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Covid : Infection rates v death rates and a possible second wave

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apk55

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One study I would like done is a follow on a survey of all those who who have had a positive covid test, probably after 28 days How many have had
1/ No symptoms (Asymptomatic)
2/ Very mild symptoms that probably normally would be ignored
3/ Ill but not seriously enough to go to hospital
4/ hospital admission
5/ Hospital admission with time in intensive care or oxygen
6/ Died
 
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talldave

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One study I would like done is a follow on a survey of all those who who have had a positive covid test, probably after 28 days How many have had
1/ No symptoms (Asymptomatic)
2/ Very mild symptoms that probably normally would be ignored
3/ Ill but not seriously enough to go to hospital
4/ hospital admission
5/ Hospital admission with time in intensive care or oxygen
6/ Died
I can see how that one would play out - anyone refusing to respond would be classified as "died"!!!
 

Meerkat

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Is it too much to ask to have:

A death rate where Covid is confirmed as the primary cause

A hospital admissions rate where Covid is the sole reason for that admission

A positive test rate where the test is the first positive test on a particular person only, and is not a follow up to see if they've recovered.

I'm no statistician, but surely this isn't beyond the capabilities of our country?


.
How do you define primary cause if someone who has an underlying health issue? I remember my gran’s death certificate being a bit pot luck - a load of possible/probable causes, probably in combination, pick one of the above as who knows which straw broke the camel’s back.
 

Bantamzen

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Is it too much to ask to have:

A death rate where Covid is confirmed as the primary cause

A hospital admissions rate where Covid is the sole reason for that admission

A positive test rate where the test is the first positive test on a particular person only, and is not a follow up to see if they've recovered.

I'm no statistician, but surely this isn't beyond the capabilities of our country?


.

I'd imagine that such data ought mostly to be available, certainly in the US the CDC seem to have at least the data on where covid is considered the only reason for admission / mortality. So its reasonable to assume that the NHS / ONS will hold similar. As to why such data isn't being made public, well its possible the in the early days it wasn't readily available or even understood. But by now there really isn't any good reason other than political to not publish more in-depth data.
 

brad465

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This report is currently topping the BBC frontpage with more info on false postives:


The main test used to diagnose coronavirus is so sensitive it could be picking up fragments of dead virus from old infections, scientists say.

Most people are infectious only for about a week, but could test positive weeks afterwards.

Researchers say this could be leading to an over-estimate of the current scale of the pandemic.

But some experts say it is uncertain how a reliable test can be produced that doesn't risk missing cases.

He believes the detection of traces of old virus could partly explain why the number of cases is rising while hospital admissions remain stable.

Wasn't 100% certain on which thread this best goes in but think this one is fairly suitable, as a further revelation on positive tests not being part of actual infections greatly influences infection rates and with further clarity lead to a change in course for the overall pandemic response.
 

Yew

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Indeed, I'm hoping that this, coupled with some of the T-cell testing that we've been hearing about is going to have a significant impact over the next few weeks.
 

MikeWM

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Carl Heneghan has been saying this (along with many other sensible things) for a while now. But if the BBC is actually reporting what he's saying, rather than generic hysteria, then maybe the worm is finally starting to turn. Fingers crossed!
 

talldave

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Hmmmm, so the indiscriminate virus...wasn't, some of the Covid deaths weren't Covid deaths and now significant numbers of cases aren't actually cases? Are there really still people who don't believe we've over reacted? I look at people in the street masked up and gloved and ask myself what on earth are they doing.

Never mind, it's not as if we've used flawed test results to shut down entire towns & cities (wrecking businesses) or locked people in their homes to quarantine (destroying livelihoods) is it? Oh hang on.....
 

adc82140

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Is there any difference between countries in what defines a positive result? France is returning 9000 cases a day, with only a small increase in hospital admissions. Although they still have over 400 in intensive care, which seems a lot. Another counting difference? Germany is returning about the same as us...
 

Meerkat

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These aren’t ‘false positives’, they are just late tests.
so whilst these people might not be active cases it means they were cases and could have created infection trails that are still going.
You cant use this to say Covid isn’t a problem!
 

Bantamzen

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These aren’t ‘false positives’, they are just late tests.
so whilst these people might not be active cases it means they were cases and could have created infection trails that are still going.
You cant use this to say Covid isn’t a problem!

Nobody is saying there isn't a problem, however what this might be saying is that the current numbers of new cases may well be out. And it is the numbers of new cases that is driving political decisions, which is a problem.
 

