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Exit strategy predictions

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Meerkat

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Wow! A future where you'll only be allowed out of your home if you not only have a smartphone but allow it to track your every move! I'm not sure that's a society I would wish to live in, certainly not in the long term.
The British government are not planning on making it compulsory and it doesn’t track you. That’s one reason they are keen to overcome the privacy worries - they need people to want to use it.
It also doesn’t need to be universal to be effective.
I would hope that a red contact gets you a priority test (drive thru?) so that your downtime is limited.
 
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Greybeard33

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Wow! A future where you'll only be allowed out of your home if you not only have a smartphone but allow it to track your every move! I'm not sure that's a society I would wish to live in, certainly not in the long term.
Most smartphone users already allow Google or Apple to track their every move, without even realising it. To change this default behaviour you have to delve into the privacy settings of the operating system.

It is not by magic or telepathy that phones manage to serve up ads relevant to where you are at the time and what your interests are. These ads finance all the "free" services that users depend on.
 

Mogster

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Good from the BBC. Lots of important points in this.


Is coronavirus causing the deaths?
The death figures being reported daily are hospital cases where a person dies with the coronavirus infection in their body - because it is a notifiable disease cases have to be reported.
But what the figures do not tell us is to what extent the virus is causing the death.
It could be the major cause, a contributory factor or simply present when they are dying of something else.
Most people who die with coronavirus have an underlying health condition, such as heart disease or diabetes, that may be more of a factor.
For example, an 18-year-old in Coventry tested positive for coronavirus the day before he died and was reported as its youngest victim at the time.
But the hospital subsequently released a statement saying his death had been due to a separate "significant" health condition and not connected to the virus.
There are, however, other cases, including health workers and a 13-year-old boy from London, who died with no known health conditions.
The Office for National Statistics is now trying to determine the proportion of these deaths that are caused specifically by coronavirus.[QUOTE\]
 

Bantamzen

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Good from the BBC. Lots of important points in this.


That is an interesting piece, as you say lots of important contextual information in that including more than a hint of the emergency measures tipping point. It mentions a drop of 6.4% in the overall economy as being the point at which politicians and their experts start to move away from the lock-down to a gradual move back to full functioning again, and this on the day that the expected drop in the economy will be 35% by the end of June. I expect that some time next month will see the beginning of relaxing the measures, 35% is way too much for anyone to consider.
 

Meerkat

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That is an interesting piece, as you say lots of important contextual information in that including more than a hint of the emergency measures tipping point. It mentions a drop of 6.4% in the overall economy as being the point at which politicians and their experts start to move away from the lock-down to a gradual move back to full functioning again, and this on the day that the expected drop in the economy will be 35% by the end of June. I expect that some time next month will see the beginning of relaxing the measures, 35% is way too much for anyone to consider.
The 35% was a quarterly drop in the OBR scenario (educated guesswork...), back to normal by Q4 with an annual 13% drop in GDP.
 

Bantamzen

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The 35% was a quarterly drop in the OBR scenario (educated guesswork...), back to normal by Q4 with an annual 13% drop in GDP.

Not with 10% unemployment, those lost jobs won't just bounce back into existence. I think its a fairly safe bet the economy won't just rebound to its previous position, especially the longer the lock-down goes on for. And the Chancellor has gone on record as saying their will be "hardship" ahead.


(Taken from the BBC live feed)
 

Meerkat

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Not with 10% unemployment, those lost jobs won't just bounce back into existence. I think its a fairly safe bet the economy won't just rebound to its previous position, especially the longer the lock-down goes on for. And the Chancellor has gone on record as saying their will be "hardship" ahead.


(Taken from the BBC live feed)
It’s all guesswork really!
Retail and hospitality might never recover but there might be an increase in manufacturing as work is onshored due to short term disruption in the developing world and a loss of confidence in just in time foreign supply for the long term.
 

Bantamzen

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It’s all guesswork really!
Retail and hospitality might never recover but there might be an increase in manufacturing as work is onshored due to short term disruption in the developing world and a loss of confidence in just in time foreign supply for the long term.

It is, but what we do know that well over a million new Universal Credit claims have been made, and that there will be likely be several million self-employed not potentially earning until at least June if the lockdown isn't lifted, not to mention as yet untold millions currently furloughed workers (we don't have those numbers yet as the HMRC system for it is only in beta). I think we all know that many of these businesses will struggle and a lot may not make it until the end. So I would wager that any forecast turnaround
in Q2 will be widely off the mark.
 

