COVID-19

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

Post by OffTheRock » Tue Oct 12, 2021 10:49 am

shpalman wrote:
Tue Oct 12, 2021 6:15 am
Yesterday in the Guardian Live Blog Patrick Vallance said his “mantra” throughout the pandemic has been that action needs to be taken sooner than it appears to be needed. This is such obvious gaslighting b.llsh.t compared to what he actually said at the beginning of the pandemic.
Stephen Barclay still going for ‘I don’t believe we did lock down too late’ on GMB this morning. Although he did admit to not actually having read the report when interviewed on Sky. We’re now going to have several days of handwringing about lessons being learnt while simultaneously claiming that the government did nothing wrong before setting up an ‘independent’ inquiry led by a Tory donor who will find the government were not at fault and couldn’t have foreseen the things that almost everybody else foresaw. I don’t see any sort of apology coming soon.

In other news, the Saj, is concerned about long covid. Not quite concerned enough to do anything about the current levels of Covid though.

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bob sterman
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Re: COVID-19

Post by bob sterman » Tue Oct 12, 2021 10:52 am

In addition to some rules - Sweden benefited from voluntary changes in behaviour that had effects similar to those changes enforced by legislation in other countries...

The lockdown effect: A counterfactual for Sweden
https://journals.plos.org/plosone/artic ... ne.0249732
...the actual adjustment of mobility patterns in Sweden suggests there has been substantial voluntary social restraint, although the adjustment was less strong than under the lockdown scenario

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Re: COVID-19

Post by sheldrake » Tue Oct 12, 2021 11:07 am

lpm wrote:
Tue Oct 12, 2021 10:48 am
Lol, you post an extract from wiki, but cut it short. You "accidentally" forgot to include the next section about the new laws in Dec 2020 and Jan 2021.

Let's all pretend you made a mistake, led astray by the bad wiki editing that retains old present tense language such as "Sweden has not imposed a lockdown" despite the next section being on subsequent lockdown laws.

Even Trump slammed Sweden's response. Yes, Sheldrake, you are being even more stupid than Donald Trump. An achievement few can dream of.
I will simillarly excuse your oversight, where you missed the line where I summarized exactly what those restrictions where here
The closest Sweden got to a lockdown was less restrictive than our 'rule of 6' when people started meeting up and going to restaurants again.
Sometimes I get the impression you are deliberately obtuse, almost as if you were trolling me. Look, before you get any angrier or funnier about this, I would like you to know that our lockdown policy was a contributing factor to my father's death last year. I'm not trolling or trying to pull people's legs on this topic. I am open to real discussion.

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lpm
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Re: COVID-19

Post by lpm » Tue Oct 12, 2021 11:09 am

There's definitely a discussion to be had about the non-Covid deaths the UK govt caused and is causing through their gross incompetence. Worth a separate thread.
What ever happened to that Trump guy, you know, the one who was president for a bit?

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bob sterman
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Re: COVID-19

Post by bob sterman » Tue Oct 12, 2021 11:11 am

shpalman wrote:
Tue Oct 12, 2021 6:15 am
Yesterday in the Guardian Live Blog Patrick Vallance said his “mantra” throughout the pandemic has been that action needs to be taken sooner than it appears to be needed. This is such obvious gaslighting b.llsh.t compared to what he actually said at the beginning of the pandemic.
A blog post by James Annan on Patrick Vallance's faulty memory
https://julesandjames.blogspot.com/2020 ... emory.html

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Re: COVID-19

Post by sheldrake » Tue Oct 12, 2021 11:17 am

lpm wrote:
Tue Oct 12, 2021 11:09 am
There's definitely a discussion to be had about the non-Covid deaths the UK govt caused and is causing through their gross incompetence. Worth a separate thread.
I do see a link between them however. One of my concerns is that our society has focussed on a kind of single-dimensional frame where we avert covid risk and judge our success based on how well we reduce that risk. I think a healthier frame would consider other risks so that a) proportionate response to risk from Covid was considered in the context of other risks we live with and b) we consider the risks which introduced by proposed mitigations, in a quantitative way.

