COVID-19

[badger]

Anyway, it's stuff like this which makes me wonder whether some harder rules (eg what defines a "close family member") and policing will be necessary.

Be careful what you wish for. If the current rules are not enforced against some people, adding more rules is no guarantee that the new ones will be enforced any more than the old ones. But you can be sure that that new rules will be enforced against you.

Indeed. It does also make non-compliance and lack of enforcement more conspicuous, however. And I'm capable of following rules.

Anyway, if we've peaked here in the UK there will be less of a call for them.

[JQH]

We've peaked on reported deaths in hospitals. Have we peaked on deaths in the wider community?

[lpm]

Anyway, it's stuff like this which makes me wonder whether some harder rules (eg what defines a "close family member") and policing will be necessary.

Be careful what you wish for. If the current rules are not enforced against some people, adding more rules is no guarantee that the new ones will be enforced any more than the old ones. But you can be sure that that new rules will be enforced against you.

Indeed. It does also make non-compliance and lack of enforcement more conspicuous, however. And I'm capable of following rules.

Anyway, if we've peaked here in the UK there will be less of a call for them.

I said before that in any society there are:

10% black marketeers, actively breaking laws to profit
25% careless cheaters, ignoring laws because they can't be bothered
50% followers, who will do what everyone else is doing
15% enforcers, obsessed with obeying rules

The lockdown doesn't seem to have been too useful to the black marketeers, but my god the enforcers are loving it. They have the upper hand, leaving notes on cars and tutting at passersby and going on Facebook to proclaim their versions of the law.

They need to be stamped on at the appropriate moment. There's a fascist streak in every society. The good news in the UK is their past few years of blaming immigrants has been structurally weakened - clapping for them every Thursday - and the police have been partially humiliated. We might emerge from this valuing our freedoms a little more.

[Sciolus]

I'd like to see more "excess deaths" above the 5 year average data. Give us a better idea of the actual numbers dying of this.

We've peaked on reported deaths in hospitals. Have we peaked on deaths in the wider community?

I agree that this is the only number that is likely to be meaningfully accurate. Other numbers such as "deaths with confirmed Covid in hospital" may be useful for specific planning tasks, but don't tell you how the pandemic as a whole is behaving, the effectiveness of control and mitigation measures, when we might be able to lift the lockdown, or anything like that.

[PeteB]

...
The lockdown doesn't seem to have been too useful to the black marketeers, but my god the enforcers are loving it. They have the upper hand, leaving notes on cars and tutting at passersby and going on Facebook to proclaim their versions of the law....

Doing a lot of walking in the countryside at the minute and I noticed a stile that had been plastered with 'GO HOME AND SAVE THE NHS'

And another very official looking one (in Mellor) claiming there was a diversion because the footpath went near peoples home "to protect residents"

[FlammableFlower]

I've seen the numbers for the whole of the south west - 92 in ICU of which 11 aren't requiring a ventilator - and that number is down 7 on yesterday.

[EACLucifer]

We've peaked on reported deaths in hospitals. Have we peaked on deaths in the wider community?

No idea.



If this graph is accurate, and the widely quoted 18-day typical time between infection and death is correct, then the peak of community transmission was about the last saturday before the (indefensibly belated) lockdown.

[Bird on a Fire]

A quick update on the situation in Portugal, based on the Health Department's comprehensive website https://covid19.min-saude.pt/ponto-de-s ... -portugal/ As a reminder, we've been on a proper lockdown (schools and non-essential workplaces closed, limits on capacity in the essential shops remaining open) since 18th March.

We're up to about 20,000 confirmed cases, and 200,000 suspected ones, with 762 deaths - suggesting a death rate of about 0.38% if all deaths are being captured and all suspected cases are legitimate. It's 3.8% including only confirmed cases. The UK has had 16,509 deaths from 124,743 confirmed cases, so 13.2% fatality - clearly nobody has any idea what's going on there, as there's woefully inadequate testing and the number of probably-but-unconfirmed cases isn't AFAICT published, even if it is being tabulated somewhere.

Most of the cases are around the country's two large urbanisations, in the north around Porto (which was hit first, and locked down before the rest of the country), and the Lisbon area (especially north of the Tagus - while a lot of workers, especially the lower-paid, live south of the river, the lockdown seems to have largely protected the south bank from infections).

