COVID-19

Covid-19 discussion, bring your own statistics
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lpm
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Re: COVID-19

Post by lpm » Sun Sep 05, 2021 8:39 am

Herainestold wrote:
Fri Sep 03, 2021 6:13 pm
So basically what we are going to see is a series of waves above a high baseline. It should diminish once everybody has either been vaccinated or infected. It will never disappear entirely as the virus is perfectly capable of infecting the vaccinated and reinfecting the previously infected. We need to get used to the idea that our hospitals are going to see permanent high numbers of Covid patients, and it will kill a certain number of people every year, just like cancers, heart attacks, strokes etc.
Wow, you finally get it. Hopefully you'll now transition from short term doom to the practical implications for the long term.

The Covid twitteratti are failing to get this. They are clinging to the world of 2019, for example expecting the pressure on the NHS to somehow revert to 2019 levels. Or death rates / life expectancy to revert. It's disappointing to hear previously sensibly people now wreck their reputations by failing to appreciate the transition to endemic Covid.

The correct way to look at this is to accept there's been a global pandemic with a novel virus that is here to stay and 2019 is gone for ever. We need to accept the long term implications of Covid circulating for a decade or more. Healthcare will need more resources, permanently. Death rates for the vulnerable will be higher, permanently. We're all going to catch it and maybe end up with protection from half a dozen sources - the original two vaccines, a couple of boosters, a couple of infections.
What ever happened to that Trump guy, you know, the one who was president for a bit?

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Re: COVID-19

Post by Woodchopper » Sun Sep 05, 2021 11:17 am

lpm wrote:
Sun Sep 05, 2021 8:39 am
The correct way to look at this is to accept there's been a global pandemic with a novel virus that is here to stay and 2019 is gone for ever. We need to accept the long term implications of Covid circulating for a decade or more. Healthcare will need more resources, permanently. Death rates for the vulnerable will be higher, permanently. We're all going to catch it and maybe end up with protection from half a dozen sources - the original two vaccines, a couple of boosters, a couple of infections.
I agree in general. What I think remains to be seen is the extent that everyday life will need to remain different from 2019. I expect that some people will want to limit chances of being infected or of infecting others - because they are vulnerable or their loved ones are. Of course everyone will be infected at some point, but given the damage that Covid infectio can do to most of the major organs (including post-viral syndrome) many people may prefer to take active steps to, say, reduce the number of times they are infected to twice in a decade rather than ten times.

This may mean that, for example, at work all members of teams are only physically present in the same place during the summer months, that foreign travel becomes much more rare than it was, that far fewer people socialize in pubs or clubs (especially in winter), and that old and vulnerable people become much more isolated (and as you write, die sooner).

But we'll have to see how well our immune systems cope. It may well come to pass that Covid ends up like influenza (for the vast majority a seasonal inconvenience). But that might take ten years or it might take 50.

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Re: COVID-19

Post by Sciolus » Sun Sep 05, 2021 8:02 pm

There's another thread for "endemic covid" discussions, but while we're here... Speaking for myself, I've decided to pretty much roll with Johnson's "infect 'em all and let God sort 'em out" policy. I'm still taking low-cost prevention measures -- wearing a mask, only going into the office 2 or 3 days when that's allowed at all, reducing time in low-value indoor environments such as casual shopping/browsing, that sort of thing. But for higher value stuff, such as choir and other necessarily indoor social activities, I'm going to just get on with it and stop worrying too much.

Again just speaking for myself, I'm less worried about acute covid (sh.t but probably survivable) than long covid (potential deeply unpleasant long-term impacts on quality of life). Hopefully this will prompt some decent understanding and treatment for post-viral syndromes.

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Re: COVID-19

Post by Herainestold » Mon Sep 06, 2021 4:11 am

Millennie Al wrote:
Sun Sep 05, 2021 1:04 am
Herainestold wrote:
Sat Sep 04, 2021 3:37 am
Millennie Al wrote:
Sat Sep 04, 2021 3:15 am
I would like to see them test masking properly - using a blinded study. This would involve giving out masks of two types - one designed to be a standard type of mask, such as a surgical mask, and the other designed to be ineffective but hard to tell apart from the effective one.
That would definitely be unethical.
Not nearly as unethical as advocating an unproven treatment. And it wouldn't be unethical at all if done with informed consent.
What unproven treatment? Vaccines?
Vaccination saves lives. Lockdowns stop transmission.

