COVID-19

[lpm]

Oh, and not just complex stuff like ventilators - there's not even basic stuff ready like PPE. How hard is it to build a hospital bed? f.cking easy, that's how hard.

[lpm]

https://twitter.com/hancocktom/status/1 ... 04032?s=09

Can this really be true? The models were based on viral pneumonia instead of Covid?

[lpm]

https://twitter.com/hancocktom/status/1 ... 04032?s=09

Can this FT claim really be true? The models were based on viral pneumonia instead of Covid?

[raven]

I’ve seen a plausible claim on twitter that the only actual powers he has for this kind of situation are in the civil contingencies act, but those are limited to 30 days so the government don’t want to use those yet. Parliament may have to grant government more powers.

Looks like Hancock will outline emergency legislation on Tuesday, followed by voting it through on Thursday:
https://www.bbc.co.uk/news/uk-politics-51916076

We clearly need an army of volunteers to help vulnerable people get groceries. It's perplexing the government hadn't thought of that before telling large groups of people to start social distancing. But people seem to be leaping into the leadership vacuum & co-ordinating volunteers themselves:
https://covidmutualaid.org/resources/

lpm is right. We need to chuck the rules out of the window and just do what needs doing. If airlines can't fly, make their creditors give them a payment holiday for the duration so they can just mothball everything for a few months and avoid bankruptcy. If ordinary people can't work & aren't getting paid, give them a mortgage/rent holiday for the duration too and make sure they have a basic income to buy food.

This is the kind of radical solution those wierdos and misfits should be coming up with, isn't it.

[EACLucifer]

I’ve seen a plausible claim on twitter that the only actual powers he has for this kind of situation are in the civil contingencies act, but those are limited to 30 days so the government don’t want to use those yet. Parliament may have to grant government more powers.

Looks like Hancock will outline emergency legislation on Tuesday, followed by voting it through on Thursday:
https://www.bbc.co.uk/news/uk-politics-51916076

We clearly need an army of volunteers to help vulnerable people get groceries. It's perplexing the government hadn't thought of that before telling large groups of people to start social distancing. But people seem to be leaping into the leadership vacuum & co-ordinating volunteers themselves:
https://covidmutualaid.org/resources/

lpm is right. We need to chuck the rules out of the window and just do what needs doing. If airlines can't fly, make their creditors give them a payment holiday for the duration so they can just mothball everything for a few months and avoid bankruptcy. If ordinary people can't work & aren't getting paid, give them a mortgage/rent holiday for the duration too and make sure they have a basic income to buy food.

This is the kind of radical solution those wierdos and misfits should be coming up with, isn't it.

Los Angeles is, I think, going with a moratorium on evictions.

We could do with that. Likewise, people need to access benefits instantly, and with no requirement to seek work.

One minor but perhaps important one I'd like to see is a suspension of MOT rules; if a vehicle wasn't SORNed and passed its last, let it stay on the road. For some people, it is the only way to travel safely, and some people will still need to travel. The test is *largely* arbitrary, and much of the risk of less reliable vehicles will be offset by lower traffic, and also we have to accept risks in other areas to mimise *overall* risk.

[Squeak]

A quick chat with my brother revealed some slightly grim but sensible planning in his hospital system. He's an ED doctor, expecting the exponential growth to turn nasty in the next couple of days. He won't see our aged parents for months*, will work until he gets sick, and then expects to work in a dirty clinic, along with all the other infected staff who are well enough to keep working and presumably will be treating COVID patients. I'm glad there's a systematic plan to keep medical staff working while still attempting to do some social distancing for them. His wife works in a genetics lab so I guess that she will be just a bit busy too.

Last night, they were playing Pandemic and managed to have four outbreaks in the first six turns. So, umm, I hope his real world pandemic work goes better.


*Unless they turn up in his emergency room

[Bird on a Fire]

Not sure the Government is living in the real world any more.

They're saying that if one person in any household has a persistent cough or fever, everyone living there must stay at home for 14 days, and that all of them should, if possible, avoid leaving the house "even to buy food or essentials".

Except that the country has gone so nuts that supermarket delivery slots are non existent, so how are these people going to get food and the like - especially given we've also been told not to stockpile. In large parts of the country, particularly in the South, people don't know their neighbours so it's not like you can just ask your neighbour next door to grab you some things from the supermarket.

CF

I’ve just delivered leaflets to 25 houses either side of ours on our street asking that we all try to work together to support one-another with help getting food or chatting things through.

I suggest you and others start doing the same.

It's been posted before but I'll post it again - if only so you get the notification, as the thread is moving fast.