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Note that the number of cases, whether suspected or confirmed, is continuing to grow linearly rather than exponentially. Annoyingly the website doesn't allow to plot on a log scale.

The number of recoveries has now outstripped deaths (which are also still growing linearly):

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There's a lot of noise in the daily number of new (confirmed) cases, but it certainly isn't growing and there might be early hints of an upcoming decline:

Screenshot_2020-04-21_14-20-27.png (38.33 KiB) Viewed 3406 times

Hospitalisations for COVID have been relatively stable at about 1,200 this month, of which about 250 are in ICU. This compares with a excess capacity in the national health service of about 2000 hospital beds, of which 300 are intensive care, following a reorganisation of services in the beginning of March (when there were hardly any cases here). So there is still room if things get worse - though it doesn't look like they're going to.

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Note that the health service here has been in a crisis for a quite a while and frontline services were already stretched to capacity - unlike in the UK the government really doesn't have much spare cash.

Portugal is managing to process about 10,000 samples a day, compared with 15,000 in the UK. Given that the population here is only 10 million, and the number of cases is much lower, I'm a lot more confident in the Portuguese figures than the UK's.

Screenshot_2020-04-21_14-22-02.png (39.52 KiB) Viewed 3406 times

Something else I've found interesting is the demographic distribution of (confirmed) cases by age and gender. In the early days, it was mostly men of working age (30-60), but now seems to have stabilised at 50:50 by gender and to have spread through the rest of the demographic pyramid. I suspect this is due to transmission originally being through workplaces from imported cases.

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Screenshot_2020-04-21_14-21-31.png (29.16 KiB) Viewed 3406 times

I like that the number of suspected cases is published, seeing as testing capacity here, while massively better per-capita than many other places, is still below what's necessary. The situation here re-affirms the value of the government and the people taking swift, decisive and clear action.

It also reinforces my bafflement at the lack of testing in the UK. The UK has a world-class biotech sector and a lot of world-leading research institutes. Portugal's sector is considerably smaller (though with a lot of recent growth), so by rights the UK should be absolutely pissing all over PT's ability to process tests, at least in terms of absolute numbers if not per capita. As we are seeing the opposite, I can only conclude that the issue is one of political will.

[shpalman]

The UK is even way behind Italy regarding the number of tests, which is especially egregious since I seem to remember that one of the justifications for "four weeks behind Italy" was iTaLy iSn'T tEsTiNg pRoPeRlY lIkE wHaT tHe uK iS.

[shpalman]

Italy is now providing the number of subjects tested as well as the number of swabs performed. So about 40% of subjects in Lombardy turned out positive for the covids, against a national average of 20% or only 10% in Veneto.

Anyway not just Italy as a whole but also Lombardy has fewer actual infections today as compared to yesterday. Lombardy had 1366 patients "cured" against 960 new positives. There were 203 deaths.

[raven]

They are from here: https://www.england.nhs.uk/statistics/s ... ly-deaths/

Cheers, Woodchopper

Those graphs from Portugal are great, very clear.

[Stranger Mouse]

Yesterday @atrupar pointed out that Trump wasn’t talking about his miracle drug

Today

https://apnews.com/a5077c7227b8eb8b0dc23423c0bbe2b2

“About 28% who were given hydroxychloroquine plus usual care died, versus 11% of those getting routine care alone. About 22% of those getting the drug plus azithromycin died too, but the difference between that group and usual care was not considered large enough to rule out other factors that could have affected survival.”

[jaap]

In the Netherlands it's been announced that primary schools will open again on May 3rd. From research and various measurements it's been determined that children tend not to be sources of transmission - transmission from parent to child happens more than child to parent; in sick households it was rarely the child who got it first; there are no clusters of sick children.

No other relaxations were announced. The ban on events has been extended a further 3 months to September 1st.


The last few days the media have continually been talking and speculating about unlocking, which in my view was irresponsible as it was setting the agenda and putting undue pressure on the government.

[mediocrity511]

In the Netherlands it's been announced that primary schools will open again on May 3rd. From research and various measurements it's been determined that children tend not to be sources of transmission - transmission from parent to child happens more than child to parent; in sick households it was rarely the child who got it first; there are no clusters of sick children.