Meerkat

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It is, but what we do know that well over a million new Universal Credit claims have been made, and that there will be likely be several million self-employed not potentially earning until at least June if the lockdown isn't lifted, not to mention as yet untold millions currently furloughed workers (we don't have those numbers yet as the HMRC system for it is only in beta). I think we all know that many of these businesses will struggle and a lot may not make it until the end. So I would wager that any forecast turnaround
in Q2 will be widely off the mark.
A lot of that self employed work will be suppressed demand, with a post lockdown rush possibly keeping prices high enough to make up a good bit of the cancelled demand.
And spending will have dropped so much that there will be a lot of people with spare cash at the end - whether they binge spend it (and much Less will go abroad than normal) or save it fearing rainy days is a big question....
 

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Bantamzen

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A lot of that self employed work will be suppressed demand, with a post lockdown rush possibly keeping prices high enough to make up a good bit of the cancelled demand.
And spending will have dropped so much that there will be a lot of people with spare cash at the end - whether they binge spend it (and much Less will go abroad than normal) or save it fearing rainy days is a big question....

Keep in mind though that there will be a lot of people on 80% of their wages or less for months. Some might save money without leisure activities, others will not. It remains to be seen what will happen, but there will be no quick bounceback, indeed the IMF are grimly predicting a global recession to match that of the 1930s.
 

yorkie

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It's difficult to say, but the longer it goes on for, the worse the outlook will be, so we can't leave it too long.
 

Greybeard33

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Yes, it's a really good article. Some of the extremists who shout very loudly really need to try to understand the bigger picture.
That article is dated 1st April. A lot has changed in the intervening 14 days, both in the science/modelling and in the acceleration of the UK death rate. The newly published ONS statistics show that, during the week ending 3rd April, there were already 60% excess deaths relative to the norm for this time of year. When the statistics for last week are eventually published, they will undoubtedly be much worse.

IMO the government will not risk relaxing the lockdown until there has been a sustained downturn in the death rate AND the modelling indicates that the residual distancing measures are sufficient to keep R0 below 1.
 

yorkie

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That article is dated 1st April. A lot has changed in the intervening 14 days, both in the science/modelling and in the acceleration of the UK death rate. The newly published ONS statistics show that, during the week ending 3rd April, there were already 60% excess deaths relative to the norm for this time of year. When the statistics for last week are eventually published, they will undoubtedly be much worse.
The main points remain unchanged, for example that ""Many people who die of Covid [the disease caused by coronavirus] would have died anyway within a short period," obviously it's difficult to say how many or how short a period. Bear in mind seasonal flu was mild in the last couple of years so there are more people who are alive now than perhaps would normally be expected to be, had seasonal flue deaths not been so low.

IMO the government will not risk relaxing the lockdown until there has been a sustained downturn in the death rate AND the modelling indicates that the residual distancing measures are sufficient to keep R0 below 1.
In an ideal world from the point of view of suppressing the virus you want the lockdown to go on for as long as possible but the bigger picture cannot be ignored.
 

C J Snarzell

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The lockdown exit strategy has to be handled very carefully and its about finding the right balance. The whole object of the lockdown is of course to protect the lives of the vulnerable and ensure the NHS is able to cope.

Unfortunately, as I've said in previous posts the knock on effect of the lockdown is mental health and other illnesses associated with being isolated and the fact many people have had their businesses/incomes wiped out because of the epidemic.

Reported domestic violence has gone through the roof because of the lockdown. At the end of March, I spoke to one of my former police colleagues who stated on working a night shift - every single job he responded to was a domestic where people had simply been spending all day cooped up indoors drinking and then falling out with one another. He said neighbour disputes have become a problem as people with too much time on their hands start having dust-ups with people next door.

People have had different predictions about how long the current lockdown measures will remain - I'm anticipating early June. If we relax some of the measures too soon the death rate will just spike again and the last 3 weeks will have been wasted.

However, if the lockdown continues too long we will be in danger of entering into the danger zone of civil unrest where normal decent people affected by things like finances, mental health, domestic violence, crime, etc will start to get angry and anxious about constantly being kept away from loved ones and earning a living.

For the time being most people in the UK (not including the small proportion of idiots who do what they want!) are following the government's guidelines but if we are still in this same situation eight weeks from now, I'm afraid we might start seeing cracks in the lockdown if the government doesn't ease the foot off the pedal.

Like I said - the exit strategy has to be carefully managed and monitored.

CJ
 

bramling

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The lockdown exit strategy has to be handled very carefully and its about finding the right balance. The whole object of the lockdown is of course to protect the lives of the vulnerable and ensure the NHS is able to cope.

