Ranking the fears

[MrFoolish]

In my humble opinion, I estimate that the fears of Sage would be ranked in the following descending order:

1. Absenteeism of NHS staff through positive covid tests and health conditions which are common in the winter (e.g. colds, flu and now covid). The consequences are obvious.

2. Covid adds a modest uptick in the number of patients; pretty mild disease in general, but adding a further strain on the system.

3. Omicron turns out to cause significant serious disease, putting high demands on intensive care.

So I suspect they are mostly (and reasonably) worried about 1 & 2, and are using the idea of 3 to encourage public compliance.

[servodude]

I think the worry is that the uptick might be more than modest; even if they are of less seriously sick people.

-sd

[Hallucigenia]

2. Covid adds a modest uptick in the number of patients; pretty mild disease in general, but adding a further strain on the system.

Trouble is, the evidence from SA is that it's rather more than an uptick, at a national level they saw a 13x increase in 4 weeks in hospitalisations with Covid, in Gauteng it was 19x. Yes, we have boosters, which help a lot - but not everyone is even 1-jabbed.

And one of the real problems is it spreads massively within hospitals :
Word from the front line trenches: omicron spreads like wildfire. Omicron went from one patient in a ward, to 8 pts and 4 staff infected overnight to 5 wards full (mostly hospital acquired)4 days later. Monday was horrible Tuesday worse....Omicron kills in the same way as 'classic covid' in the elderly - exponential oxygen or a more gentle oxygen demand and then death. Lots of back pain and diarrhoea as a feature as well as sore throat. Most of the old who are dying are double vaxed with AZ

[MrFoolish]

2. Covid adds a modest uptick in the number of patients; pretty mild disease in general, but adding a further strain on the system.

Trouble is, the evidence from SA is that it's rather more than an uptick, at a national level they saw a 13x increase in 4 weeks in hospitalisations with Covid, in Gauteng it was 19x. Yes, we have boosters, which help a lot - but not everyone is even 1-jabbed.

But didn't South Africa previously have very low numbers of hospitalisations? If you go from 1 person to 20 persons you get a multiplier of 20x (and 0 persons to 1 person is a multiplier of infinity). Now obviously these numbers aren't real, but you get the idea. You can't take a multiplier effect from omicron and apply it to the numbers in hospital from delta.

And one of the real problems is it spreads massively within hospitals :
Word from the front line trenches: omicron spreads like wildfire. Omicron went from one patient in a ward, to 8 pts and 4 staff infected overnight to 5 wards full (mostly hospital acquired)4 days later. Monday was horrible Tuesday worse....Omicron kills in the same way as 'classic covid' in the elderly - exponential oxygen or a more gentle oxygen demand and then death. Lots of back pain and diarrhoea as a feature as well as sore throat. Most of the old who are dying are double vaxed with AZ

I'm skeptical about these anecdotes which are clearly written in such a way as to cause maximum alarm. It's interesting to note what wasn't said in that paragraph, such as the numbers that died. Seems an odd omission.

Regarding the needs for oxygen, what has happened with our own Nightingale hospitals? I haven't heard any mention of them on the news. You'd think they'd be on active standby with staff and the army being trained to administer oxygen, no?

[MrFoolish]

On a slightly tangential note, there was a sign up the other day in my local pharmacy saying no covid tests were available due to a national shortage. If this national shortage is real, how much is this influencing policy?

[jackdaww]

.

my own fear is that a seriously very nasty variant will emerge.

[Hallucigenia]

But didn't South Africa previously have very low numbers of hospitalisations? If you go from 1 person to 20 persons you get a multiplier of 20x (and 0 persons to 1 person is a multiplier of infinity). Now obviously these numbers aren't real, but you get the idea. You can't take a multiplier effect from omicron and apply it to the numbers in hospital from delta.

Obviously each country has run its own course, but overall SA has had ~85% of the per capita hospitalisations of the UK across the pandemic, so they're not one of these countries that's escaped lightly. My point was less about the specific numbers and more about the rise. If you'd rather deal in absolute numbers, SA has seen hospitalisations so far increase by the UK-per-capita-equivalent of 1200 per day, which on top of our existing delta infections would represent a trebling from where we were a few weeks ago. Given that hospitalisations are still rising in SA, once can imagine that the UK could end up peaking at around 2500-3000 per day, or 4x the autumn low (which was still a time of considerable stress on the NHS). Which feels appropriately near the "optimistic" end of the LSHTM modelling.

It's not as bad as it could be, but it's still not to be dismissed as "a modest uptick". Obviously the data in SA is limited and provisional, but if you combine their "BUPA" saying cases in this wave are hospitalised at 71% of the rate of their previous wave (adjusted for age and jabs but not infection nor variant) with their health minister saying their case fatality rate was a third of the previous wave, with hospital stays about half as long, whilst their dashboard was saying about 8% of the hospital population was in ICU and a similar number in "high care".