No other relaxations were announced. The ban on events has been extended a further 3 months to September 1st.


The last few days the media have continually been talking and speculating about unlocking, which in my view was irresponsible as it was setting the agenda and putting undue pressure on the government.

Any plans announced on enforcing social distancing for parents and carers at pick ups and drop offs? I know that before schools closed here, it was the most close contact I got with other adults, probably analogous to being on fairly busy public transport. Are there any arrangements for children with vulnerable family members?

[dyqik]

In the Netherlands it's been announced that primary schools will open again on May 3rd. From research and various measurements it's been determined that children tend not to be sources of transmission - transmission from parent to child happens more than child to parent; in sick households it was rarely the child who got it first; there are no clusters of sick children.

No other relaxations were announced. The ban on events has been extended a further 3 months to September 1st.


The last few days the media have continually been talking and speculating about unlocking, which in my view was irresponsible as it was setting the agenda and putting undue pressure on the government.

Our schools are closed until the new school year in late August/September.

[jaap]

In the Netherlands it's been announced that primary schools will open again on May 3rd. From research and various measurements it's been determined that children tend not to be sources of transmission - transmission from parent to child happens more than child to parent; in sick households it was rarely the child who got it first; there are no clusters of sick children.

No other relaxations were announced. The ban on events has been extended a further 3 months to September 1st.


The last few days the media have continually been talking and speculating about unlocking, which in my view was irresponsible as it was setting the agenda and putting undue pressure on the government.

Any plans announced on enforcing social distancing for parents and carers at pick ups and drop offs? I know that before schools closed here, it was the most close contact I got with other adults, probably analogous to being on fairly busy public transport. Are there any arrangements for children with vulnerable family members?

The rules on keeping 1.5m distance between people who are 12 years or older continue to hold, and people will be expected to follow them and use their own judgement. It was mentioned that at first kids will only attend for half-days, so that schools will have half the number of kids attending at any one time. The usual rules of staying at home if you're exhibiting any symptoms remain in force, and teachers will have access to regular testing. There was no mention of children with vulnerable family members in the prime minister's press conference, but maybe further details will come out later.

[badger]

The lockdown doesn't seem to have been too useful to the black marketeers, but my god the enforcers are loving it. They have the upper hand, leaving notes on cars and tutting at passersby and going on Facebook to proclaim their versions of the law.

They need to be stamped on at the appropriate moment. There's a fascist streak in every society. The good news in the UK is their past few years of blaming immigrants has been structurally weakened - clapping for them every Thursday - and the police have been partially humiliated. We might emerge from this valuing our freedoms a little more.

Am not sure how leaving notes, tutting and spaffing on Facebook is having "the upper hand". By your analysis, the other groups don't pay the 'enforcers' any attention, and aren't going to change their behaviour anyway as you imply.

"Stamping" on them for getting in a froth about non-compliance seems a tad.... hypocritical? The lack of clarity around the lockdown rules and the pisspoor communication mean that people are more inclined to take the piss, whichever group they are in and in whatever direction suits them at the time. I even find myself feeling a bit sorry for the police!

[Woodchopper]

New York City’s multitentacled subway system was a major disseminator – if not the principal transmission vehicle – of coronavirus infection during the initial takeoff of the massive epidemic that became evident throughout the city during March 2020. The near shutoff of subway ridership in Manhattan – down by over 90 percent at the end of March – correlates strongly with the substantial increase in the doubling time of new cases in this borough. Maps of subway station turnstile entries, superimposed upon zip code-level maps of reported coronavirus incidence, are strongly consistent with subway-facilitated disease propagation. Local train lines appear to have a higher propensity to transmit infection than express lines. Reciprocal seeding of infection appears to be the best explanation for the emergence of a single hotspot in Midtown West in Manhattan. Bus hubs may have served as secondary transmission routes out to the periphery of the city.

https://www.nber.org/papers/w27021#fromrss

Seems plausible to me. Perhaps relevant for the unlockdown as it suggests that some businesses could reopen so long as people could walk, cycle or drive there.

[PeteB]

The UK is even way behind Italy regarding the number of tests, which is especially egregious since I seem to remember that one of the justifications for "four weeks behind Italy" was iTaLy iSn'T tEsTiNg pRoPeRlY lIkE wHaT tHe uK iS.

