New lockdown in England, including school closures, announced by Johnson, 4/1/21

[yorksrob]

I think there's also a problem with everyone considering COVID in isolation.

We're still not really told how many people are actually dying from COVID, vs COVID being a factor in worsening a situation where someone was already seriously ill

Indeed. I think that someone said that typically there is space for three causes of death on a death certificate. Regardless of where in the pecking order COVID is, if it's on there, it will go down as a COVID death.

 

[initiation]

If 100,000+ deaths in less than a year aren't a clear reason for doing something, I don't know what is

Ahh the classic you don't care about killing people insinuation. Where was I advocating doing nothing? All I'm saying is that any measures should be carefully balanced with the default situation, if evidence is not forthcoming that a measure is of material net benefit, being to not impose that restriction.

I could easily turn your point around and say if 10+% being knocked off our national wealth, millions of kids missing education, hundreds of thousands made jobless, and people banned from seeing family and friends for months on end is not a good reason for demanding evidence based measures, what is?

One thing the last year has shown is that given a nudge, many people (politicians and public alike) in this supposedly free country have a strong authoritarian streak and are happy to trade their freedom for perceived safety. I hope I am wrong but I don't think we will truely ever fully recover from this as the cat is out the bag.

 

[35B]

I once did a thread on the concept of "human exceptionalism" and argue that Covid has really shone a light on it, even if the actual concept is not acknowledged, with regards to trying to save lives and in general increase life expectancy, even though doing so only leads to more health problems in later life.

I forget the source, but believe the figure for those reported as "died with" for whom the primary cause of death was Covid was in excess of 90%.

We have upwards of 600,000 deaths a year anyway so willing to bet a good proportion of those would have occurred in not too distant future anyway. We need to realise death is an inevitably, you never save a life, you just delay death.

This is an important point that the wider population need to be educated on. Yes, at times over the past year, excess deaths have been very high. At others it hasn't. Once the year has panned out, the overall excess death figure compared to the average will be unusually large. But not as large as I think many people would expect. People need to be educated to the reality that COVID will likely become just one of the various fatal afflictions that we have lived (and died) with for centuries.

As I understand it, excess deaths for 2020 - over the year - were well over 60,000, and that before the 100,000 deaths directly attributed to Covid. While I accept there are merits in a QALY based argument for the value of intervention, I have a real moral problem with the assumption that those deaths would have occurred soon, so are somehow unimportant. The same argument was applied to Harold Shipman's victims, despite ample evidence to the contrary.

 

[Domh245]

This is an important point that the wider population need to be educated on. Yes, at times over the past year, excess deaths have been very high. At others it hasn't. Once the year has panned out, the overall excess death figure compared to the average will be unusually large. But not as large as I think many people would expect. People need to be educated to the reality that COVID will likely become just one of the various fatal afflictions that we have lived (and died) with for centuries.

Depends how you look at it. In terms of excess deaths 2020 was pretty horrific, and it'll require quite a sustained number of lower than usual death rates to bring the average back down to somewhere near normal.



Plotting what is fundamentally the same data a different way (cumulative average vs 2020) makes it look a little less terrible but still quite obviously bad

I think there's also a problem with everyone considering COVID in isolation.

We're still not really told how many people are actually dying from COVID, vs COVID being a factor in worsening a situation where someone was already seriously ill

Using the CEBM method to determine covid being the underlying cause of death (as opposed to someone dying of something else but covid was a contributory factor or otherwise just present), 88.57% of deaths were covid as the underlying cause

 

[DerekC]

I forget the source, but believe the figure for those reported as "died with" for whom the primary cause of death was Covid was in excess of 90%.

As I understand it, excess deaths for 2020 - over the year - were well over 60,000, and that before the 100,000 deaths directly attributed to Covid. While I accept there are merits in a QALY based argument for the value of intervention, I have a real moral problem with the assumption that those deaths would have occurred soon, so are somehow unimportant. The same argument was applied to Harold Shipman's victims, despite ample evidence to the contrary.

I agree 100% with your last point - but the problem with the QALY argument is that it would be impossible to apply on the scale needed for the vaccine rollout. It's OK when a doctor is making a judgement about where to apply limited resources between a small number of people, because she/he can be aware of the quality of life of the people involved. On a mass basis no. What would you end up with? A 23-page form devised by civil servants to fill in, an algorithm designed by consultants to process the results, long delay, confusion, error and lots of very dissatisfied and unhappy people. Age is known, easy to handle and generally accepted as fair given the risk profile of the virus.