Risk from dying from Covid if you catch it unvaccinated seems to range from 0.25% to 0.75% (trimming off outliers at the low end like those from Ioannidis at Stanford around 0.1% and at the high end like early WHO estimates of 1%). Once you've caught it your chance of catching it again or of dying if you do catch it are radically reduced, as they are from a disease like measles. I think IFR is probably a good proxy for your lifetime risk of dying from Covid if you stay unvaccinated (open to arguments here).

If that's true, then people in the US have a greater lifetime risk of dying in an autoaccident (1 in 103) and most of us are at greater risk of heart disease induced by our diets. I don't know what the risk of death or serious injury from the vaccines are. I assume it's much lower than the disease for most people over 40, but non-zero. We're panicking ourselves into a state where we might start vaccinating children without their parents' consent even though the drive to school or the McDonald's they eat is probably more likely to kill them

Age-adjusted excess deaths in 2020 are barely noticeable on a 30 year timescale
https://www.ons.gov.uk/aboutus/transpar ... 51wKzm7uiQ

Do we really think it's proportionate to deny people access to normal freedom of association for months at a time to mitigate a risk like that? to cause the other deaths through suicide and disrupted access to healthcare? To allow a permanent system of digital ID that can be used to block you from entering your place of work? I'm very unconvinced.

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lpm
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Re: COVID-19

Post by lpm » Tue Oct 12, 2021 11:31 am

I'm sorry you lost your father. But on this forum we have discussed excess death charts and the knock-on impacts of lockdown. Go back to the end of January 2020 and you'll find concerns about impacts mixed with the need for a lockdown in Wuhan. We never had a single-dimensional frame.

We have not, however, done a look back. The use of hindsight could be informative at this point.
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 sheldrake » Tue Oct 12, 2021 11:43 am

lpm wrote:
Tue Oct 12, 2021 11:31 am
I'm sorry you lost your father. But on this forum we have discussed excess death charts and the knock-on impacts of lockdown. Go back to the end of January 2020 and you'll find concerns about impacts mixed with the need for a lockdown in Wuhan. We never had a single-dimensional frame.
I'm sorry if the 'single frame' comment sounded like it was aimed at you personally, and a quick search on the term 'excess deaths' shows posts from you arguing with exactly the kind of comparisons I've just made.

I'm joining late and I worry about knee jerk reactions that could make life unnecessarily miserable for millions of people for years to come, and I'm used to seeing alarmist 'excess deaths' comparisons in the media that only go back 5 years, but I will quieten down on this and read to pick up the flow of the thread, as I do take it very seriously.

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Re: COVID-19

Post by lpm » Tue Oct 12, 2021 11:56 am

bob sterman wrote:
Tue Oct 12, 2021 11:11 am
shpalman wrote:
Tue Oct 12, 2021 6:15 am
Yesterday in the Guardian Live Blog Patrick Vallance said his “mantra” throughout the pandemic has been that action needs to be taken sooner than it appears to be needed. This is such obvious gaslighting b.llsh.t compared to what he actually said at the beginning of the pandemic.
A blog post by James Annan on Patrick Vallance's faulty memory
https://julesandjames.blogspot.com/2020 ... emory.html
It's well worth reading that with the following context: on this forum we were two weeks ahead of SAGE.

- on 9 March we were talking about two doublings per week
- on 11 March EPD did a quick spreadsheet that showed doubling every 2.4 days viewtopic.php?f=19&t=747&p=22083#p22083
- on 12 March we were aghast at the claim we were 4 weeks behind Italy because all of us could see we were 2 weeks behind

With this context it's utterly astonishing that SAGE thought doubling time was around 5-7 days on 18 March!

They didn't catch up with EPD's spreadsheet until 23 March!!

No wonder we were all screaming with frustration during those crucial couple of weeks. They were divorced from reality and anyone with a calculator could see it.
What ever happened to that Trump guy, you know, the one who was president for a bit?