Unfortunately, as I've said in previous posts the knock on effect of the lockdown is mental health and other illnesses associated with being isolated and the fact many people have had their businesses/incomes wiped out because of the epidemic.

Reported domestic violence has gone through the roof because of the lockdown. At the end of March, I spoke to one of my former police colleagues who stated on working a night shift - every single job he responded to was a domestic where people had simply been spending all day cooped up indoors drinking and then falling out with one another. He said neighbour disputes have become a problem as people with too much time on their hands start having dust-ups with people next door.

People have had different predictions about how long the current lockdown measures will remain - I'm anticipating early June. If we relax some of the measures too soon the death rate will just spike again and the last 3 weeks will have been wasted.

However, if the lockdown continues too long we will be in danger of entering into the danger zone of civil unrest where normal decent people affected by things like finances, mental health, domestic violence, crime, etc will start to get angry and anxious about constantly being kept away from loved ones and earning a living.

For the time being most people in the UK (not including the small proportion of idiots who do what they want!) are following the government's guidelines but if we are still in this same situation eight weeks from now, I'm afraid we might start seeing cracks in the lockdown if the government doesn't ease the foot off the pedal.

Like I said - the exit strategy has to be carefully managed and monitored.

CJ

The one thing which will be essential is to avoid any kind of post-lockdown euphoria, in other words a sudden mad dash for freedom. Any exit strategy will have to be heavily phased for that reason.

If social distancing needs to be maintained which I think is inevitable then phasing will be essential anyway.
 

Qwerty133

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That article is dated 1st April. A lot has changed in the intervening 14 days, both in the science/modelling and in the acceleration of the UK death rate. The newly published ONS statistics show that, during the week ending 3rd April, there were already 60% excess deaths relative to the norm for this time of year. When the statistics for last week are eventually published, they will undoubtedly be much worse.

IMO the government will not risk relaxing the lockdown until there has been a sustained downturn in the death rate AND the modelling indicates that the residual distancing measures are sufficient to keep R0 below 1.
Just because there is a large increase in weekly deaths it does not mean the majority of those who have died weren't going to die in the near future and it will take a number of months to become clear how many of those who have died were not otherwise close to death. Unfortunately this makes it hard to work out the economic cost per life saved in the short run, let alone the more sophisticated models that are usually used in health economics in determining whether a treatment is value for money. In normal circumstances the NHS uses a threshold of around £20-30,000 per QALY* gained from the use of a treatment (with some exceptions, such as for rare diseases where it is accepted the development costs have to be spread over fewer patients and therefor the cost per patient is going to be higher). Even if the economic cost of lockdown could be quantified at this stage (which it realistically could not), the problems with working out such a cost for the current situation are multiple. for example it is impossible to accurately predict how many (and who) would have died in the absence of lockdown, and while the typical life expectancy could be substituted to work out how long people had left to live (using figures accounting for diagnosed preexisting conditions and socio-economic factors) and the average quality of life with age there is quite possibly a reason why some are more likely to die of COVID than others, and that reason could be linked to early mortality more generally even if whatever the link is hasn't yet been detected.
*QALY or quality adjusted life year, is a way to put a value on different qualities of life compared to perfect health (1) or death (0) and is used instead of pure time of life added to allow for treatments that increase the quality of life but not the quantity of life as well as reduce the stated value of treatments that are successful in keeping people alive in a very but not in giving them a decent quality of life. It is also possible that a disease itself could technically increase the QALYs as in some data sets many states are considered worse than death and therefore something that kills the extremely vulnerable immediately may technically increase the remaining QALYs from some negative value to 0 (morally however this does not mean that any disease that purely effects such people should be allowed to spread unchecked and shows why deeper analysis is needed).
 
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edwin_m

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I assume the QALY methodology doesn't take account of the possibility of the number of people needing particular medical facilities exceeding the number of those facilities that are available,. At that point the death rate would go up and there might be an increase in deaths from other causes when Covid patients have taken up the facilities that would normally be available to treat them. When that happens I would guess a QALY calculation becomes even more impossible.
 

Mogster

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That article is dated 1st April. A lot has changed in the intervening 14 days, both in the science/modelling and in the acceleration of the UK death rate. The newly published ONS statistics show that, during the week ending 3rd April, there were already 60% excess deaths relative to the norm for this time of year. When the statistics for last week are eventually published, they will undoubtedly be much worse.

IMO the government will not risk relaxing the lockdown until there has been a sustained downturn in the death rate AND the modelling indicates that the residual distancing measures are sufficient to keep R0 below 1.