 

[35B]

Ahh the classic you don't care about killing people insinuation. Where was I advocating doing nothing? All I'm saying is that any measures should be carefully balanced with the default situation, if evidence is not forthcoming that a measure is of material net benefit, being to not impose that restriction.

I could easily turn your point around and say if 10+% being knocked off our national wealth, millions of kids missing education, hundreds of thousands made jobless, and people banned from seeing family and friends for months on end is not a good reason for demanding evidence based measures, what is?

One thing the last year has shown is that given a nudge, many people (politicians and public alike) in this supposedly free country have a strong authoritarian streak and are happy to trade their freedom for perceived safety. I hope I am wrong but I don't think we will truely ever fully recover from this as the cat is out the bag.

Where did I suggest you were advocating doing nothing, or that you don't care about people dying? I find the idea that a single infectious disease is, from nowhere, killing over 100,000 people in a year appalling and justification in itself for taking robust action. I don't conclude from our disagreement, or even your misrepresentation of my argument, that you are in some way a bad person; this is the sort of matter on which it is inevitable that people of good conscience will disagree significantly on the balance of benefits and harms.

In particular, I acknowledge the tremendous impacts on society of the measures you are rightly concerned have had serious impact. In particular, as both a parent of secondary school children and a primary school governor, I see the huge impact on youth of these measures, and my support for them is at most on a lesser evil basis, and subject to their being part of a broader strategy that seeks to yield the maximum benefit from the costs imposed on us - in my developing views, the part remembered snippets of student lectures on just war theory come to mind. However, taking your point about cost/benefit analysis, I increasingly consider the impact of not having reacted more robustly as a major factor in why the costs you rightly outline have been so high, in deaths, money and emotional/psychological impact. The results achieved in the likes of NZ and Australia, however fragile they are, and however challenging opening up will be, demonstrate how very robust containment measures can actually deliver freedoms to people.

That's not about my being a fan of authoritarianism*, but of cold recognition that Covid imposes costs both through policies intended to deal with the disease, and where controls are not put in place. Measuring the cost of Covid policy by only ascribing costs to what the government have done, and not acknowlegding that inaction has, for example, imposed tremendous costs on the health service, fails to fairly represent how the cost of Covid shakes out.

* - as an aside, I find the attempt to define policy on Covid as "authoritarian" suggests a very poor understanding of what an authoritarian regime is, and what authoritarian policing is. British government policies and their implementation have been many things, but not authoritarian.

== Doublepost prevention - post automatically merged: 31 Jan 2021 ==

I agree 100% with your last point - but the problem with the QALY argument is that it would be impossible to apply on the scale needed for the vaccine rollout. It's OK when a doctor is making a judgement about where to apply limited resources between a small number of people, because she/he can be aware of the quality of life of the people involved. On a mass basis no. What would you end up with? A 23-page form devised by civil servants to fill in, an algorithm designed by consultants to process the results, long delay, confusion, error and lots of very dissatisfied and unhappy people. Age is known, easy to handle and generally accepted as fair given the risk profile of the virus.

I completely agree - QALYs are an analytical tool for populations and determining strategic decisions, not for applying to individual patients for individual treatments. Having set that policy on, for example, what treatments are offered, it is then a question of clinical judgement about whether an indiviudal patient would or wouldn't benefit from that treatment.

In the context of Covid, my wife's godfather is in his late 80s, suffers mild COPD, is generally frail, and lives in a care home. There is no way that, were he to catch Covid, he would be likely to benefit from ICU-type treatment, or that he would be likely to survive a serious infection. A doctor choosing to provide palliative care and keep him comfortable were he to catch Covid would have my absolute support. However, in the absence of Covid, he is enjoying a reasonable quality of life, is content, and has a reasonable life expectancy. Therefore, the judgements that apply to infection with Covid do not automatically apply to any other condition he may suffer from - and I expect those looking after him to make their decisions on treatment based on him, and the burdens that individual disease treatments might impose on him. The metric of the QALY can't capture that complexity about him, even if it can help guide the overall approach to care for people in his broad category.