Meerkat

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Nobody is saying there isn't a problem, however what this might be saying is that the current numbers of new cases may well be out. And it is the numbers of new cases that is driving political decisions, which is a problem.
There is no mass testing though - finding more cases must be linked to symptomatic people getting tested, even if their contacts might be ‘not really positive at this time‘ positives.
 

yorksrob

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There is no mass testing though - finding more cases must be linked to symptomatic people getting tested, even if their contacts might be ‘not really positive at this time‘ positives.

There is the community testing programme though. I'm sure I read this week that it was still finding the rate of infections to be steady.
 

Meerkat

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There is the community testing programme though. I'm sure I read this week that it was still finding the rate of infections to be steady.
That’s national, and national policy is opening up. Lockdowns are local and relate to localised spikes.
 

30907

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There is the community testing programme though. I'm sure I read this week that it was still finding the rate of infections to be steady.
Yes, that is correct, though ISTR a caveat that it is not a representative sample
Similarly, if you compare the proportion of cases to tests (the govt. graph), it is now around 1:100 whereas back in July (when cases were at their lowest) it was around 1:200. So the real increase countrywide is certainly lower than the headline figure though not actually nil.
What we seem to be seeing is numbers of localised spikes against a flat trend nationally.
(Meerkat is I think making similar points)
 

yorkie

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This report is currently topping the BBC frontpage with more info on false postives:


Wasn't 100% certain on which thread this best goes in but think this one is fairly suitable, as a further revelation on positive tests not being part of actual infections greatly influences infection rates and with further clarity lead to a change in course for the overall pandemic response.
Interesting that this is being treated as breaking news; it was mentioned months ago!

I posted that this could happen on the forum back on 23 May 2020:
https://www.railforums.co.uk/threads/have-you-had-the-virus.204490/page-2#post-4590891
The South Korea Centre for Disease Control and Prevention examined 285 Covid-19 survivors who had recovered, tested negative and then tested positive for a second time. ....

Virus samples collected from them could not be grown in culture in the lab, indicating that they were shedding non-infectious or dead virus particles.
There is the community testing programme though. I'm sure I read this week that it was still finding the rate of infections to be steady.
Yes this is true, despite some sections of the media constantly telling us the "R" value (which is virtually meaningless at low infection levels) is above one. I know some people in York who are part of the programme (they get paid £25 per test; payment is in the form of vouchers)
 

adc82140

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Interesting that this is being treated as breaking news; it was mentioned months ago!

I posted that this could happen on the forum back on 23 May 2020:
https://www.railforums.co.uk/threads/have-you-had-the-virus.204490/page-2#post-4590891


Yes this is true, despite some sections of the media constantly telling us the "R" value (which is virtually meaningless at low infection levels) is above one.

A member of Sage has gone public about the disquiet regarding letting the public and media latch on to the R value. Reported in this tweet from a Sky News reporter


"The focus on the R number has been unhelpful... The general feeling in SPI-M is, well, perhaps we’ve created a monster here"

Prof Mark Woolhouse, a member of the government's modelling committee, talking to the Science and Technology Committee
 

furlong

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There's a new write-up of how things went wrong with reporting of the numbers at COVID – why terminology really, really matters (includes some speculation)
Since the start of the COVID pandemic I have watched almost everyone get mission critical things wrong.
...
On March 26th, just before their deaths peaked, there were 3,900 hundred ‘cases’. Fourteen days later, there were 1,400 deaths. So, using a widely accepted figure, which is a delay of around two weeks between diagnoses and death, 36% of cases died.

In stark contrast, on August 16th, there were 3,000 cases. Fourteen days later there were 26 deaths. Which means that, in March, 36% of ‘cases’ died. In August 0.8% of ‘cases’ died. This, in turn, means that COVID was 45 times as deadly in March, as it was in August?

This seems extremely unlikely. In fact, it is so unlikely that it is, in fact, complete rubbish.
...
So yes, it does seem that ‘the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza.’
...


I know it is going to be virtually impossible to walk the world back from having made such a ridiculous, stupid, mistake. There are so many reputations at stake. The entire egg production of the world will be required to supply enough yoke[sic] to cover appropriate faces.
...
Of course, it will be denied, absolutely, vehemently, angrily, that anyone got anything wrong. It will be denied that a simple error, a mix up between case fatality and infection fatality led to this. It will even more forcefully stated that COVID remains a deadly killer disease and that all Governments around the world have done exactly the right thing. The actions were right, the models were correct. We all did the RIGHT thing. Only those who are stupid, or incompetent cannot see it.

When wrong, shout louder, get angry, double-down, attack your critics in any way possible. Accuse them of being anti-vaxx, or something of the sort. Dig for the dirt. ‘How to succeed in politics 101, page one, paragraph one.’
...
 

bramling

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An interesting piece, and quite honestly refreshing from someone within the medical community.