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Re: COVID-19

Post by Woodchopper » Mon Sep 06, 2021 7:39 am

Millennie Al wrote:
Sun Sep 05, 2021 1:04 am
Herainestold wrote:
Sat Sep 04, 2021 3:37 am
Millennie Al wrote:
Sat Sep 04, 2021 3:15 am
I would like to see them test masking properly - using a blinded study. This would involve giving out masks of two types - one designed to be a standard type of mask, such as a surgical mask, and the other designed to be ineffective but hard to tell apart from the effective one.
That would definitely be unethical.
Not nearly as unethical as advocating an unproven treatment. And it wouldn't be unethical at all if done with informed consent.
Your second sentence isn't correct. Medical ethics principles hold that its unethical to give someone a placebo or no intervention if a proven intervention exists. So new treatments are compared to existing treatments.

Is wearing masks an unproven intervention? That comes down to our criteria for whether its proven or not.

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Re: COVID-19

Post by nezumi » Mon Sep 06, 2021 10:16 am

Sciolus wrote:
Sun Sep 05, 2021 8:02 pm
There's another thread for "endemic covid" discussions, but while we're here... Speaking for myself, I've decided to pretty much roll with Johnson's "infect 'em all and let God sort 'em out" policy. I'm still taking low-cost prevention measures -- wearing a mask, only going into the office 2 or 3 days when that's allowed at all, reducing time in low-value indoor environments such as casual shopping/browsing, that sort of thing. But for higher value stuff, such as choir and other necessarily indoor social activities, I'm going to just get on with it and stop worrying too much.

Again just speaking for myself, I'm less worried about acute covid (sh.t but probably survivable) than long covid (potential deeply unpleasant long-term impacts on quality of life). Hopefully this will prompt some decent understanding and treatment for post-viral syndromes.
I'm basically doing the same - thankfully we haven't been called to the office yet. They keep saying next month it'll be compulsory for at least one day and then putting it off. I am pleased of course, I hate going into the office at the best of times (it's noisy and bright and the temperature is always wrong).

I'm carrying on with masking for all indoor activities but for me that's essentially the odd bit of shopping a couple of times a week. I'd love to join a choir at some point but it's too risky for now. Besides, all the local ones are religious or showtunes. I'd also like to go back to singing lessons at some point.

Just about everything social I do is online anyway!

Masking is now down to about 20% of the people I see out and about. Some are still masking outdoors while others don't care at all - even in the pharmacy this morning there were people without masks despite the obvious sign saying "wear a mask"! The staff didn't seem to care either.

I hope they do boosters (particularly for me in group 4) and that the booster is a different vaccine than the one originally given. Seems logical to have the booster be a different vaccine so it can attack the problem from a different angle.

My area looks to have a fairly low prevalence but it's only recently that people known to me have caught the disease. The sister-in-law that didn't want to isolate now has it. Obviously. I just hope she didn't infect anyone!
Non fui. Fui. Non sum. Non curo.

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Re: COVID-19

Post by shpalman » Mon Sep 06, 2021 10:33 am

Next week my in-person teaching of both physics and dancing will start and both of these activities will require Green Passes from everybody; last year it was partner dancing which was first to go, even if the couples were fixed, then solo dancing, then in-person lectures by the end of October. Dancing outside was allowed during the summer, but it was supposed to be socially distanced and/or between couples who were shagging anyway, so I don't think there were any actual swing evenings.

