COVID-19

[lpm]

COronaVIrus Disease - but it's like Nasa, when said as a word instead of initials it's Covid. You are completely and utterly wrong.

[lpm]

Dorries provides a useful illustration.

Infected: unknown. Infectious: unkown. First symptoms: Friday. Official case: Tuesday.

I hope this makes politicians realise their daily dashboard of cases is days behind reality. Like a star, what we see isn't today's activity.

If the lag is about 8 days then that's in the region of two doublings.

Given the turn around for testing I suspect she was recorded as an official case before today. Rather than "official case", the phrase you are looking for is "public case".

In outbreaks there is always a delay while figures are compiled and quality assured. This delay is usually in things being publicly announced. the officials see the raw figures with that caveat that there may be small fluctuations as a result of QA and elimination of duplicates.

OK, but the BBC and others are massively misleading. The whole thing is always presented as "the number of cases today rose by 48 to 380" - when it's not today at all. It's approximately a week ago.

The public aren't prepared because they are being misled. And I bet politicians are also viewing it through this bias, even if they know about the lag.

Also, I would have expected Johnson to have gone Churchillian. Surely he'd love to do a special broadcast from Number 10? The TV schedules cleared, a Dimbleby or two announcing "We now go live to the Prime Minister in Downing Street", Johnson as statesman presenting his own statement that will be part of history.

That's what we need. I think Johnson is scared and confused.

[OneOffDave]

OK, but the BBC and others are massively misleading. The whole thing is always presented as "the number of cases today rose by 48 to 380" - when it's not today at all. It's approximately a week ago.

The BBC and other news outlets announce the official announcement and report it as that. They don't state that that is the total numbers of all cases.

All outbreaks are dealt with the same way so there's consistency in the approach. No matter what the disease. Tho people who actually need to understand this to provide appropriate advice do understand that there is always a margin of pseudo-cases in a population. PHE deals with over 10,000 outbreaks of infectious disease a year, every year. Some of these are diseases with a much much higher case fatality rate than COVID-19.

Also a case isn't a case until it's diagnosed. Someone has an RTI but until diagnosis is could be any number of things. Flu A and B are still circulating in the community along with other assorted RTIs. Should we lump them in with the COVID-19 figures until testing comes back and excludes them? The lag is consistent generally across diseases so fudging the figures to account for cases in potentia doesn't help the response to the outbreak at all.

The balance is when to jump to more severe measures and it's a tricky one. If your measures do more damage to the economy than the outbreak then you've failed as a government. long term lock down has significant health impacts and may cause premature deaths. If we are looking at locking down from now to a predicted peak than we might be looking at 8-12 weeks. That's incredibly hard to sustain.

[lpm]

Why is the government keep repeating "the start of the UK peak"? WTF does that mean? It's bit like saying Wastwater is the start of the peak of Scafell Pike. A peak is a peak. A slope is a slope.

This was a terrible, terrible blunder in communications. The phrase used by was that the start of the UK peak would be in two weeks, The following places are reporting it as "virus peak expected in two weeks":

ITV
Telegraph
Express
Metro

and probably others.

And presumably the error will spread via Facebook.

[lpm]

The balance is when to jump to more severe measures and it's a tricky one. If your measures do more damage to the economy than the outbreak then you've failed as a government. long term lock down has significant health impacts and may cause premature deaths. If we are looking at locking down from now to a predicted peak than we might be looking at 8-12 weeks. That's incredibly hard to sustain.

That's presenting it as binary, all or nothing.

This is like climate change: do nothing for ages means massively costly intervention later. Do half-measures now and at least the later emergency measures won't be so hard.

So why not do a mixture right now? E.g.

Cancel all festivals and conferences, but keep restaurants open
Cancel normal church services but continue funerals and weddings
Ask people to work from home if they can, but keep offices open
Premier League matches behind closed doors but lower league fixtures unchanged
Close university lecture rooms and common rooms, but keep the library open

[badger]

Rory Stewart has gone public today saying the government isn't doing enough, BoJo is scared, shutdown now etc. It seems his position is based mainly on reading this

https://medium.com/@tomaspueyo/coronavi ... d3d9cd99ca

Which he has tweeted.