This page seems have useful ideas, as well as links to existing groups.

https://covidmutualaid.org/ - the name is clearly a nod to Kropotkin, who I'm sure would approve.

If you don't know your neighbours, now is a good time to get to know them. It isn't only the government that needs to be thinking ahead and making contingency plans.

[Bird on a Fire]

Oh, and not just complex stuff like ventilators - there's not even basic stuff ready like PPE. How hard is it to build a hospital bed? f.cking easy, that's how hard.

I've always assumed that the difficulty with hospital beds isn't the bed per se, but the space and sterile equipment and staffing and all that gubbins? Otherwise yeah, just cable-tie a couple of pallets together and stick a mattress on top.

People can start making their own soap from cooking fat, distilling hand-sanitizer from whatever is leftover in now-vacant pubs, all sorts.

[Bird on a Fire]

Seen a claim on FaceBook that Johnson is only "advising" people not to go to pubs etc rater than ordering the venues to close because if he did the latter the venues could claim on their business insurance. While this fits in with my prejudices about Johnson, I've no clue how this kind of insurance actually works and hence whether there's any truth in the post. Anybody better informed?

It seems to be the case that business interruption insurance kicks in for a forced closure, but not for businesses that close voluntarily or are empty because nobody is actually daft enough to go to the pub in a pandemic.

Here's a take from the landlord of a pub I'm very fond of:

Given the new advice relayed by Boris Johnson at his press conference concerning COVID 19 this afternoon, the doors are open for now. (please do not visit if you are sick) We are currently stuck between a rock and a hard place. Morally we would love to close but financially, we can't. We already have advised all staff to wear gloves and wash their hands regularly behind the bar, we currently use single-use plastic disposable glasses and we now only accept card at the bar to prevent contamination from cash transactions.

Because of this government's lack of preparedness and refusal to actually enforce closures of pubs/clubs/music venues, as it stands we will not receive our business interruption insurance. As a direct result of that, this could be it for us. We cannot survive a multi-week to month(s) closure.

From https://www.crowdfunder.co.uk/railwayinn

I assume they've checked.

[Bird on a Fire]

For what its worth, blog post from me on this evenings updates, plus the new Imperial College London modelling paper (unsure if its upthread anywhere, if not already seen then there's lot of data to unpick and its clearly informed CMO policy)

https://medium.com/@michael.g.head/uk-c ... 6e146e4be3

Thanks for this.

That graph really brought this home. We're still off the left hand side of the x axis. It ends in August. Hooooly crap.

So, let's minimise the area under that curve!

[Woodchopper]

Tool up time is probably faster now than the kind of serial production we were doing then for armaments.

That said, the time lost is inexcusable. There is a lead time on production of any product; that could have been underway in January at very little cost if the products were not needed, and it was not.

The same things that worked then would work now, though. It's too late for the Shadow Factories approach, though it would have given us a head start, it isn't too late for some of the other tricks, namely distributed production of components with centralised assembly and testing, and also kicking all intellectual property issues into the long grass. Build now, a comission can work out who gets paid what later.

Yes, I agree. Lead time is probably shorter now - for example via 3d printing.

On the other hand, back in the 1930s the UK economy imported raw materials and then manufactured pretty much everything at home. The capacity to make the components needed already existed (given enough lead time for retooling etc).

Now that the UK is part of global supply chains the capacity to make certain components likely doesn't exist. Production capacity could be set up but probably not in weeks. Trade in goods hasn't been interrupted by very much yet. However if every country is bidding against each other for those components it gets more difficult.

[Woodchopper]

https://twitter.com/hancocktom/status/1 ... 04032?s=09

Can this really be true? The models were based on viral pneumonia instead of Covid?

Better link: https://twitter.com/hancocktom/status/1 ... 5586604032

[jimbob]

Good article in the Washington Post on South Korea and how it brought the epidemic under control without too draconian controls but proactive testing and early treatment.

https://www.washingtonpost.com/world/20 ... ly-failed/

[badger]

I've worked out the UK strategy. Confuse the bejesus out of everyone. Use language that has the widest possible number of interpretations. Make it impossible to know what we should be doing and how to prepare for it when we do it, or not do it.

What is non-essential? Why advise people not to go to my business but not ask me to close? Why is advisory guidance "Draconian"? My partner is about to go to work today as from the snippet of the clips she saw last night it doesn't change her employer's instruction yesterday to come to work today, even though the instruction was made before the press conference. My parent WhatsApp groups are awash with people trying to work it out, not least over whether to send in kids with health issues in (they're mainly not).