It will still be limited numbers of fixed couples for dance lessons, without the usual rotation of partners during the lesson and of course no chance of social dancing evenings (not even outside, although the season for that will end soon) and this ruins the main motivations for why someone would want to learn to dance (i.e. meet new people at the lessons and then meet new people going out dancing). Social dancing is basically the only thing I want to do but can't, so if all the willfully unvaccinated people pushing the hospitalization and death statistics up can all just f.cking die already, that would be good.
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Re: COVID-19

Post by WFJ » Mon Sep 06, 2021 10:44 am

Woodchopper wrote:
Mon Sep 06, 2021 7:39 am
Millennie Al wrote:
Sun Sep 05, 2021 1:04 am
Herainestold wrote:
Sat Sep 04, 2021 3:37 am


That would definitely be unethical.
Not nearly as unethical as advocating an unproven treatment. And it wouldn't be unethical at all if done with informed consent.
Your second sentence isn't correct. Medical ethics principles hold that its unethical to give someone a placebo or no intervention if a proven intervention exists. So new treatments are compared to existing treatments.

Is wearing masks an unproven intervention? That comes down to our criteria for whether its proven or not.
Isn't that only true when no intervention results in a significant risk of serious harm to the participant? I'm not sure that applies for (lack of) mask wearing by healthy trial participants.

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Re: COVID-19

Post by shpalman » Mon Sep 06, 2021 3:01 pm

PeteB wrote:
Fri Sep 03, 2021 12:08 pm
In England, the Covid epidemic has de-facto ended

I know it's a bit overblown, but isn't his central point valid : We have reached the point where the number of vaccinated and recovered have effectively hit the herd immunity threshold given current behaviour. Because R0 is so high for delta any change in R will have limited effect (see linked graph), When schools return & over winter when more people indoors, any increase in numbers will soon take us over the herd immunity threshold again ?
England cases 2021-09-05.png
England cases 2021-09-05.png (19.68 KiB) Viewed 516 times
Your issue is that R is close to 1 and the quantitative changes in R are quite small at the moment, but this gives rise to opposite qualitative behaviour i.e. "going up" or "going down". It's meaningless as long as it's only going up or down slowly.

Of course you had that peak in mid July which is completely unexplained but definitely had nothing to do with the football, and while it doesn't seem to have been followed by an obvious peak in deaths (because it was mainly cases between younger people), it does demonstrate the kind of thing which could still happen unless there's been a substantial decrease in the susceptible population since then.
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Re: COVID-19

Post by shpalman » Mon Sep 06, 2021 4:24 pm

Ha I thought about waiting until today's numbers had come in, but usually on a Monday the numbers are a bit low because of the weekend and it would have maybe diluted the point I was trying to make.
England cases 2021-09-06.png
England cases 2021-09-06.png (19.97 KiB) Viewed 494 times
(Today's England daily reported case number was the highest Monday number since the July peak.)

Also you can see how cases have been proportionally increasing in the >60 age group since the beginning of August.
England cases 2021-09-06 age groups.png
England cases 2021-09-06 age groups.png (43.41 KiB) Viewed 494 times
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Re: COVID-19

Post by lpm » Mon Sep 06, 2021 4:30 pm

shpalman wrote:
Mon Sep 06, 2021 3:01 pm
Of course you had that peak in mid July which is completely unexplained but definitely had nothing to do with the football, and while it doesn't seem to have been followed by an obvious peak in deaths (because it was mainly cases between younger people), it does demonstrate the kind of thing which could still happen unless there's been a substantial decrease in the susceptible population since then.
The UK peaked on 17 July.

Since then injections and infections have been:

1,974,260 people have had 1st dose
7,484,234 people have had 2nd dose
1,632,587 people have had official infection
Unknown people have had asymptomatic/untested infection

Total Susceptiblity Points won: 11,091,081 = 17% of population.

So, yes, there has been "a substantial decrease in the susceptible population" since the July peak.
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Re: COVID-19

Post by shpalman » Mon Sep 06, 2021 4:34 pm

lpm wrote:
Mon Sep 06, 2021 4:30 pm
shpalman wrote:
Mon Sep 06, 2021 3:01 pm
Of course you had that peak in mid July which is completely unexplained but definitely had nothing to do with the football, and while it doesn't seem to have been followed by an obvious peak in deaths (because it was mainly cases between younger people), it does demonstrate the kind of thing which could still happen unless there's been a substantial decrease in the susceptible population since then.
The UK peaked on 17 July.

Since then injections and infections have been:

1,974,260 people have had 1st dose
7,484,234 people have had 2nd dose
1,632,587 people have had official infection
Unknown people have had asymptomatic/untested infection

Total Susceptiblity Points won: 11,091,081 = 17% of population.