He's being accused of scaremongering and breaking with government convention. I suspect we shall see more of this.

[OneOffDave]

The balance is when to jump to more severe measures and it's a tricky one. If your measures do more damage to the economy than the outbreak then you've failed as a government. long term lock down has significant health impacts and may cause premature deaths. If we are looking at locking down from now to a predicted peak than we might be looking at 8-12 weeks. That's incredibly hard to sustain.

That's presenting it as binary, all or nothing.

This is like climate change: do nothing for ages means massively costly intervention later. Do half-measures now and at least the later emergency measures won't be so hard.

So why not do a mixture right now? E.g.

Cancel all festivals and conferences, but keep restaurants open
Cancel normal church services but continue funerals and weddings
Ask people to work from home if they can, but keep offices open
Premier League matches behind closed doors but lower league fixtures unchanged
Close university lecture rooms and common rooms, but keep the library open

Good luck framing a regulatory order to do that. a lot of organisations won't close until told to as they would have to bear the cost burden themselves. With a regulatory structure in place making it compulsory, insurance is more likely to pay out as you have to close rather than it being a choice. I'd say weddings are much higher risk than ordinary services as they involve a wider range of people from a more geographically dispersed area.There's also a much higher likelihood of close contact too.

Of course, the FA could do that now if it wanted to. there's nothing stopping it. So could universities, employers etc.

[Little waster]

I'm still getting emails from airlines suggesting I treat myself to a little trip... perhaps their marketing departments should turn that sh.t off for now.

I'm currently sat in a telephonic queue for BA to change my flights, the hold music alternates between updates about COVID-19, apologies about the high volume of calls COVID-19 has generated ... and exhortations to consider taking a city break with BA presumably to take your mind off COVID-19.

[TopBadger]

I'm still getting emails from airlines suggesting I treat myself to a little trip... perhaps their marketing departments should turn that sh.t off for now.

I'm currently sat in a telephonic queue for BA to change my flights, the hold music alternates between updates about COVID-19, apologies about the high volume of calls COVID-19 has generated ... and exhortations to consider taking a city break with BA presumably to take your mind off COVID-19.

To Rome, Milan, Firenze?

[Vertigowooyay]

Unsurprisingly, the conference in Lille I was meant to attend has been cancelled (a couple of days after we decided not to go anyway.)

Shame, I was looking forward to a nice Tartiflette. Loads of Lille restaurants serve it...

[TopBadger]

Loads of Lille restaurants serve it...

Why don't the big ones serve it?*

*Sorry - couldn't resist

[lpm]

The balance is when to jump to more severe measures and it's a tricky one. If your measures do more damage to the economy than the outbreak then you've failed as a government. long term lock down has significant health impacts and may cause premature deaths. If we are looking at locking down from now to a predicted peak than we might be looking at 8-12 weeks. That's incredibly hard to sustain.

That's presenting it as binary, all or nothing.

This is like climate change: do nothing for ages means massively costly intervention later. Do half-measures now and at least the later emergency measures won't be so hard.

So why not do a mixture right now? E.g.

Cancel all festivals and conferences, but keep restaurants open
Cancel normal church services but continue funerals and weddings
Ask people to work from home if they can, but keep offices open
Premier League matches behind closed doors but lower league fixtures unchanged
Close university lecture rooms and common rooms, but keep the library open

Good luck framing a regulatory order to do that. a lot of organisations won't close until told to as they would have to bear the cost burden themselves. With a regulatory structure in place making it compulsory, insurance is more likely to pay out as you have to close rather than it being a choice. I'd say weddings are much higher risk than ordinary services as they involve a wider range of people from a more geographically dispersed area.There's also a much higher likelihood of close contact too.

Of course, the FA could do that now if it wanted to. there's nothing stopping it. So could universities, employers etc.

Oh come on, when elderly people are dying on trolleys, Johnson will say "It was hard to frame a regulatory order and we were concerned about insurance and it was all very tricky"???

When things are messy, the best thing to do is to accept it will be a mess. Do not:

- aim for perfect
- try to be efficient
- try to be fair

and instead just aim to be partially effective.