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Woodchopper
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Re: COVID-19

Post by Woodchopper » Wed Oct 13, 2021 5:01 am


Today's report examining the UK’s pandemic response completely ignores the most obvious explanation for the excess mortality among BAME people. Crucial technology simply did not work properly for them. Thousands of people died literally because of the colour of their skin.
https://twitter.com/davecurtis314/statu ... 27714?s=21

Follow the thread for why

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bob sterman
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Re: COVID-19

Post by bob sterman » Wed Oct 13, 2021 8:19 am

Woodchopper wrote:
Wed Oct 13, 2021 5:01 am

Today's report examining the UK’s pandemic response completely ignores the most obvious explanation for the excess mortality among BAME people. Crucial technology simply did not work properly for them. Thousands of people died literally because of the colour of their skin.
https://twitter.com/davecurtis314/statu ... 27714?s=21

Follow the thread for why
He goes on to write..
At every stage of the clinical journey, from calling for assistance to being admitted to being provided with oxygen to being transferred to ITU, a BAME patient would be at much higher risk of a false oximetry reading which would mean that they did not get the correct care.
It's certainly an issue that needs investigating. However, in the USA at least, while "Black or African American" case rates are only 1.1x higher than "White, Non-Hispanic" rates the hospitalization rates are 2.8x higher...

https://www.cdc.gov/coronavirus/2019-nc ... icity.html

Moreover, I would expect oximetry errors are more likely to be a factor in primary care and triage. Not later in a clinical journey. Clinicians making ITU admission and treatment decisions will have access to a range of other data (e.g. imaging, blood gas etc). And in the UK ITU admission and invasive ventilation rates have been higher for BAME patients.

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bob sterman
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Re: COVID-19

Post by bob sterman » Wed Oct 13, 2021 8:54 am

P.S. Looks like someone has tried to study this directly..

https://associationofanaesthetists-publ ... anae.15581

But a very small sample...
194 patients (135 White ethnic origin, 34 Asian ethnic origin, 19 Black ethnic origin and 6 other ethnic origin)
And they've used 6216 paired SaO2/SpO2 measurements from this sample.

So pseudoreplication is a bit of an issue!

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Re: COVID-19

Post by WFJ » Wed Oct 13, 2021 1:55 pm

Haven't low vitamin D levels been suggested as a risk factor for more severe covid? Or has that been found to be b.llsh.t? I know there has been a lot of pseudoscience regarding high dose vitamin D for treatment/prophylaxis.

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Re: COVID-19

Post by Gfamily » Wed Oct 13, 2021 2:01 pm

WFJ wrote:
Wed Oct 13, 2021 1:55 pm
Haven't low vitamin D levels been suggested as a risk factor for more severe covid? Or has that been found to be b.llsh.t? I know there has been a lot of pseudoscience regarding high dose vitamin D for treatment/prophylaxis.
There's a general concern about chronic Vitamin D deficiency, particularly in older people; so the reports of hospitalised Covid patients showing deficiencies may just have been a correlation based on their age profile.

I don't know, and I don't know if there's been any definitive studies done on Vitamin D as a preventative measure.
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raven
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Re: COVID-19

Post by raven » Wed Oct 13, 2021 3:58 pm

Back to the +ve LFT, -ve PCR for a moment.
jdc wrote:
Sun Oct 10, 2021 4:52 pm
Couple of additional suggestions from Kit Yates - increased reporting, people faking a positive LFT result, or changes in test accuracy due to vaccination or demographic infected. (He also thinks faulty tests and new variant are possible explanations.)

More here, including a diagram based on 1% prevalence https://twitter.com/Kit_Yates_Maths/sta ... 6328343552
I like his diagram, much easier to see how the percentages shake out from a picture.
Kit Yates on Twitter PCR & LFT %.png
Kit Yates on Twitter PCR & LFT %.png (214.07 KiB) Viewed 112 times
So, very roughly, for every 25 people with a +ve LFT, about 24 people really have Covid, and 1 doesn't. But 2 of those 25 people will have a subsequent -ve PCR, and we won't know which of them is infected.

I'm sure that he's right and there'll be a positive feedback loop of people reporting this on social media getting responses from other people it's happened to. But I don't know that it seems likely enough from those % to account for it happening to multiple people in the same family though.

If what I read yesterday online is accurate....

It's possible the LFT might be picking up another corona virus because the LFTs have been checked against 3 of the 4 common ones here and don't pick them up, but the 4th is too hard to grow in vitro so hasn't been checked & might be the issue.

Our PCR tests usually look at 3 points of RNA, so it seems unlikely a new variant would read as completely negative. You'd be more likely to see a drop out on one test-point I think, like there's been for variants before -- Delta iirc -- and that still counts as positive. Plus I think we're still doing a fair bit of sequencing from PCRs so I'd hope a new variant would get picked up that way.