So, yes, there has been "a substantial decrease in the susceptible population" since the July peak.
Most of the people who've had the second dose by now would have been protected by their first dose back in July. Or else you don't get to subtract the new first doses from today's susceptible population.
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Re: COVID-19

Post by lpm » Mon Sep 06, 2021 4:37 pm

Total Susceptibility Points won by the UK since the game began are:

48,270,113 1st dose
43,455,083 2nd dose
7,018,927 official infections
Unknown asymptomatic/untested infections

Total 98,744,123 points = 1.48 points per person

This is when Raven's clique theory needs to come into play. Uneven distribution of the 1.48 points per person leads to highly protected areas of the population but some poorly protected segments.

In July, 18-30 year olds were a key clique with poor protection. I bet it's also visible geographically - no coincidence that Cornwall had it easy in first and second waves, leaving low points per person and a vulnerability across the summer, while London had it bad in the early waves but had an easier summer.
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Re: COVID-19

Post by lpm » Mon Sep 06, 2021 4:44 pm

shpalman wrote:
Mon Sep 06, 2021 4:34 pm
Most of the people who've had the second dose by now would have been protected by their first dose back in July. Or else you don't get to subtract the new first doses from today's susceptible population.
I'm not assigning protective values to each component of Susceptibility Points. Mainly because we don't know what the double counts are. And we don't know precise Vaccine Effectiveness vs Infection Spreading for a first dose for an 18 year old who had Covid in March 2020.

Doesn't matter. We've increased points from 1.31 to 1.48 per person.

Alternatively, the UK had a low percentage of poorly unprotected people in July, and taking off 17 percentage points from that minority is a major chunk dealt with.
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Re: COVID-19

Post by shpalman » Mon Sep 06, 2021 5:56 pm

What was the official estimate of R_t on the way up to the July peak and what will it be in mid September considering the reduced susceptible population given by the first doses and infections since then?

(Second doses don't count because as long as you get it on time it doesn't change a person's susceptibility).
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Re: COVID-19

Post by lpm » Mon Sep 06, 2021 6:45 pm

Second doses don't count? Tell that to the "not yet fully vaccinated" moaners.

Overall population R_t is irrelevant under the Raven Clique hypothesis, isn't it? If "social networks are more cliquey than we expect" then R also gets divided up into the cliques.

I'm on 2 points, being two doses, which must be the mode. Plenty of 3 pointers, two doses plus an infection, some 4s from two infections. Over the years there'll be 5s and 6s, then people with two doses, three boosters and four infections.

If what matters is turning 0 into 1, then the cliquiness of 0s is what determines R for that segment. And most 0s are children <16, plus some adult morons. We know for sure that children <16 are incredibly cliquey, assembling in indoor rooms every Monday to Friday where they encounter the same 30 others every day. Maybe the adult morons still on 0 are slightly cliquey as well - idiots of a feather flock together.

High cliquiness will drive a high R and a very high case rate, but simultaneously implies lower spread to 2 and 3 pointers, namely their parents and other family. The government policy is to directly increase R in children over the next two months, taking a huge chunk out of susceptible 0s. Injection vs infection is a marginal decision for a 12 year old and infection is the only route for under 12s anyway. In effect the government is running Covid parties for primary school children across Sept and Oct, with the intention of the wave dying out in November ahead of the winter flu season.

If cliquiness drove the July peak in 18-30, then the sudden falling away when that group went from 0 to 1 via infection or injection, then there's no reason why the same won't work in the coming peak - very high cases in a concentrated clique that quickly falls away as they switch from 0 to 1. A very spikey chart when viewed in narrow geographies and particularly at a school or classroom level.
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Re: COVID-19

Post by Millennie Al » Mon Sep 06, 2021 7:15 pm

Woodchopper wrote:
Mon Sep 06, 2021 7:39 am
Millennie Al wrote:
Sun Sep 05, 2021 1:04 am
it wouldn't be unethical at all if done with informed consent.
Your second sentence isn't correct. Medical ethics principles hold that its unethical to give someone a placebo or no intervention if a proven intervention exists. So new treatments are compared to existing treatments.
Then that ethics is wrong. My body, my choice.
Is wearing masks an unproven intervention? That comes down to our criteria for whether its proven or not.
Have there been randomised blinded trials? I haven't seen any, but I have seen several studies which did not adequately control for confounding factors.