[Brightonian]

The balance is when to jump to more severe measures and it's a tricky one. If your measures do more damage to the economy than the outbreak then you've failed as a government. long term lock down has significant health impacts and may cause premature deaths. If we are looking at locking down from now to a predicted peak than we might be looking at 8-12 weeks. That's incredibly hard to sustain.

That's presenting it as binary, all or nothing.

This is like climate change: do nothing for ages means massively costly intervention later. Do half-measures now and at least the later emergency measures won't be so hard.

So why not do a mixture right now? E.g.

Cancel all festivals and conferences, but keep restaurants open
Cancel normal church services but continue funerals and weddings
Ask people to work from home if they can, but keep offices open
Premier League matches behind closed doors but lower league fixtures unchanged
Close university lecture rooms and common rooms, but keep the library open

If Premier League matches are behind closed doors then people will watch them in pubs, so just cancel them.

[Brightonian]

Duplicate.

[El Pollo Diablo]

The balance is when to jump to more severe measures and it's a tricky one. If your measures do more damage to the economy than the outbreak then you've failed as a government. long term lock down has significant health impacts and may cause premature deaths. If we are looking at locking down from now to a predicted peak than we might be looking at 8-12 weeks. That's incredibly hard to sustain.

That's presenting it as binary, all or nothing.

This is like climate change: do nothing for ages means massively costly intervention later. Do half-measures now and at least the later emergency measures won't be so hard.

So why not do a mixture right now? E.g.

Cancel all festivals and conferences, but keep restaurants open
Cancel normal church services but continue funerals and weddings
Ask people to work from home if they can, but keep offices open
Premier League matches behind closed doors but lower league fixtures unchanged
Close university lecture rooms and common rooms, but keep the library open

If Premier League matches are behind closed doors then people will watch them in pubs, so just cancel them.

Best just to cancel the season, and accept that no one wins the trophy this year.

[Vertigowooyay]

Loads of Lille restaurants serve it...

Why don't the big ones serve it?*

*Sorry - couldn't resist

I’ll set ‘em up, you knock ‘em down.

[Gentleman Jim]

If Premier League matches are behind closed doors then people will watch them in pubs, so just cancel them.

Plenty of alcohol for hand rubs though*


*yes, yes. Wrong strength

[Little waster]

That's presenting it as binary, all or nothing.

This is like climate change: do nothing for ages means massively costly intervention later. Do half-measures now and at least the later emergency measures won't be so hard.

So why not do a mixture right now? E.g.

Cancel all festivals and conferences, but keep restaurants open
Cancel normal church services but continue funerals and weddings
Ask people to work from home if they can, but keep offices open
Premier League matches behind closed doors but lower league fixtures unchanged
Close university lecture rooms and common rooms, but keep the library open

If Premier League matches are behind closed doors then people will watch them in pubs, so just cancel them.

Best just to cancel the season, and accept that no one wins the trophy this year.

This sounds an equitable solution, I can't see anybody significantly disagreeing with it.

We can then just start a brand new season from scratch in the Summer.

[lpm]

If Premier League matches are behind closed doors then people will watch them in pubs, so just cancel them.

No they won't. What evidence is there that there will be an increase in people watching in pubs?

People aren't units following routine, they are informed decision makers. Almost certainly, people will choose to not go to crowded pubs once the government gives a clear statement of what is happening.

All evidence suggests that in emergencies, a well-informed public does not panic and makes reasonable decisions.

[Bird on a Fire]

The balance is when to jump to more severe measures and it's a tricky one. If your measures do more damage to the economy than the outbreak then you've failed as a government. long term lock down has significant health impacts and may cause premature deaths. If we are looking at locking down from now to a predicted peak than we might be looking at 8-12 weeks. That's incredibly hard to sustain.

That's presenting it as binary, all or nothing.

This is like climate change: do nothing for ages means massively costly intervention later. Do half-measures now and at least the later emergency measures won't be so hard.

So why not do a mixture right now? E.g.