 

[Yew]

I forget the source, but believe the figure for those reported as "died with" for whom the primary cause of death was Covid was in excess of 90%.

As I understand it, excess deaths for 2020 - over the year - were well over 60,000, and that before the 100,000 deaths directly attributed to Covid. While I accept there are merits in a QALY based argument for the value of intervention, I have a real moral problem with the assumption that those deaths would have occurred soon, so are somehow unimportant. The same argument was applied to Harold Shipman's victims, despite ample evidence to the contrary.

Surely you can see the difference between intentional murder, and not deciding to make unlimited and intrusive sacrifices?

== Doublepost prevention - post automatically merged: 31 Jan 2021 ==

In the context of Covid, my wife's godfather is in his late 80s, suffers mild COPD, is generally frail, and lives in a care home. There is no way that, were he to catch Covid, he would be likely to benefit from ICU-type treatment, or that he would be likely to survive a serious infection. A doctor choosing to provide palliative care and keep him comfortable were he to catch Covid would have my absolute support. However, in the absence of Covid, he is enjoying a reasonable quality of life, is content, and has a reasonable life expectancy. Therefore, the judgements that apply to infection with Covid do not automatically apply to any other condition he may suffer from - and I expect those looking after him to make their decisions on treatment based on him, and the burdens that individual disease treatments might impose on him. The metric of the QALY can't capture that complexity about him, even if it can help guide the overall approach to care for people in his broad category.

Any treatment or mitigation would be subject to evaluation in terms of the QALYS saved, yet no such scrutiny is applied to these invasive, damaging and compulsory non-pharmaceutical interventions that are applied to the whole population

 

[yorksrob]

I forget the source, but believe the figure for those reported as "died with" for whom the primary cause of death was Covid was in excess of 90%.

As I understand it, excess deaths for 2020 - over the year - were well over 60,000, and that before the 100,000 deaths directly attributed to Covid. While I accept there are merits in a QALY based argument for the value of intervention, I have a real moral problem with the assumption that those deaths would have occurred soon, so are somehow unimportant. The same argument was applied to Harold Shipman's victims, despite ample evidence to the contrary.

But at some stage in the future, we will have a bad flu year, when excess deaths will also be unusually high. Would you propose extreme interventions such as lockdown for those as well ?

This isn't an argument against non-clinical interventions per se. More that we should be proportionate in those interventions.

 

[Class 317]

I think we need to be careful in over thinking the application of QALY to measures to control the wider spread of Covid. This is using it to do some thing which it's has not been designed to do.

A better option would be to create a new criteria to assess measures that have large effects on the wider population and the wider effects if the health service were to be overwhelmed and unable to treat everyone it would normally do so.

 

[brad465]

I forget the source, but believe the figure for those reported as "died with" for whom the primary cause of death was Covid was in excess of 90%.

As I understand it, excess deaths for 2020 - over the year - were well over 60,000, and that before the 100,000 deaths directly attributed to Covid. While I accept there are merits in a QALY based argument for the value of intervention, I have a real moral problem with the assumption that those deaths would have occurred soon, so are somehow unimportant. The same argument was applied to Harold Shipman's victims, despite ample evidence to the contrary.

I think we need to be careful in over thinking the application of QALY to measures to control the wider spread of Covid. This is using it to do some thing which it's has not been designed to do.

A better option would be to create a new criteria to assess measures that have large effects on the wider population and the wider effects if the health service were to be overwhelmed and unable to treat everyone it would normally do so.

In the near future we will reach the point where the baby-boomer generation will be dying off in greater numbers. The defined period for this generation is 1946-1964, so they are currently aged 56-75, so I think in around 15 years time the death rate will be much higher than the current average just by way of more people being around the natural life expectancy. In the build up to this the health service demands will likely increase so its essential capacity does so as well, or else we may have a real crisis on our hands that maybe at least comparable to the last year but going on over a much longer period of time.

 

[35B]

Surely you can see the difference between intentional murder, and not deciding to make unlimited and intrusive sacrifices?

== Doublepost prevention - post automatically merged: 31 Jan 2021 ==


Any treatment or mitigation would be subject to evaluation in terms of the QALYS saved, yet no such scrutiny is applied to these invasive, damaging and compulsory non-pharmaceutical interventions that are applied to the whole population

Yes, I do see the difference between murder and non intervention. Unfortunately, the assumption of old = decrepit led to a lack of interest in his habits for many years, and I have the same deep distaste for the assumption that if someone is old and frail their lives are not worth protecting.

