COVID-19

[shpalman]

This morning I tried setting up a SEIQR model in a spreadsheet. (Susceptible - Exposed - Infectious - Quarantined - Recovered, in which I'm assuming a certain probability of an infection getting detected and quarantined, alternatively it could recover without being detected).

I've realized a thing: if the number of new infections per day is going down, it does not mean that the reproduction number has dropped below 1 and that the infections are tending to zero. It just means you reduced the contagion parameter β. If the number of infectious people (I) is climbing anyway, then once the product βI reaches the value it had before, you'll get the same infection rate you had before. This seems to have happened a few times in Italy already: "yay it's going down no wait it's gone up again".

This will carry on until a substantial fraction of the susceptible population has been infected. Or you really do manage to get the reproduction number to below 1. But if it's not below 1 now in Italy I struggle to think of what more can be done.

It looks like mortality is declining now in Italy, Spain, Belgium, Austria. So it looks like the lockdown measures implemented there about 3-4 weeks ago are having an effect. So either the lockdowns have got R to below 1 on average at a national level, or at least the lockdowns have protected the most vulnerable members of society.

Well I hope so. It's anyway the case that there are now fewer covid cases in hospital, both in non-intensive and intensive care. Yay, the recovery rate is currently faster than the infection rate was one incubation time period ago. Boo, the death rate isn't much less than the recovery rate. But yay, it frees up beds. Hmmm.

(Recovery tends to take longer than death, this is why the figures for survival of ICU admissions look so bad now but will improve over the next few weeks.)

[Squeak]

Cautiously, Australia just might be managing this ok, so far, touch wood, and all similar invocations of hope.

A couple of weeks ago, we were doubling cases every three-and-a-bit days. Now it's ten days. Our testing rates are on par with Germany and Italy but only 2.1% of tests are coming back positive so we're not just testing the obvious cases but we're probably picking up most of what's out there. That we've stopped the exponential growth in new cases and they or mortality rate seems to be around 0.2% add more support to the idea that there aren't large pockets of mild but infectious disease that our testing systems are missing.

Some of this is dumb luck of geography that gave us some time to slowly organise a social/political response and sprawling cities that make social distancing easier. But maybe, just maybe, if we keep doing what we're doing, we can keep this bubbling at manageable levels until we get a vaccine.

Have I added enough caveats yet? Obvs new data tomorrow night undermine all of this or Easter beach holidays might screw it up, even if the current trends is right.

[Woodchopper]

Thread about the situation in New York: https://twitter.com/MarkLevineNYC/statu ... 41696?s=20

f.cking hell.

Bodies to be temporarily buried in parks. Death rate is underestimated as circa 200 people a day are dying at home and there is no capacity to test them.

[shpalman]

I put reasons why the UK actually does look like Italy if you look properly in the police state thread but I feel like it's more relevant to continue with it here:

The number of confirmed cases is not the same as the number of actual cases. It depends on how many infected people are detected.

The epidemics in both countries may be growing at a similar rate now, but early on the UK had more diagnosed cases than Italy. Italian numbers shot up on 23 February, leading scientists to think there was a period when the virus was spreading without being detected.

That gave less room for measures like tracing contacts of those who had fallen ill and isolating cases to slow the spread.

How did it go with the contact tracing in the UK, then?

https://www.theguardian.com/uk-news/202 ... xperts-say

By the time that BBC article had been published, the UK had already stopped bothering with it, and Italy was on a normal exponential curve which had already demonstrated a slowdown due to the first containment measures. Every bored moron with a spreadsheet could see the UK exactly two weeks behind Italy.

Professor of international public health Jimmy Whitworth says that put the health system "behind the curve" in controlling the epidemic.

Researchers also warn that the Italy virus testing system has become overwhelmed and is not keeping up with new cases. This means Italy's figures could be falling further behind the total number of actual cases.

How's the UK's totally not overwhelmed virus testing system getting on?

Health experts 'frustrated' by low UK virus testing

Italy carried out 30000 tests yesterday and was already on about 12000 per day when that reasons why the UK will be just as f.cked as Italy if not actually more so article was published. Two weeks ago numbers were sometimes already about 25000 per day, which is the target I'm assuming that the UK hasn't been able to reach in the past 4 days.

The UK has a similarly terrible CFR to that in Italy, so if Italy is only picking up the cases serious enough to need the hospital then so is the UK; Italy may have an aging population but the UK has a spectacularly unhealthy one.

[lpm]

But the UK has had 3 days of very low deaths. Maybe dying in homes or a weekend effect? Still, currently on track for a better outcome than we feared.

[headshot]

Johnson has been moved to intensive care.