Cancel all festivals and conferences, but keep restaurants open
Cancel normal church services but continue funerals and weddings
Ask people to work from home if they can, but keep offices open
Premier League matches behind closed doors but lower league fixtures unchanged
Close university lecture rooms and common rooms, but keep the library open

If Premier League matches are behind closed doors then people will watch them in pubs, so just cancel them.

They will, but they won't travel hundreds of miles to watch them in pubs, which is the risk with the big league. People in pubs are going to be the same locals who are in the streets and the shops and popping round to your house and whatever - probably still an increase in risk of transmission, but not to such an extent.

People aren't going to voluntarily self-isolate 100% anyway for long periods of time. The options are to close all public spaces (in which case they'll go to each others houses), enforce a strict curfew (with fines presumably, as there's not enough space to isolate everyone in prison) or to accept imperfection and try to channel people into safer decisions.

[badger]

Quick q for the med experts.

Is there much bed (and staffing) capacity in private hospitals that could be sequestered in the next few weeks as/when NHS becomes overloaded?

Assuming we could force/induce/beg them to postpone non-essential operations?

Sorry if this has been done elsewhere.

[OneOffDave]

Oh come on, when elderly people are dying on trolleys, Johnson will say "It was hard to frame a regulatory order and we were concerned about insurance and it was all very tricky"???

When things are messy, the best thing to do is to accept it will be a mess. Do not:

- aim for perfect
- try to be efficient
- try to be fair

and instead just aim to be partially effective.

I never said the government were concerned about insurance but individual organisations are so let's kill that canard first

You appear to have a very poor grasp of how government and the production of legislation works. It's not some cluster of words thrown together haphazardly as it all has impacts in the real world.

Given your exhortation to not try to be fair then delaying is the best option. It harms the vulnerable but lessens the impact on the wider population. Or do we kill a tier of businesses to save a slack handful of lives? Pushing people into poverty/homelessness also kills people but in a more subtle longer term way.

The regulations also have to be legal. The really tricky bit. The only way round this would be to invoke emergency powers which would be 'interesting'.

[Gfamily]

Quick q for the med experts.

Is there much bed (and staffing) capacity in private hospitals that could be sequestered in the next few weeks as/when NHS becomes overloaded?

Assuming we could force/induce/beg them to postpone non-essential operations?

Sorry if this has been done elsewhere.

Not a med expert...
I don't know how much 'bed care' is an issue, Covid-19 patients who need hospital care are in hospital because they need ITU care, and I'm not sure if private hospitals have enough ITU beds to make a significant difference. AIUI, they would not expect their patients to be significantly dependent on ITU care.

[OneOffDave]

Quick q for the med experts.

Is there much bed (and staffing) capacity in private hospitals that could be sequestered in the next few weeks as/when NHS becomes overloaded?

Assuming we could force/induce/beg them to postpone non-essential operations?

Sorry if this has been done elsewhere.

As I understand it, they could be compelled with new regulations. In reality, a lot of them depend on the NHS for things like CSSD or laundry supplies so a pressed NHS would prioritise itself first effectively preventing them from operating. They'd probably co-operate willingly as it's in their interests to do so and the relationships at a local level are usually pretty good. The big issue would be if they had the right type and number of staff. There's almost no ventilated bed capacity in the private sector.

[badger]

Quick q for the med experts.

Is there much bed (and staffing) capacity in private hospitals that could be sequestered in the next few weeks as/when NHS becomes overloaded?

Assuming we could force/induce/beg them to postpone non-essential operations?

Sorry if this has been done elsewhere.

Not a med expert...
I don't know how much 'bed care' is an issue, Covid-19 patients who need hospital care are in hospital because they need ITU care, and I'm not sure if private hospitals have enough ITU beds to make a significant difference. AIUI, they would not expect their patients to be significantly dependent on ITU care.

Sure - and thanks OneoffDave too - that makes sense. I'm just wondering if/when we get to the stage where there's more people who need ITU care than beds, what happens. Seems like people still need *some" kind of bed, even if not intubated etc.

Also, as other departments take a hit to staff numbers, what capacity there might be elsewhere (eg delivery suites and Maternity wards) and how we go about using them.