As for QALY assessment of treatments, I await the after the event analysis to test the cost benefit equation of Covid approaches. However, I do also believe that the costs of non intervention are high, and easily discounted in conversations such as these.

 

[DB]

However, I do also believe that the costs of non intervention are high, and easily discounted in conversations such as these.

The costs of excessive intervention are also high, and almost completely discounted by polticians and their advisors.

 

[Yew]

However, I do also believe that the costs of non intervention are high, and easily discounted in conversations such as these.

I'll try and find the source, but I've seen analysis that suggest that we're at around £1,000,000 per QALY for the current NPI's, for comparison, we usually NICE wouldn't usually recommend a treatment if it can't beat £20,000-30,000 per QALY.

 

[Bikeman78]

We have upwards of 600,000 deaths a year anyway so willing to bet a good proportion of those would have occurred in not too distant future anyway. We need to realise death is an inevitably, you never save a life, you just delay death.

Thus far no one I know personally has died of Covid. Several people have tested positive, a very small number have felt rotton for a few days. Conversely, in the last 10 years two people I knew died suddenly in their 40s. A few others of various ages died of cancer and a relative of mine has recently been diagnosed with cancer.

 

[Philip]

One thing the last year has shown is that given a nudge, many people (politicians and public alike) in this supposedly free country have a strong authoritarian streak and are happy to trade their freedom for perceived safety. I hope I am wrong but I don't think we will truely ever fully recover from this as the cat is out the bag.

We are not a free country. It is an overused and inaccurate term; we're a democratic country with laws, including coronavirus restrictions at this time. If it was a free country then there would be anarchy and we absolutely don't want that. The fact that we haven't had any notable civil unrest in the last 10 months is testament to the above.

There needs to be a balance between authoritarianism and anarchy and I think UK does it pretty well.

 

[35B]

I'll try and find the source, but I've seen analysis that suggest that we're at around £1,000,000 per QALY for the current NPI's, for comparison, we usually NICE wouldn't usually recommend a treatment if it can't beat £20,000-30,000 per QALY.

Thanks, I’d be interested to see the source. I’d also be interested to see how it apportions the costs of Covid between the costs of the actions taken, and the actions not taken - there are a lot of costs incurred by Covid that are arguably the result of not imposing restrictions and therefore facing the consequences of spread.

 

[yorksrob]

I hear on the news that the CBI is calling for a roadmap as to when businesses should be allowed to open. This is good news and hopefully they will keep up the pressure.

 

[kristiang85]

Thanks, I’d be interested to see the source. I’d also be interested to see how it apportions the costs of Covid between the costs of the actions taken, and the actions not taken - there are a lot of costs incurred by Covid that are arguably the result of not imposing restrictions and therefore facing the consequences of spread.

I *think* I posted an article saying this a couple of months back; when I get a moment later I'll dig through my past posts to see if I can find it.

 

[35B]

I *think* I posted an article saying this a couple of months back; when I get a moment later I'll dig through my past posts to see if I can find it.

Thanks, that'd be interesting - though an update reflecting the experience of the last couple of months would be an interesting extension of that analysis.

 

[yorksrob]

That'll be the next thing.

You can guarantee it will be found to be endemic here within the next two weeks.

"Surprise Surprise"

The radio is now saying we've got the South African varient in community transition.

Perhaps we're going for the full set.

 

[6862]

"Surprise Surprise"

The radio is now saying we've got the South African varient in community transition.

Perhaps we're going for the full set.

Might be a useful excuse for them to announce a stricter set of restrictions soon?

 

[nlogax]

"Surprise Surprise"

The radio is now saying we've got the South African varient in community transition.

Perhaps we're going for the full set.

Looks like Surrey is the hotspot. This is going to be fun :/

 

[brad465]

Might be a useful excuse for them to announce a stricter set of restrictions soon?

Or at least keep the current ones going longer.

This is definitely humans effectively showing we've advanced too much for our own good in places; our ancestors wouldn't have been aware of variants to the extent we know about this but it didn't hold them back.