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Re: COVID-19

Post by raven » Wed Oct 13, 2021 4:36 pm

sheldrake wrote:
Tue Oct 12, 2021 11:17 am

Risk from dying from Covid if you catch it unvaccinated seems to range from 0.25% to 0.75% (trimming off outliers at the low end like those from Ioannidis at Stanford around 0.1% and at the high end like early WHO estimates of 1%). Once you've caught it your chance of catching it again or of dying if you do catch it are radically reduced, as they are from a disease like measles. I think IFR is probably a good proxy for your lifetime risk of dying from Covid if you stay unvaccinated (open to arguments here).
Those % for fatality you've got there.... If you're talking about decisions made in March 2020, you'd be fairer to look at the data coming out at the time, which was, like the early WHO estimates, more towards 1%. Plus I seem to remember that case fatality on the ground in Wuhan was initially even higher, maybe 4%?, because a) hospitals were overwhelmed and b)cases were underestimated. There was a lot of uncertainty in March 2020.

And anyway, in terms of deciding to lockdown, you've got to also look at rates of hospitalisation not just deaths. And factor in not just individual risk, but population risk. It's large numbers of cases in a short amount of time that break systems like the NHS.

ETA: I'm surprised by the ONS death data going back to the 90s though. Why was the death rate higher in the past? Is that the reduction in smoking, or what?

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Re: COVID-19

Post by sheldrake » Wed Oct 13, 2021 4:44 pm

raven wrote:
Wed Oct 13, 2021 4:36 pm


Those % for fatality you've got there.... If you're talking about decisions made in March 2020, you'd be fairer to look at the data coming out at the time, which was, like the early WHO estimates, more towards 1%. Plus I seem to remember that case fatality on the ground in Wuhan was initially even higher, maybe 4%?, because a) hospitals were overwhelmed and b)cases were underestimated. There was a lot of uncertainty in March 2020.
I agree that harsher measures are justifiable when we're still trying to work out exactly how dangerous something is, my concern is this stretching out over months even after the lower figures had been established; the comparitive risk discussion I think our society needed to have didn't seem to happen for 2 reasons: -

1) Behavioural science was being consulted to ensure compliance with measures, in effect this meant deliberately scaring people and suppressing stuff which might have made them doubtful; this had knock on effects into the decision-making process..

2) Once the press were focussed on this single frame of Covid deaths without makign comparisons with other risks, politicians and officials are incentivized to try and minimise deaths due to Covid. Allowing more Covid deaths (or allowing the same number to happen at a higher rate) as part of a bigger picture analysis became politically too hard (at least for weak, popularity obsessed politicians) even if it was the right thing to do. The decision makers themselves were probably also having their own perceptions and judgements skewed by the propaganda their colleagues had unleashed, so it's a vicious feedback cycle (bad things can happen at scale without invoking conspiracies)
And anyway, in terms of deciding to lockdown, you've got to also look at rates of hospitalisation not just deaths. And factor in not just individual risk, but population risk. It's large numbers of cases in a short amount of time that break systems like the NHS.
I understand that was the logic, but I also remember the Nightingale hospitals being dismantled unused. During the winter peak, the figures I saw suggested than only 50 additional acute beds were taken across the whole of London. The main capacity problem actually seemed to be caused by staff shortages as NHS staff were forced into isolation.

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lpm
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Re: COVID-19

Post by lpm » Wed Oct 13, 2021 4:56 pm

The IFR statistics basically assume a functioning health system. Death rates would jump if Covid patients or car crash patients were treated in corridors and car parks.

The lockdowns kept the NHS functioning. There was probably a bit of margin, but various hotspots took it close. Even so Covid has caused huge damage to the treatment of other conditions.

The fundamental stupidity of the government in March 2020 was a simple count of available nurses+beds vs a model of Covid patients without a lockdown. The gap was an order of magnitude - 10x more patients than possible nurses+beds.
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 shpalman » Wed Oct 13, 2021 5:00 pm

lpm wrote:
Wed Oct 13, 2021 4:56 pm
The IFR statistics basically assume a functioning health system. Death rates would jump if Covid patients or car crash patients were treated in corridors and car parks.

The lockdowns kept the NHS functioning. There was probably a bit of margin, but various hotspots took it close. Even so Covid has caused huge damage to the treatment of other conditions.