And there are two interventions that need to be considered: mask wearing and mask mandates. It's possible that voluntary mask wearing works, while forced mask wearing doesn't.
Covid-19 - Don't catch it: don't spread it.

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Re: COVID-19

Post by Millennie Al » Mon Sep 06, 2021 7:16 pm

Herainestold wrote:
Mon Sep 06, 2021 4:11 am
Millennie Al wrote:
Sun Sep 05, 2021 1:04 am
advocating an unproven treatment.
What unproven treatment? Vaccines?
No. Vaccines are very well proven. Things like Hydroxychloroquine, Ivermectin, mask wearing, double masking, sanitising surfaces.
Covid-19 - Don't catch it: don't spread it.

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COVID-19 cliques

Post by jdc » Mon Sep 06, 2021 7:29 pm

https://academic.oup.com/cid/article/52/7/911/299077
Heterogeneous Populations—Nonrandom Mixing
Modeling heterogeneous populations requires knowledge—or assumptions—about how different groups interact. The dynamics of infection within each group depend on the rate of acquisition of infection from all other groups. In simple random models, all mixing behavior is captured by a single parameter, but in heterogeneous populations this must be replaced by an array of parameters that describe how each group interacts with each other group. Evaluating this contact matrix may be impracticable, or impossible, and so approximations are often used. Recent questionnaire studies have collected detailed data about levels of interactions between different age groups, allowing evidence-based parameterization of age-structured models with complex mixing [24]. Similarly, spatially explicit models can be parameterized using transport data [25].

Although the mathematics to describe heterogeneous mixing are complex, the critical threshold remains: Vc = (1− 1/R0)/E, except that R0 is no longer a simple function of the average number of contacts of individuals. Instead, R0 is a measure of the average number of secondary cases generated by a “typical” infectious person [14]. This average depends on how the various groups interact and can be calculated from a matrix describing how infection spreads within and between groups. Interactions are often observed to be more frequent within than between groups [24], in which case the most highly connected groups will dominate transmission, resulting in a higher value of R0, and a larger vaccination threshold than would be obtained by assuming that all individuals display average behavior.
refs 24, 25 and 14: https://pubmed.ncbi.nlm.nih.gov/18366252/, https://pubmed.ncbi.nlm.nih.gov/16461461/, https://pubmed.ncbi.nlm.nih.gov/12211331/

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Re: COVID-19

Post by Herainestold » Tue Sep 07, 2021 3:40 am

Woodchopper wrote:
Mon Sep 06, 2021 7:39 am

Is wearing masks an unproven intervention? That comes down to our criteria for whether its proven or not.
Depends what you mean by proven. There definitely is some evidence but most of it is not very robust. The trial being discussed
in Bangladesh seems to be one of the better ones, but the evidence certainly isn't strong at this point. We need more trials like that one.
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Re: COVID-19

Post by Herainestold » Tue Sep 07, 2021 3:43 am

Woodchopper wrote:
Sun Sep 05, 2021 11:17 am
This may mean that, for example, at work all members of teams are only physically present in the same place during the summer months, that foreign travel becomes much more rare than it was, that far fewer people socialize in pubs or clubs (especially in winter), and that old and vulnerable people become much more isolated (and as you write, die sooner).
This is the world we are in now. Better get used to it.
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Re: COVID-19

Post by shpalman » Tue Sep 07, 2021 8:27 am

lpm wrote:
Mon Sep 06, 2021 6:45 pm
Second doses don't count? Tell that to the "not yet fully vaccinated" moaners.
I don't think the second dose strongly increases your protection against infection compared to the first dose, it just extends it.
lpm wrote:
Mon Sep 06, 2021 6:45 pm
Overall population R_t is irrelevant under the Raven Clique hypothesis, isn't it? If "social networks are more cliquey than we expect" then R also gets divided up into the cliques.