 

[Tezza1978]

Might be a useful excuse for them to announce a stricter set of restrictions soon?

Unnecessary and just won't happen for lots of reasons. This isnt some sort of super strain, the same precautions stop it being passed on and there is no surge in cases in Surrey . The government is taking precautions for variant surveillance reasons and so it should be.

The vaccines do work for this variant, even if slightly less effective and are easily adaptable. Thing is - they only will be changed if the variant becomes widespread and as Patrick Vallance said there is no evidence that the SA train is more transmissible than the Kent strain.

The government is beginning to realise that this will never disappear, we will live with it at an acceptable risk level. Its good in a way as it stops the zero COVID fanatics gaining any traction. You can't eliminate the common cold or influenza either.

 

[Nicholas Lewis]

Unnecessary and just won't happen for lots of reasons. This isnt some sort of super strain, the same precautions stop it being passed on and there is no surge in cases in Surrey . The government is taking precautions for variant surveillance reasons and so it should be.

The vaccines do work for this variant, even if slightly less effective and are easily adaptable. Thing is - they only will be changed if the variant becomes widespread and as Patrick Vallance said there is no evidence that the SA train is more transmissible than the Kent strain.

The government is beginning to realise that this will never disappear, we will live with it at an acceptable risk level. Its good in a way as it stops the zero COVID fanatics gaining any traction. You can't eliminate the common cold or influenza either.

At least in Surrey the local public health teams are taking direct action rather than waiting for trace & isolate to catch up This sort of rapid response if successful may provide a blueprint of how we learn to live with the virus without wrecking our society.

 

[6862]

Or at least keep the current ones going longer.

This is definitely humans effectively showing we've advanced too much for our own good in places; our ancestors wouldn't have been aware of variants to the extent we know about this but it didn't hold them back.

Yes, this is very true! Too much knowledge can sometimes ultimately be harmful inasmuch as we respond to that knowledge in the wrong way! I'm not suggesting we just bury our heads in the sand and ignore all the valid science being done involving Covid, but rather that we should acknowledge that if we're going down the 'follow the science' route, it will do a lot of harm as we understand more and more about the disease.

 

[DannyMich2018]

I think society needs to accept that even months ahead there will be cases and deaths (both very low hopefully) for a very long time and just like other diseases, no vaccination or treatment will stop ALL deaths. Covid isn't going away any time soon so we need to accept a small amount of cases and deaths for a very long time but this does not justify indefinite restrictions. Remember we have lots of Flu and other deaths per year but we don't go into Lockdown every winter for that. Also of the 34000ish Covid patients in hospital the number in intensive care is not a lot more than the first peak. How many of these people in hospital were admitted due to a fall/heart attack/RTC/other but then happened to test positive so are a Covid Stat even though they weren't admitted as a Covid patient and may not even have any symptons?

 

[6862]

Remember we have lots of Flu and other deaths per year but we don't go into Lockdown every winter for that.

I think such a statement was probably true until early 2020, but with the precedent that has been set by the last year, I expect that lockdowns will now be a permanent part of the public health toolkit for tackling respiratory viruses.

 

[NorthOxonian]

I think such a statement was probably true until early 2020, but with the precedent that has been set by the last year, I expect that lockdowns will now be a permanent part of the public health toolkit for tackling respiratory viruses.

Perhaps for a few years.

Once the long term social and economic damage of the last year becomes apparent (which will gradually become more and more clear over the next decade or so), we'll realise what a costly mistake lockdown was.

 

[Class 33]

I think society needs to accept that even months ahead there will be cases and deaths (both very low hopefully) for a very long time and just like other diseases, no vaccination or treatment will stop ALL deaths. Covid isn't going away any time soon so we need to accept a small amount of cases and deaths for a very long time but this does not justify indefinite restrictions. Remember we have lots of Flu and other deaths per year but we don't go into Lockdown every winter for that. Also of the 34000ish Covid patients in hospital the number in intensive care is not a lot more than the first peak. How many of these people in hospital were admitted due to a fall/heart attack/RTC/other but then happened to test positive so are a Covid Stat even though they weren't admitted as a Covid patient and may not even have any symptons?

Indeed, this really has got to be the very last lockdown now. No more of this nonsense happening again and the devastating impacts it will have on the economy and mental health of millions. Absolutely has to be the VERY last lockdown now.