really happens is everyone gets "the care they can"
- (or in Swedish care homes - morphine)

- sd

[Wizard]

The scientist I saw on the BBC quoted figures for the proportion in hospital who are unvaccinated Scotland was explicit on selection. She said the reason the proportion of unvaccinated in ICU was 60%, ie higher than the 40% of admissions was because there was no point putting many elderly people in ICU as they don't respond to the ventilators, etc. Now I get that is selection for a treatment reason and vaccination status is not always the same, but choices are made every day.

[redsturgeon]

(*) I did ask in another post if anyone actually had some reliable data on current PCR turnaround time, time to sequence, and if my assumption that all samples sent for sequencing would have first been PCR tested. If anyone can supply numbers better than my “I think I read somewhere” almost guesses I would love to know what the actual turnaround times are and if my assumption of PCR-then-sequencing is correct.

There is no easy answer for this one for several reasons. NB I am only speaking for private PCR testing here I cannot comment on the NHS system.

- Different types of PCR test. Some tests only sequence one gene and would not be able to provide the data required to detect Omicron. We use machines that provide a result within 90 minutes of the sample taken but this is just a binary positive or negative.

- More detailed testing that can detect the S- gene drop out is available from the bigger laboratories. They usually work on a 24 hour turnaround for the primary result but I can tell you in the last two days they are not achieving this figure due to high demand.

- Once the binary result has been found then any positives can be gene sequenced by these labs if required. A have no idea how long this takes.

- The government only asks for gene sequencing from day 2 testing in the private sector, any positive "fit to fly tests" are not gene sequenced.

HTH

John

[TUK020]

…
There has ALWAYS been the possibility of needing triage - I fully expect it has been done and kept quiet throughout the past few waves
- there are a slew of factors that will be considered - when that happens its not a social judgement it's just a cold hard and difficult decision
- because when this disease turns nasty in a patient it can do so very quickly
…

Details kept quiet yes (to my knowledge) but the fact of the matter not kept quiet as completely as you might think at least in the UK. I can’t remember if it was during the first or second wave but I remember seeing a news piece of the still-common inside-the-hospital variety with access to various clinical and management teams that explicitly touched open the fact that they were working on creating clinical guideInes for the front line staff on how to triage patients in the face of insufficient resources to provide everyone the care they needed. The rationale was to get ahead of the problem and make things easier for the medical staff by enabling them to be guided strongly by following pre-proscribed rules rather than having to agonise over on-the-spot personal judgements. They didn’t mention the specifics but the fact that they were trying to create formulas to follow to at least to some extent reduce the feeling of personal responsibility was definitely a thing way back whenever.

- Julian

Need to get Allegra Stratton on the case, and then the government could announce:
"Funding for a s significant expansion of NHS capacity especially to cope with unvaccinated COVID patients" (a tent in the car park)
"that would be staffed by massive productivity gains in caregiving" (a DIY guide to self ventilation).
You see, simple!