Holy crap, there's been a huge leap just in the last day or two since I last looked, the dashboard is saying their Covid hospital population is now 9.02k when it was 2-3k for most of last week, which is rather more than the new admission rate implying they're staying longer. There was some suspicion out there that there was something up with the SA stay data, maybe that's been resolved. So the new data is saying 6.7% of the population in ICU, compared to the UK's ~12% on ventilation (down a bit recently from 14% or so over the autumn).

So if you say the UK has been on around 35k cases/day since August, around 2.5% of those have been admitted to hospital, the hospital population has been 8x the daily admission rate (ie average stay 8 days) and 14% have been on ventilation.

If you use the South African numbers, then the UK will go to 1.775% of cases going to hospital, hospital population will be 4x the daily admission rate, and 7% will be on ventilation. So for a given case rate, we'll have 35.5% of the hospital population compared to the autumn, and 17.75% of the numbers on ventilation.

But the latest finalised case rate is 102k last Wednesday. If that was all omicron and the SA stats apply, it would mean roughly the same hospital population and half the ventilation is already "baked in" for later this week - and some of it is delta, so it's worse.

Now the UK is a bit different - much older population, but more jabs/boosters - and omicron so far has been concentrated in the 20-somethings who don't get as sick. But in time it will spread to the older generations.

Last year the peak cases were four days after Christmas and four days after NYE. If cases were to double every 4 days (rather than the current 2-3 days), it's 14 days from the 15th to Christmas+4 so potentially the cases on the 29th could be 11x 100k - which means a week or two later 11x the current hospital population and 5x the ventilation.

A "modest uptick" indeed.

And one of the real problems is it spreads massively within hospitals :
Word from the front line trenches: omicron spreads like wildfire. Omicron went from one patient in a ward, to 8 pts and 4 staff infected overnight to 5 wards full (mostly hospital acquired)4 days later. Monday was horrible Tuesday worse....Omicron kills in the same way as 'classic covid' in the elderly - exponential oxygen or a more gentle oxygen demand and then death. Lots of back pain and diarrhoea as a feature as well as sore throat. Most of the old who are dying are double vaxed with AZ

I'm skeptical about these anecdotes which are clearly written in such a way as to cause maximum alarm. It's interesting to note what wasn't said in that paragraph, such as the numbers that died. Seems an odd omission.

Typically it takes 28 days to die from Covid, and omicron has been in the UK just over 3 weeks - only an idiot would be looking at death rates right now.

Aside from the fact that as above, it's mostly in 20-somethings at the moment who are less likely to die. And are you equally as sceptical of media who have tried to minimise the severity of omicron? Frankly if I was a doctor on the frontline, I would be feeling pretty alarmist about seeing a spread from one patient to 5 wards in a matter of days - wouldn't you? And it ties in with what we know of previous variants being very "super-spready" and some of the data that suggests 20-25% of all omicron infections are caught in hospital, so I don't think it's implausible.

Regarding the needs for oxygen, what has happened with our own Nightingale hospitals? I haven't heard any mention of them on the news. You'd think they'd be on active standby with staff and the army being trained to administer oxygen, no?

Because Nightingale hospitals were an embarassing failure last time, because ministers thought that if you build them, the staff will appear out of nowhere and they didn't, they were all needed in the normal hospitals. There's actually an argument that omicron is better suited to a Nightingale approach, given its transmissibility and apparently somewhat lower severity, but politically that's probably impossible now.

[Hallucigenia]

On a slightly tangential note, there was a sign up the other day in my local pharmacy saying no covid tests were available due to a national shortage. If this national shortage is real, how much is this influencing policy?

That seems to have been a fairly short-lived problem, around the time that the public began to appreciate what omicron could mean for Christmas, but it only lasted a day or two.

Potentially a greater problem is people not taking a PCR when LFT-positive or with symptoms, because they don't want to be isolating during Christmas.

[MrFoolish]

Thanks for your very detailed replies Hallucigenia. It's a lot to take in but I do appreciate your effort.

[9873210]

You don't want Nightingale hospitals to be a success.

They are designed around triage. The only way to staff and equip those beds is to pull resources from more intensive levels of care. All resources (including staff) used to give low levels of care (e.g. Oxygen cannulas) to save as many as possible. Those who need higher levels of care die. If Nightingales are saving lives the situation is pretty dire. Still there should be plans to do this, if you get to that point the alternatives are worse.

[murraypaul]

You don't want Nightingale hospitals to be a success.

They are designed around triage. The only way to staff and equip those beds is to pull resources from more intensive levels of care. All resources (including staff) used to give low levels of care (e.g. Oxygen cannulas) to save as many as possible. Those who need higher levels of care die. If Nightingales are saving lives the situation is pretty dire. Still there should be plans to do this, if you get to that point the alternatives are worse.