I'm on 2 points, being two doses, which must be the mode. Plenty of 3 pointers, two doses plus an infection, some 4s from two infections. Over the years there'll be 5s and 6s, then people with two doses, three boosters and four infections.

If what matters is turning 0 into 1, then the cliquiness of 0s is what determines R for that segment. And most 0s are children <16, plus some adult morons. We know for sure that children <16 are incredibly cliquey, assembling in indoor rooms every Monday to Friday where they encounter the same 30 others every day. Maybe the adult morons still on 0 are slightly cliquey as well - idiots of a feather flock together.

High cliquiness will drive a high R and a very high case rate, but simultaneously implies lower spread to 2 and 3 pointers, namely their parents and other family. The government policy is to directly increase R in children over the next two months, taking a huge chunk out of susceptible 0s.

Injection vs infection is a marginal decision for a 12 year old and infection is the only route for under 12s anyway. In effect the government is running Covid parties for primary school children across Sept and Oct, with the intention of the wave dying out in November ahead of the winter flu season.

If cliquiness drove the July peak in 18-30, then the sudden falling away when that group went from 0 to 1 via infection or injection, then there's no reason why the same won't work in the coming peak - very high cases in a concentrated clique that quickly falls away as they switch from 0 to 1. A very spikey chart when viewed in narrow geographies and particularly at a school or classroom level.
Well ok, then you'll see a peak similar in character to the July one but there'll be nothing much to worry about, so we're only really discussing the magnitude of it based on how many younger adults have stopped being susceptible in the meantime.

However, high infection rates in young cliques do lead to more older people being exposed to more virus, since no cliques are completely isolated. Something is driving the increase in infection and death rate in the >60 age range.

Also you're maybe used to talking about the UK as if it has particular good vaccination coverage, and maybe it's relatively good for coverage in the older age ranges, but overall most of Western Europe has caught up if not overtaken. And also maybe the vaccination effectiveness in the oldest and most vulnerable, who were done first, is fading a bit.
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Re: COVID-19

Post by shpalman » Tue Sep 07, 2021 3:52 pm

shpalman wrote:
Mon Sep 06, 2021 4:24 pm
Ha I thought about waiting until today's numbers had come in, but usually on a Monday the numbers are a bit low because of the weekend and it would have maybe diluted the point I was trying to make.

Image
Still aging badly:
England cases 2021-09-07.png
England cases 2021-09-07.png (22 KiB) Viewed 323 times
And from someone else who doesn't fully understand 7-day averages:
Britain has recorded 209 deaths on Tuesday, the highest number since March.

The sum of the last seven days' deaths is 948, by the way, and the seven-day average is currently 135.4.
shpalman wrote:
Fri Aug 27, 2021 11:03 am
Woodchopper wrote:
Fri Aug 27, 2021 10:08 am

A cost-benefit analysis will have set the acceptable level of Covid-19 deaths before restrictions are reintroduced at around 1,000 deaths a week, two Government advisers have told i.

Downing Street has denied it has set any “acceptable level” of Covid deaths but one adviser, who has been close to the Government since coronavirus struck 18 months ago, told i that Prime Minister Boris Johnson had privately accepted that there would be at least a further 30,000 deaths in the UK over the next year, and that the Prime Minister would “only consider imposing further restrictions if that figure looked like it could rise above 50,000”.
https://inews.co.uk/news/boris-johnson- ... el-1170069
Well you're already on 110 deaths per day on average, and it's going up with the same doubling time as cases have been for the past 20 days or so. It's a slow doubling time of 50 days but an average 140 deaths per day will arrive on about the 10th of September once the numbers for the 13th have come in. So the week after that, ending Sunday the 19th, will be the first one with more than 1000 deaths.