I don't know whether BoJo is badly advised or not listening to his advisors, but I think whatever plan they come up with next they need to stress test it for sense and think about how it actually applies to people's decisions in the real world. I was working til late yesterday but forced myself to watch the entire press conference in full and do some reading after (and lots of head shaking and scratching), and now I'm having to deal with lots of confused friends and family or some who understandably think it's business as usual.

I'm also exhausted, and am not even a frontline worker or have lost business or job. Sorry for the rant.

[veravista]

OK, serious question. How hard would it be to knock up a crude but serviceable ventilator? When I was at college we did this sort of thing for water pumps and the like that could be knocked up out of wood, piping and corrugated iron. I'm not talking an all singing and dancing machine that goes beep, but just enough to get by safely. In our village we have all sorts of practical people who have access to lathes, milling machines,3D printers and the like. Get a community design for one and small groups could make millions of them.

[OneOffDave]

What is going on now?

What does SAGE mean?

I'm not sure what Alexander Johnson is talking about.

Mass gatherings?

Over 70s?

Travel restrictions?

What is the government advice.

SAGE stands for Scientific Advice to Government in Emergencies. A group run by the Chief Scientist that looks at the best available scientific advice around a subject and can commission specific research. SAGE isn't a new thing it's been around for years.

All the current advice can always be found at Gov.uk Advice Two more bits of guidance went up overnight

[El Pollo Diablo]

https://twitter.com/hancocktom/status/1 ... 04032?s=09

Can this really be true? The models were based on viral pneumonia instead of Covid?

I notice they're now saying we're three weeks behind Italy. Presumably at some point "two weeks" will become the truth, which of course it was all along.

Also, Boris Johnson yesterday said that the doubling was every five days, which is utter sh.t - it's every 2.7 days. Why is he talking such bollocks?

[lpm]

OK, serious question. How hard would it be to knock up a crude but serviceable ventilator? When I was at college we did this sort of thing for water pumps and the like that could be knocked up out of wood, piping and corrugated iron. I'm not talking an all singing and dancing machine that goes beep, but just enough to get by safely. In our village we have all sorts of practical people who have access to lathes, milling machines,3D printers and the like. Get a community design for one and small groups could make millions of them.

OK, serious question. How hard would it be to knock up a crude but serviceable ventilator? When I was at college we did this sort of thing for water pumps and the like that could be knocked up out of wood, piping and corrugated iron. I'm not talking an all singing and dancing machine that goes beep, but just enough to get by safely. In our village we have all sorts of practical people who have access to lathes, milling machines,3D printers and the like. Get a community design for one and small groups could make millions of them.

kin
The proper ones are incredibly complex - always feeding back and adjusting with every breath. I think it sort of puts resistance in so the lungs have to keep working a bit, and this resistance must constantly change. They self-check themselves every second and give clear messages to nurses.

You could have grades A, B and C - but even C would need to be far beyond what you are talking about.

I wonder what happened to old ventilators when new and better versions came along. It would have been sensible to stockpile them, and have old 1990s versions lying around ready for a really bad flu season or a pandemic. No doubt the UK never had the foresight, but other countries?

[lpm]

OK, serious question. How hard would it be to knock up a crude but serviceable ventilator? When I was at college we did this sort of thing for water pumps and the like that could be knocked up out of wood, piping and corrugated iron. I'm not talking an all singing and dancing machine that goes beep, but just enough to get by safely. In our village we have all sorts of practical people who have access to lathes, milling machines,3D printers and the like. Get a community design for one and small groups could make millions of them.

OK, serious question. How hard would it be to knock up a crude but serviceable ventilator? When I was at college we did this sort of thing for water pumps and the like that could be knocked up out of wood, piping and corrugated iron. I'm not talking an all singing and dancing machine that goes beep, but just enough to get by safely. In our village we have all sorts of practical people who have access to lathes, milling machines,3D printers and the like. Get a community design for one and small groups could make millions of them.

The proper ones are incredibly complex - always feeding back and adjusting with every breath. I think it sort of puts resistance in so the lungs have to keep working a bit, and this resistance must constantly change. They self-check themselves every second and give clear messages to nurses.

You could have grades A, B and C - but even C would need to be far beyond what you are talking about.

I wonder what happened to old ventilators when new and better versions came along. It would have been sensible to stockpile them, and have old 1990s versions lying around ready for a really bad flu season or a pandemic. No doubt the UK never had the foresight, but other countries?

[lpm]

DP

[mikeh]

https://twitter.com/hancocktom/status/1 ... 04032?s=09

Can this really be true? The models were based on viral pneumonia instead of Covid?

Better link: https://twitter.com/hancocktom/status/1 ... 5586604032

To clarify, COVID causes viral pneumonia (lower respiratory tract infections, essentially).