The 4 weeks behind Italy thing is interesting - I think that is what their model told them but the doubling time in the model was too long

[Woodchopper]

A summary of the data on asymptomatic or pre-symptomatic infections.
https://www.scripps.edu/science-and-med ... index.html

The bigger samples are giving a rate of about 40%.

[Woodchopper]

Coronavirus death toll in UK twice as high as official figure


The coronavirus pandemic has already caused as many as 41,000 deaths in the UK, according to a Financial Times analysis of the latest data from the Office for National Statistics.

The estimate is more than double the official figure of 17,337 released by ministers on Tuesday, which is updated daily and only counts those who have died in hospitals after testing positive for the virus.

The FT extrapolation, based on figures from the ONS that were also published on Tuesday, includes deaths that occurred outside hospitals updated to reflect recent mortality trends.

The analysis also supports emerging evidence that the peak of deaths in the UK occurred on April 8 with the mortality rate gradually trending lower since, despite the 823 hospital deaths announced on Tuesday, which were sharply up on the 449 in the previous 24 hours.

The ONS data showed that deaths registered in the week ending April 10 were 75 per cent above normal in England and Wales, the highest level for more than 20 years.

There were 18,516 deaths registered during that period compared with the most recent five year average of 10,520 for the same week of the year. There were similar patterns in Scotland and Northern Ireland 

Nick Stripe, head of life events at the Office for National Statistics, said the figure was “unprecedented”, especially as the weather had been sunny and warm in the run-up to the Easter weekend.

He added that because the week included Good Friday, when registrations were much lower than on a normal working day, the ONS numbers were also “conservatively” at least 2,000 too low.

The number of deaths in the UK has moved from running at below long term averages to well above them as a result of the pandemic. Excess deaths from all causes stand 16,952 above the seasonal average across the UK since fatalities from Covid-19, the disease caused by the virus, began to mount in mid-March.

The “all cause excess mortality” figure is widely recognised as the best measure of the death toll linked to the pandemic.

David Spiegelhalter, the Winton professor of public understanding of risk at Cambridge university, said it was “the only unbiased comparison” given the problems measuring deaths and their causes.

[...]

The FT’s analysis has extrapolated these figures using the latest trends in the daily hospital deaths assuming the relationship between these and total excess deaths remained stable, as it has so far over the course of the pandemic.

Using this calculation, a conservative estimate of UK excess deaths by April 21 was 41,102.

[...]

The ONS data also showed that deaths at home and in care homes had also jumped sharply during the pandemic. In the week ending April 10, deaths in care homes reached 4,927, almost double the figure of 2,471 a month earlier.

https://www.ft.com/content/67e6a4ee-3d0 ... 39799fa6ab

[shpalman]

The UK is even way behind Italy regarding the number of tests, which is especially egregious since I seem to remember that one of the justifications for "four weeks behind Italy" was iTaLy iSn'T tEsTiNg pRoPeRlY lIkE wHaT tHe uK iS.

The 4 weeks behind Italy thing is interesting - I think that is what their model told them but the doubling time in the model was too long

Thanks for that, it's basically what I thought. I too tried fitting a simple SIR model to the first ten days of the Italian outbreak and also got a peak in April, so even I could see that the idea of calmly applying a few measures at the right time to flatten the peak in July was nonsense.

The hardest part about getting the doubling time from the early stages of the outbreak is remembering to multiply the exponential time constant by ln(2).

[El Pollo Diablo]

Yep, it seemed odd at the time, and tbh was the main reason I started collating the DHSC numbers together, even if those numbers turned out to be a huuuge underestimate.

[badger]

https://www.ft.com/content/67e6a4ee-3d0 ... 39799fa6ab

Good find, thank you. Interesting (and sobering) to be able to see the stats from that perspective. I do hope someone asks the government about this in the next day or two. Do we have a functioning parliament yet, or are we still at the mercy of the journalists to scrutinise the government on our behalf?

[shpalman]

Yep, it seemed odd at the time, and tbh was the main reason I started collating the DHSC numbers together, even if those numbers turned out to be a huuuge underestimate.

You can really see how we're trying to reduce the cognitive dissonance between "well, those are actual scientists saying that" and "it looks like total nonsense from even the most cursory glance at the numbers".