It would certainly explain why, for example, America has seen a massive growth in “cases” but not such a massive corresponding growth in deaths, despite the fact that most of the “cases” are in parts of America not previously hit.

Of course, no political leader is going to want to admit that they trashed their economy off the back of dodgy figures.

Easy to keep people scared by showing footage of the Italian hospitals, with people unable to delve further and form more informed opinions.

I have a feeling there’s more than a grain of truth in the rumour of Boris going at some point in the next year, with the official line being health reasons.
 

Meerkat

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Isnt the difference mainly that the vulnerable people are keeping out of sight At the moment?
 

yorkie

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Isnt the difference mainly that the vulnerable people are keeping out of sight At the moment?
Some are but many aren't. In any case, how do you explain such a huge differential as that described in the article linked to by @furlong? The idea that such a huge decrease is down to people keeping 'out of sight' cannot possibly be true. That said, it may be having some impact, but that just highlights how minimal the effect of this virus is on the vast majority of healthy people.
 

trebor79

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Isnt the difference mainly that the vulnerable people are keeping out of sight At the moment?
No. Shielding was "paused" at the start of August. My parents are certainly carrying on with normal activity.
 

Meerkat

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Some are but many aren't. In any case, how do you explain such a huge differential as that described in the article linked to by @furlong? The idea that such a huge decrease is down to people keeping 'out of sight' cannot possibly be true. That said, it may be having some impact, but that just highlights how minimal the effect of this virus is on the vast majority of healthy people.
Testing has got better - they were pretty much only testing people in hospital to start with
No. Shielding was "paused" at the start of August. My parents are certainly carrying on with normal activity.
Shielding might have been paused, but a lot of people are being a lot more careful, and the care homes are in better control.
 

Bletchleyite

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Shielding might have been paused, but a lot of people are being a lot more careful, and the care homes are in better control.

True. I think it's probably fair to say that if we'd put everything we have now in place in early March we wouldn't have needed the actual lockdown - which is about what Sweden did.
 

yorkie

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Testing has got better - they were pretty much only testing people in hospital to start with...
Exactly so it sounds like it's very possible many more people had it than we thought.

So, why is it that we are seeing only a tiny proportion of the hospitalisations and deaths that we previously saw for a similar number of positive cases?

There are many theories, but there doesn't appear to be a strong case for any specific theory to be the only reason, but it could be that several of these theories are true, to some extent.
  • Could the increasingly prevalent D614G variant be more infectious but result less severe symptoms than previously dominant D614? Many people do make this claim and it does sound plausible. There may be some truth in this, but nowhere near enough to explain what we are now seeing.

  • Could it be the case that comparatively few younger people were infected earlier in the pandemic, and now it is the case that it is mostly younger people getting it? I don't doubt there is at least some truth in this; it's likely the proportions to which different age groups have been exposed to the virus has changed over time, but perhaps not to the extent some people are claiming? Surely this factor alone could possibly explain what we are seeing; bear in mind only seriously ill hospitalised patients could get a test early on, so most young people would not have been able to get a test even if they felt quite ill.

  • There is no doubt that we know a lot more about how to treat people who become seriously ill, for example we know that reliance on ventilators was vastly overestimated. Again I don't doubt this is reducing the death rate, but nowhere near to the extent that could explain the huge shift we are seeing; for a start very few people are becoming seriously ill.

  • More testing is definitely having an effect, there is no doubt about that. But if more testing is the only explanation for why people are hospitalised, then that means an absolutely massive number of people had the virus back in March/April. If that is true then many millions were exposed and did not get ill. Of course, we know that in the early days only seriously ill patients were tested, so no-one is doubting several million were exposed to the virus, but if this was the main reason, that number would have to be even bigger than anyone is estimating. Antibody studies have suggested only a relatively small proportion of the population were exposed, but we now know that T-cells play an important role; so that does make it possible that a large proportion of the population were exposed to the virus. Still, I don't think this alone can explain it, though it is likely to be the biggest factor.

True. I think it's probably fair to say that if we'd put everything we have now in place in early March we wouldn't have needed the actual lockdown - which is about what Sweden did.

Agreed; the more time goes on, the more obvious it is that lockdown was a terrible mistake.
 

trebor79

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Agreed; the more time goes on, the more obvious it is that lockdown was a terrible mistake.
I'm increasingly of the view that most of the measures are terrible mistakes.
Really, sensible measures to protect care homes should have been taken, and little else.
I think the road back for many sectors of the economy is long, hard and uncertain to succeed.
 
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