Flu is typically upper respiratory tract, as is the common cold (for example caused by a different type of coronavirus). If flu or the common cold virus (much more rarely, of course), invades the lower respiratory tract that is then typically described as a pneumonia.

I'm slightly baffled by the widespread assumptions that modelling different kinds of viral pneumonia, when we're talking about a cause of viral pneumonia, is wrong.
Elsewhere, you can for example have a look at the Every Breath Counts Coalition, which covered advocacy around coronavirus in the recent conference https://stoppneumonia.org/open-letter-t ... -covid-19/

Neil Ferguson, he of the Imperial modelling, gave an interview on (I think) the Today programme. I've been sent a transcript of the interview, am asking permission if I can share it. (But for now, I don't reckon his responses really don't equate to "we modelled the wrong disease"....)

[lpm]

OK, that makes sense.

[OneOffDave]

OK, serious question. How hard would it be to knock up a crude but serviceable ventilator? When I was at college we did this sort of thing for water pumps and the like that could be knocked up out of wood, piping and corrugated iron. I'm not talking an all singing and dancing machine that goes beep, but just enough to get by safely. In our village we have all sorts of practical people who have access to lathes, milling machines,3D printers and the like. Get a community design for one and small groups could make millions of them.

I would have thought a gas-powered design like the Pneupac would be fairly straightforward as it's all mechanical rather than electronic. I would have thought a lot of the valves and gauges cold be sourced from stock items.

The trickier bit would be ensuring enough stocks of the consumables like tubing and the other stuff that comes into contact with the patient

[mikeh]

The proper ones are incredibly complex - always feeding back and adjusting with every breath. I think it sort of puts resistance in so the lungs have to keep working a bit, and this resistance must constantly change. They self-check themselves every second and give clear messages to nurses.

You could have grades A, B and C - but even C would need to be far beyond what you are talking about.

I wonder what happened to old ventilators when new and better versions came along. It would have been sensible to stockpile them, and have old 1990s versions lying around ready for a really bad flu season or a pandemic. No doubt the UK never had the foresight, but other countries?

When the dust has settled, I'd really like to see the old fashioned idea of a health service with spare capacity. Beds lying empty 99% of the time? Super stuff!

I wonder about equipment like ventilators. How long can they sit in a cupboard before they become out of date/much less useful for whatever reason (e.g. not compatible with the new whizzy machine that goes bing that came in ten years later)?

(Though OOD's post just above at least partially answers that)

Something else I've been wondering - after swine flu 2009, UK funded about 12 studies to reactivate during the next pandemic, whenever that be. They were funded, ethically approved, institutional support guaranteed etc (So all the time-consuming admin needed to set up a study in normal circumstances already navigated).
I am unsure if it was specifically focused on 'flu pandemic', one would hope current scenarios would be close enough to the definitions of their original T&Cs.
I haven't obviously seen them being activated and ongoing (though they may be). if I recall correctly, there was a time frame the contracts were valid for. Genuinely can't remember how long. If it was 10 years...

[Little waster]

Crucially, we will not import health resources (we cannot import ICU nurses and presumably no country will be mad enough to sell us their ventilators). We have local resources to exploit instead. So many that we can rotate people in and out if they get sick. We have unemployed people who can design, manufacture and deliver materiel to front line troops, and to build hundreds of Treatment Centres, and act as support staff.

In WW2 it took 8 months to train a fighter pilot, it is a 22 week course to train an army medic. A huge well educated country can do pretty much anything if that is its only focus.

This is not as hard a task as it looks. In 6 months there could be a bed and nurse for every patient and many multiples of current ICU beds. Governments are able to ignore money. All it needs is to list your resource priorities, list your unused resources, and start redirecting.

One thing I've been wondering - we should soon have tests for serum antibodies to check who for sure has recovered from the virus. While there's an unclear risk of reinfection, the expanding immune population are a high value resource, and it would be good to think what roles they could be used for.

Faced with a potential shutdown of our main business yesterday my boss half-seriously decided to research the potential of importing COVID-19 antibody kits as an alternative revenue stream.

He is Chinese originally so was able to navigate the chinese-internet and reckons he's found a Chinese supplier of a home blood kit which detects IgG and IgM within 15 minutes, a box of 20 is £6.

He hasn't gone ahead with it yet and that has to come with a metric f.ck-tonne of caveats but even if that particular supplier is shipping boxes of lolly-pop sticks dyed green there must be other legitimate ones doing the same. A quick google search brings up a number of US companies shipping similar sounding kits. Or as above we could always make our own in the UK.

That has to beat the precautionary self-isolation for a fortnight everyone and their family who wakes up with a sore throat.