[Stranger Mouse]

The Doctor Drew supercut has been restored

Let the Streisand Effect commencr

https://arstechnica.com/tech-policy/202 ... -takedown/

[Stranger Mouse]

And a bit of light relief as Randy Rainbow does Andrew Cuomo

Brilliant

https://twitter.com/randyrainbow/status ... 85473?s=21

[discovolante]

J K Rowling has tweeted a link to this video with advice about preventing respiratory difficulties if you get infected: https://youtu.be/HwLzAdriec0 it's a breathing technique. What do you reckon? I've saved the vid for now anyway.

[raven]

But the UK has had 3 days of very low deaths. Maybe dying in homes or a weekend effect? Still, currently on track for a better outcome than we feared.

Who knows. I'm a bit worried that this is true - https://www.theguardian.com/world/2020/ ... p-too-late

The initial advice to stay home and not phone 111 unless you got worse wasn't totally clear to some people, who thought they were to stay home full stop, no help coming type of deal. And there'll be people who just don't want to go near a hospital right now, so I can believe people are waiting too long. If only we were doing what Heidelberg was - student doctors calling people at home to check up on them and sending the 'corona taxi' round if they sound worse...

Here, your GP might not even realise you're got it which seems stupid. We've got a ready-made network of local doctors who could be advising/checking up on cases by phone, surely. Why not use them?

I'm also a bit worried by the reports of China locking down another area & what that means for our chances of a second peak. https://www.reuters.com/article/us-heal ... SKBN21J64X

Only 600,000 people this time, seemingly triggered by one case in contact with two doctors who later tested positive. Which is impressively aggressive quarantining, I guess.

[sTeamTraen]

What would the effect on observance of the not-really-a-lockdown be if the Prime Minister's outcome was to demonstrate the vulnerability of the highest in the land to the virus? Would it change anything?

[Martin_B]

Should this bad graph be here?

Argh - that Y axis! Why did you post that... why!?

It's certainly an interesting y-axis. How does anyone manage to put those numbers on a y-axis? It surely must be more difficult to construct a graph that badly than simply making one in Excel* and pasting it into the screen graphics.

(* other spreadsheet packages are available)

[Bewildered]

Cautiously, Australia just might be managing this ok, so far, touch wood, and all similar invocations of hope.

A couple of weeks ago, we were doubling cases every three-and-a-bit days. Now it's ten days. Our testing rates are on par with Germany and Italy but only 2.1% of tests are coming back positive so we're not just testing the obvious cases but we're probably picking up most of what's out there. That we've stopped the exponential growth in new cases and they or mortality rate seems to be around 0.2% add more support to the idea that there aren't large pockets of mild but infectious disease that our testing systems are missing.

Some of this is dumb luck of geography that gave us some time to slowly organise a social/political response and sprawling cities that make social distancing easier. But maybe, just maybe, if we keep doing what we're doing, we can keep this bubbling at manageable levels until we get a vaccine.

Have I added enough caveats yet? Obvs new data tomorrow night undermine all of this or Easter beach holidays might screw it up, even if the current trends is right.

Yes I am cautiously optimistic. I have been worried that underneath the original exponentially growing infections directly related to people arriving here, which we seem to have got under control, there is internal community infections that slipped through the net. My fear was while that would have to start small to be underneath the main trend in deaths it could suddenly show up given the two or so week lag. However they are loosening testing criteria and numbers are still going down, so hope my concerns were unwarranted.

[Bewildered]

Sorry to spoil the tone with a YouTube video, but I have been worried for a while what is going to happen in poorer countries if rich countries with far less overcrowding and higher resources for health care are in so much trouble. Then I watched this Channel 4 on Bangladesh (which looking at worldometer data seems to just be at the start of the outbreak) and I find it really frightening:

https://www.youtube.com/watch?v=zeZyRVk_3D4

[Woodchopper]

What would the effect on observance of the not-really-a-lockdown be if the Prime Minister's outcome was to demonstrate the vulnerability of the highest in the land to the virus? Would it change anything?

Some of the tories on my social media feeds have stopped stating that’s it’s all media hysteria and Covid is no worse than flu.

[bmforre]

Some of the tories on my social media feeds have stopped stating that’s it’s all media hysteria and Covid is no worse than flu.

Don't they any longer trust Trump, Bolsonaro and Even Higher powers?

[Woodchopper]

Some of the tories on my social media feeds have stopped stating that’s it’s all media hysteria and Covid is no worse than flu.

Don't they any longer trust Trump, Bolsonaro and Even Higher powers?

They don't like Trump, are only vaguely aware of the existence of Bolsonaro and think that religion is for idiots.

[Woodchopper]

But the UK has had 3 days of very low deaths. Maybe dying in homes or a weekend effect? Still, currently on track for a better outcome than we feared.

Well lower, in any other context it would be bad. Its actually two days in a row of markedly lower mortality (5 and 6 April), and one day of lower confirmed cases. I think its too early to declare a trend, but if mortality continues to decline for another few more days then we can start to be hopeful.

[bob sterman]

But the UK has had 3 days of very low deaths. Maybe dying in homes or a weekend effect? Still, currently on track for a better outcome than we feared.