This. It was absolutely sensible to put the Nightingale plan in place, and it is a fantastic result that we didn't need to use them.

[Nimrod103]

You don't want Nightingale hospitals to be a success.

They are designed around triage. The only way to staff and equip those beds is to pull resources from more intensive levels of care. All resources (including staff) used to give low levels of care (e.g. Oxygen cannulas) to save as many as possible. Those who need higher levels of care die. If Nightingales are saving lives the situation is pretty dire. Still there should be plans to do this, if you get to that point the alternatives are worse.

I am sure you are right, and know more about it than me.
I have to say I always thought the Nightingale hospitals were designed purely to prevent the terminal Covid sufferers dying on the street - which seemed to be the case at the time in China. Hence AIUI there were pop up morgues alongside each Nightingale.

[Hallucigenia]

I have to say I always thought the Nightingale hospitals were designed purely to prevent the terminal Covid sufferers dying on the street - which seemed to be the case at the time in China. Hence AIUI there were pop up morgues alongside each Nightingale.

Nah - they were intended to provide limited-capability capacity for the sort-of-bad cases who should hopefully live, to free up space in the main hospitals for the worst cases who were more likely to need the full capabilities (scans etc) of a hospital close by.

They were also convenient places to put extra morgue capacity that could be used by the main hospitals.

[MrFoolish]

Well, so far it seems to have progressed pretty much as I suggested: lots of widespread infection but limited serious illness; the concern is more about staff absenteeism and a creaking strain on services. Just like in South Africa, unsuprisingly.

[Steveam]

I think you are rather too early in asserting only a modest increase. I think the size of any uptick in hospitalisations is still very unknown and, given the high number of infections, could be very significant.

Best wishes,

Steve

[swill453]

I think you are rather too early in asserting only a modest increase. I think the size of any uptick in hospitalisations is still very unknown and, given the high number of infections, could be very significant.

The expectation, in Scotland anyway, is that the peak of the current wave of infections is expected towards the end of January. This implies that peak hospitalisation figures will be well into February.

And peak deaths late February.

Scott.

[88V8]

I have to say I always thought the Nightingale hospitals were designed purely to prevent the terminal Covid sufferers dying on the street ...

Whatever they were for, I heard on't wireless this morning that eight of them are being reactivated, although as was also commented in the same piece, where will they find the staff.
Given the rate of spread within hospitals there could be considerable merit is sending all covid patients to the Nightingales as a sort of isolation, assuming of course that one could head them off before they reach the general wards.

V8

[murraypaul]

I have to say I always thought the Nightingale hospitals were designed purely to prevent the terminal Covid sufferers dying on the street ...

Whatever they were for, I heard on't wireless this morning that eight of them are being reactivated, although as was also commented in the same piece, where will they find the staff.

The reporting is confusing, but what is happening now is nothing to do with the previous Nightingale operations.

This time they are setting up temporary wards on the site of existing hospitals.

[moorfield]

With apologies, I'm in a more cynical than usual mood this morning.


0. Loss of professional standing and reputation, some tidy consultancy fees, and platform for lobbying govt and industry for funding their own research interests. Let's keep this gravy committee rolling.

In my humble opinion, I estimate that the fears of Sage would be ranked in the following descending order:

1. Absenteeism of NHS staff through positive covid tests and health conditions which are common in the winter (e.g. colds, flu and now covid). The consequences are obvious.

2. Covid adds a modest uptick in the number of patients; pretty mild disease in general, but adding a further strain on the system.

3. Omicron turns out to cause significant serious disease, putting high demands on intensive care.

So I suspect they are mostly (and reasonably) worried about 1 & 2, and are using the idea of 3 to encourage public compliance.

[XFool]

Regarding the needs for oxygen, what has happened with our own Nightingale hospitals? I haven't heard any mention of them on the news. You'd think they'd be on active standby with staff and the army being trained to administer oxygen, no?

Because Nightingale hospitals were an embarassing failure last time, because ministers thought that if you build them, the staff will appear out of nowhere and they didn't, they were all needed in the normal hospitals. There's actually an argument that omicron is better suited to a Nightingale approach, given its transmissibility and apparently somewhat lower severity, but politically that's probably impossible now.

Not the original Nightingales, but it is reported that temporary overflow units are being set up in some hospitals.

Covid: Nightingale surge hubs to be set up in eight hospitals, NHS England says

BBC News

Coronavirus "surge hubs" are to be set up at hospitals across England in preparation for a potential wave of Omicron admissions, the NHS has said.

"The eight temporary "Nightingale" units will each house about 100 patients, with building starting this week."


PS. Apologies about repetition of above, but I got distracted when originally posting a while ago and then had to redo post as login seemed to have lapsed.