The fundamental stupidity of the government in March 2020 was a simple count of available nurses+beds vs a model of Covid patients without a lockdown. The gap was an order of magnitude - 10x more patients than possible nurses+beds.
I think the stupidity of March 2020 was not to put those two things on the same scale at all, which Neil Ferguson eventually did. They originally just assumed that the Italian data could be ignored in favour of an overcomplicated bit of computer code which was actually set up for 'flu-like transmission.
molto tricky

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Re: COVID-19

Post by sheldrake » Wed Oct 13, 2021 5:18 pm

lpm wrote:
Wed Oct 13, 2021 4:56 pm
The IFR statistics basically assume a functioning health system. Death rates would jump if Covid patients or car crash patients were treated in corridors and car parks.

The lockdowns kept the NHS functioning. There was probably a bit of margin, but various hotspots took it close. Even so Covid has caused huge damage to the treatment of other conditions.
https://bmjopen.bmj.com/content/11/1/e042945
Results At peak availability, there were 2711 additional beds compatible with mechanical ventilation across England, reflecting a 53% increase in capacity, and occupancy never exceeded 62%. A consequence of the repurposing of beds meant that at the trough there were 8.7% (8508) fewer general and acute beds across England, but occupancy never exceeded 72%. The closest to full occupancy of general and acute bed (surge) capacity that any trust in England reached was 99.8% . For beds compatible with mechanical ventilation there were 326 trust-days (3.7%) spent above 85% of surge capacity and 154 trust-days (1.8%) spent above 92%. 23 trusts spent a cumulative 81 days at 100% saturation of their surge ventilator bed capacity (median number of days per trust=1, range: 1–17). However, only three sustainability and transformation partnerships (aggregates of geographically co-located trusts) reached 100% saturation of their mechanical ventilation beds.
The paper does go on to say that unequal geographic distribution was an issue leading to some areas getting close to capacity, but then notes
Conclusions Throughout the first wave of the pandemic, an adequate supply of all bed types existed at a national level. However, due to an unequal distribution of bed utilisation, many trusts spent a significant period operating above ‘safe-occupancy’ thresholds despite substantial capacity in geographically co-located trusts, a key operational issue to address in preparing for future waves.
The fundamental stupidity of the government in March 2020 was a simple count of available nurses+beds vs a model of Covid patients without a lockdown. The gap was an order of magnitude - 10x more patients than possible nurses+beds.
I think given the above, and given the dismantling of Nightingale capacity, it's worth looking at the accuracy of the model used in March 2020.
The fact that bed capacity is reduced when too many staff are pinged and told to self-isolate also needs to be considered.

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Re: COVID-19

Post by Woodchopper » Wed Oct 13, 2021 6:21 pm

Back to PCR and LFT this thread has some pretty graphs.
https://twitter.com/artysmokesps/status ... 58949?s=21

Apologies if posted already, on my phone and in a rush.

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Re: COVID-19

Post by lpm » Wed Oct 13, 2021 6:48 pm

sheldrake wrote:
Wed Oct 13, 2021 5:18 pm
lpm wrote:
Wed Oct 13, 2021 4:56 pm
The IFR statistics basically assume a functioning health system. Death rates would jump if Covid patients or car crash patients were treated in corridors and car parks.

The lockdowns kept the NHS functioning. There was probably a bit of margin, but various hotspots took it close. Even so Covid has caused huge damage to the treatment of other conditions.
https://bmjopen.bmj.com/content/11/1/e042945
Results At peak availability, there were 2711 additional beds compatible with mechanical ventilation across England, reflecting a 53% increase in capacity, and occupancy never exceeded 62%. A consequence of the repurposing of beds meant that at the trough there were 8.7% (8508) fewer general and acute beds across England, but occupancy never exceeded 72%. The closest to full occupancy of general and acute bed (surge) capacity that any trust in England reached was 99.8% . For beds compatible with mechanical ventilation there were 326 trust-days (3.7%) spent above 85% of surge capacity and 154 trust-days (1.8%) spent above 92%. 23 trusts spent a cumulative 81 days at 100% saturation of their surge ventilator bed capacity (median number of days per trust=1, range: 1–17). However, only three sustainability and transformation partnerships (aggregates of geographically co-located trusts) reached 100% saturation of their mechanical ventilation beds.
The paper does go on to say that unequal geographic distribution was an issue leading to some areas getting close to capacity, but then notes
Conclusions Throughout the first wave of the pandemic, an adequate supply of all bed types existed at a national level. However, due to an unequal distribution of bed utilisation, many trusts spent a significant period operating above ‘safe-occupancy’ thresholds despite substantial capacity in geographically co-located trusts, a key operational issue to address in preparing for future waves.
The fundamental stupidity of the government in March 2020 was a simple count of available nurses+beds vs a model of Covid patients without a lockdown. The gap was an order of magnitude - 10x more patients than possible nurses+beds.
I think given the above, and given the dismantling of Nightingale capacity, it's worth looking at the accuracy of the model used in March 2020.
The fact that bed capacity is reduced when too many staff are pinged and told to self-isolate also needs to be considered.
I think we need to introduce you to the word "exponential" at this point.