Who knows. I'm a bit worried that this is true - https://www.theguardian.com/world/2020/ ... p-too-late

The initial advice to stay home and not phone 111 unless you got worse wasn't totally clear to some people, who thought they were to stay home full stop, no help coming type of deal. And there'll be people who just don't want to go near a hospital right now, so I can believe people are waiting too long.

The shift in behaviour by both patients and doctors has been huge. Previously people with respiratory problems that were almost universally self-limiting would flock to GP surgeries and even A&E departments. Moreover, GPs would call in patients for appointments to discuss risk factors (e.g. lifestyle, cholesterol) that raise someone's risk of cardiovascular disease a bit over the next 10 years (e.g. from 6% to 9%).

Now we have people, with an acute condition that perhaps has a 3-5% chance of killing them within a couple of weeks - and is likely to infect the rest of their household - who are following advice to stay home and not even call 111 in the first instance!

In China they took mildly symptomatic cases out of their homes, and put them into isolation facilities (not full hospitals) for monitoring and to prevent household transmission.

[tom p]

Cloth masks seem a very sensible way to get some degree of mass mask wearing without drawing on stocks of PPE needed by healthcare and other key workers. Yes, the government should have prepared, given the warning they had, but they didn't - as citizens, we can complain, or we can complain and also fix the f.cking problem.

I've started work on trying to make masks for everyone on my street. The test example I ran up first seems to work fine, and is comfortable enough. It's based on a design requested by a health provider in the States, although with the elastic patterned after a painter's mask instead, for greater comfort.

Unfortunately, I - unrelatedly - hurt my hip badly enough to leave me stuck in bed, but once I'm back to work, would people here be interested in an illustrated guide to making them?

That's a very kind thing you're doing.
Get well soon.

My sister is some senior bod in a fashion house (a proper one that does catwalk shows at the fashion weeks and charges thousands for dresses) & she has put all their seamstresses to work making masks which are more comfortable than standard ones so that people who need to wear them for long periods (not cos they have a specific PPE need, but as a precaution, so just a face covering is helpful, even if imperfect), won't get that pressure mark around their ears. They are using buttons and material that can be washed easily.
They have perfected their design and are now bashing out loads of them.

[FlammableFlower]

That's a bl..dy good thing, tomp.

My institutions mech eng dept has started churning out 1,400 face visors a day from their facilities.

The science depts donated all their stocks of gloves, goggles & safety glasses and made an awful lot of WHO recipe sanitiser (we had several hundred litres of ethanol and IPA).

[Stranger Mouse]

Laura Ingraham having coronavirus meetings in the White House

https://www.washingtonpost.com/politics ... story.html

[raven]

Well lower, in any other context it would be bad. Its actually two days in a row of markedly lower mortality (5 and 6 April), and one day of lower confirmed cases. I think its too early to declare a trend, but if mortality continues to decline for another few more days then we can start to be hopeful.

I'm dubious. If weekend deaths aren't getting added until mid-week, if we're missing a bunch of community deaths... Actually, why is it the deaths aren't back-dated to the date they occured? Wouldn't that help the people monitoring this get a more accurate picture of what's happening?

In China they took mildly symptomatic cases out of their homes, and put them into isolation facilities (not full hospitals) for monitoring and to prevent household transmission.

Yes, that's the bit our strategy is missing. And, having got Johnson's letter this morning, complete with a diagram explaining how long a 4-person household should isolate as one after another get it.... I mean, it shows person no.3, who's symptomless, out of isolation while person no.4 is symptomatic. Surely that's not great?

[jimbob]

Well lower, in any other context it would be bad. Its actually two days in a row of markedly lower mortality (5 and 6 April), and one day of lower confirmed cases. I think its too early to declare a trend, but if mortality continues to decline for another few more days then we can start to be hopeful.

I'm dubious. If weekend deaths aren't getting added until mid-week, if we're missing a bunch of community deaths... Actually, why is it the deaths aren't back-dated to the date they occured? Wouldn't that help the people monitoring this get a more accurate picture of what's happening?

In China they took mildly symptomatic cases out of their homes, and put them into isolation facilities (not full hospitals) for monitoring and to prevent household transmission.

Yes, that's the bit our strategy is missing. And, having got Johnson's letter this morning, complete with a diagram explaining how long a 4-person household should isolate as one after another get it.... I mean, it shows person no.3, who's symptomless, out of isolation while person no.4 is symptomatic. Surely that's not great?

Your last paragraph.

That's where I went, "Wut?"

[raven]

Page 5 of this leaflet here : https://assets.publishing.service.gov.u ... eaflet.pdf

(Sorry. There's probably a way of posting that, but I don't know how.)

It just seems to me that everyone in a household should be quarantined until they're all over it or we can be reasonably sure they're not going to get it. I mean, yeah, people who've recovered may be immune and thus unable to spread it. But that person C hasn't had it. Unless we're assuming they're one of those asymptomatic cases.