That's only 3 weeks from now and those deaths are inevitable because they correspond to infections which happened this week. (I previously had 0.3% CFR, but it's more like 0.4% if you ignore that peak of cases caused by young people rediscovering nightclubs and football and try to line things up with how they're going now. So you want less than about 36,000 cases per day but the current 7-day average is 34,000.)
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Re: COVID-19

Post by shpalman » Wed Sep 08, 2021 12:59 pm

Regarding an "October firebreak"
The UK health secretary wrote:I don’t think that’s something we need to consider. It is true that no one knows the future pathway of this. I haven’t even thought about that as an option at this point.
Is that supposed to be reassuring?
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Re: COVID-19

Post by Herainestold » Wed Sep 08, 2021 10:53 pm

shpalman wrote:
Fri Sep 03, 2021 7:58 am
Woodchopper wrote:
Fri Sep 03, 2021 7:50 am
lpm wrote:
Fri Sep 03, 2021 7:37 am
Doesn't sound ethical? Extra people will have died in the experiment's control group.
As I understand it, it wouldn't be unethical if they only had enough masks for half the population in the study, and then distributed them randomly (and followed-up with monitoring). IMHO it would have been a ethical problem if they could have given masks to everyone but decided to restrict them form half the population.
https://www.poverty-action.org/sites/de ... 083121.pdf
All intervention arms received free masks, information on the importance of masking, role modeling by community leaders, and in-person reminders for 8 weeks. The control group did not receive any interventions.
They didn't prevent the control group from wearing masks just like they didn't force the intervention group to wear them. They just didn't give them free ones. They didn't even get some moron telling them that masks lead to a false sense of security or lead you to touch your face more or whatever.
The intervention increased proper mask-wearing from 13.3% in control villages (N=806,547 observations) to 42.3% in treatment villages (N=797,715 observations) (adjusted percentage point difference = 0.29 [0.27, 0.31]). This tripling of mask usage was sustained during the intervention period and two weeks after.
The proportion of individuals with COVID-like symptoms was 7.62% (N=13,273) in the intervention arm and 8.62% (N=13,893) in the control arm. Blood samples were collected from N=10,952 consenting, symptomatic individuals. Adjusting for baseline covariates, the intervention reduced symptomatic seroprevalence by 9.3% (adjusted prevalence ratio (aPR) = 0.91 [0.82, 1.00]; control prevalence 0.76%; treatment prevalence 0.68%). In villages randomized to surgical masks (n = 200), the relative reduction was 11.2% overall (aPR = 0.89 [0.78, 1.00]) and 34.7% among individuals 60+ (aPR = 0.65 [0.46, 0.85]). No adverse events were reported.
Some more commentary on Bangladeshi study.
The Study

The study randomized 600 villages to cloth masks, surgical masks, or usual care. More than 340,000 people were included. The primary endpoint was reporting symptoms consistent with COVID-19 followed by a positive serology test to document SARS-CoV-2 infection. The intervention included giving people a mask -- a surgical mask that could be washed and reused, or a cloth mask of high quality (3 layers) -- in addition to role-modeling by community leaders and mask promotion efforts. Readers of this column will know I am happy, as I have been pushing for such a cluster RCT since 2020.

The Results

The primary findings include:

Cloth masks had no advantage over the control arm (no intervention), but surgical masks showed a modest, statistically significant benefit
The surgical mask intervention reduced symptomatic seroprevalence by 11.2%; the endpoint -- COVID-19 symptoms followed by a positive COVID-19 test -- occurred in 0.76% of people in the control group compared to 0.67% for those assigned to surgical mask villages
All those selfies of people wearing fashionable cloth masks; all those videos and memes of how to make a mask from a sock or t-shirt -- those were all misguided! We spent massive political capital on the wrong mask. We pushed mask mandates and guidelines that mostly got Americans to wear any type of mask at all when certain types did not work in this study.

Had we done this study a year ago, we would have been able to provide important health guidance. We would have been able to distribute surgical masks to all Americans or, at a minimum, high-risk individuals. We could have discouraged bandanas, gaiters, and cloth masks, and focused on the mask that works: surgical masks. It isn't too late. The CDC should immediately update all their guidance, and click on find and replace: "cloth masks" to "surgical masks."
The second lesson of the study is that cluster randomization is possible, feasible, doable, and useful in a global pandemic. Knowing the right mask to use is a lamp-post in a sea of darkness. The Bangladesh study shows that even in a resource-poor setting, such trials are possible. Now imagine similar trials in key settings: U.S. schools, daycares, offices, and communities.
https://www.medpagetoday.com/opinion/vinay-prasad/94399
Vaccination saves lives. Lockdowns stop transmission.

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