And get you to think about how it compares to linear increases in bed capacity.

Hospitalisations hitting 72% of max seems fine to an ill-informed observer. It is terrifying when you know that unvaxxed, unlockdowned Covid can double hospitalisations in 3.5 days, double again in another 3.5 days and be at 16x in a fortnight.

Obviously society breaks well before that. The public lockdown voluntarily. People refuse to go to work. The news shows Grandma dying on a trolley. The government falls. Non Covid patients die in the hospital car park.
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 sheldrake » Wed Oct 13, 2021 6:56 pm

lpm wrote:
Wed Oct 13, 2021 6:48 pm

I think we need to introduce you to the word "exponential" at this point.
If you think infections in real epidemics grow exponentially continually until everybody has caught the disease or been vaccinated, you are mistaken. We saw waves peak before any tightening measures were introduced on at least one occasion in the UK.

The rest of your lurid apocalypse scenario didn't happen anywhere, even in countries like Sweden, Japan and Belarus with no lockdown.

You are very bright, there's no need to be so intellectually insecure and spikey when you don't understand something. Just ask. I'm perfectly happy to talk to you like a respected adult.

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Re: COVID-19

Post by Gfamily » Wed Oct 13, 2021 7:08 pm

lpm wrote:
Wed Oct 13, 2021 6:48 pm
I think we need to introduce you to the word "exponential" at this point.
but last week would have been too soon ?
My avatar was a scientific result that was later found to be 'mistaken' - I rarely claim to be 100% correct
ETA 5/8/20: I've been advised that the result was correct, it was the initial interpretation that needed to be withdrawn
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Re: COVID-19

Post by bob sterman » Wed Oct 13, 2021 7:17 pm

sheldrake wrote:
Wed Oct 13, 2021 5:18 pm
https://bmjopen.bmj.com/content/11/1/e042945
Results At peak availability, there were 2711 additional beds compatible with mechanical ventilation across England, reflecting a 53% increase in capacity, and occupancy never exceeded 62%. A consequence of the repurposing of beds meant that at the trough there were 8.7% (8508) fewer general and acute beds across England, but occupancy never exceeded 72%. The closest to full occupancy of general and acute bed (surge) capacity that any trust in England reached was 99.8% . For beds compatible with mechanical ventilation there were 326 trust-days (3.7%) spent above 85% of surge capacity and 154 trust-days (1.8%) spent above 92%. 23 trusts spent a cumulative 81 days at 100% saturation of their surge ventilator bed capacity (median number of days per trust=1, range: 1–17). However, only three sustainability and transformation partnerships (aggregates of geographically co-located trusts) reached 100% saturation of their mechanical ventilation beds.
The paper does go on to say that unequal geographic distribution was an issue leading to some areas getting close to capacity, but then notes
Conclusions Throughout the first wave of the pandemic, an adequate supply of all bed types existed at a national level. However, due to an unequal distribution of bed utilisation, many trusts spent a significant period operating above ‘safe-occupancy’ thresholds despite substantial capacity in geographically co-located trusts, a key operational issue to address in preparing for future waves.
This may sound reassuring to a certain extent - but you have to bear in mind that triage, admission and discharge practices were and are dynamic - changing as hospitals start to get close to full occupancy.

So when a hospital is getting close to full occupancy - you can be sure that some patients are not being admitted that would be admitted during more normal times. While others are being discharged early (notoriously into care homes).

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