It was published today, no? Maybe they’ve updated it And changed the date. It refers to the ONS stats to 3rd April which were published today With the usual 10 day delay.
 

Qwerty133

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I assume the QALY methodology doesn't take account of the possibility of the number of people needing particular medical facilities exceeding the number of those facilities that are available,. At that point the death rate would go up and there might be an increase in deaths from other causes when Covid patients have taken up the facilities that would normally be available to treat them. When that happens I would guess a QALY calculation becomes even more impossible.
A QALY related methodology does not care why an outcome is the way that it is but purely what that outcome is as it is (in fact as an economic tool many of those calculating such outcomes probably have no idea or understanding as to the scientific reasoning). That means it would consider the outcome in lockdown in comparison to there having been no 'treatment' (in other words allowing the virus to spread until heard immunity is achieved naturally) and would therefore include deaths for whatever reason. For example if 500,000 people with an average of 10 QALYS to live would die without intervention and 20,000 with an average of 5 QALYS (assuming a lower QALY value on the reasonable assumption that those who die due to a lack of available treatment will on average be younger and in better health than those who die due to the treatment not being sufficient to keep them alive) die despite lockdown, lockdown will have saved 4.9million QALYs will have been saved by locking down. The cost per QALY would then be worked out by dividing the cost of lockdown by 4.9 million. Based upon the typical NICE value of £30,000 in this case lockdown would have to cost no more than £14.7billion for lockdown to be considered a value for money treatment (although as the QALY values were plucked out of thin air the true acceptable cost in usual circumstances is almost certainly different to this).
 

Greybeard33

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It was published today, no? Maybe they’ve updated it And changed the date. It refers to the ONS stats to 3rd April which were published today With the usual 10 day delay.
The BBC article was updated on 14 April, after I posted #163 at 15:55. A cache of the original 1 April version can still be viewed on the Wayback Machine, see http://web.archive.org/web/20200406065850/https://www.bbc.co.uk/news/health-51979654 . Comparing the two versions, the following passage was deleted:
This, of course, can be done in the future only. But researchers at University College London have been trying to model it in advance.

If coronavirus turns out to be no more deadly than flu, the lockdown could limit the number of excess deaths to under 1,400 - more than 12,000 fewer than would have happened under the previous strategy of slowing its spread, before the decision was taken to move to lockdown.

If it turns out to be five times more deadly than flu, the lockdown could limit coronavirus to 6,900 extra deaths - more than 60,000 fewer than under the previous strategy.
The replacement in the updated version is:
This, of course, can be done in the future only.

But the Office for National Statistics has started to track this on a weekly basis.

The most recent data goes up to the start of April and shows in the week ending 3 April there were 6,000 deaths above what would be expected - this includes deaths in the community as well, so not just hospital deaths as is the case for England and Northern Ireland in the government's daily figures.

Interestingly, just over half of these were linked to coronavirus.

It is unclear what had caused the rest of the increase.

It could be that coronavirus deaths were being under-reported or there may have been an increase in indirect deaths linked to the virus, including people not seeking help for other health conditions or a rise in mental health-related deaths.
This change shows how the number of excess deaths directly attributed to Covid-19 in just w/e 3 April was nearly half that of the worst case number predicted for the whole epidemic in the UCL modelling quoted in the original version! No wonder the author deleted the reference to that discredited modelling. Of course the death rate has accelerated further since 3 April. Hospital deaths alone now total more than 12000, and even if we assume no more than 10% extra in care homes and the community, the excess death total is already more than double the UCL worst case of 6900, and still rising at nearly 1000/day.

The updated version still quotes the old Imperial College modelling of 16 March, which predicted the lockdown would restrict UK deaths to 20000, but I think it is now clear that that figure will be exceeded by a large margin, even if the lockdown is kept in place for months.

The issue the article fails to bring out is that removal of the lockdown would likely result in the Covid-19 death rate reverting to exponential growth, whereas on the other hand the deaths caused by a continued lockdown, due to mental health issues etc., would grow at a much slower rate.
 

Qwerty133

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The BBC article was updated on 14 April, after I posted #163 at 15:55. A cache of the original 1 April version can still be viewed on the Wayback Machine, see http://web.archive.org/web/20200406065850/https://www.bbc.co.uk/news/health-51979654 . Comparing the two versions, the following passage was deleted:

The replacement in the updated version is:

This change shows how the number of excess deaths directly attributed to Covid-19 in just w/e 3 April was nearly half that of the worst case number predicted for the whole epidemic in the UCL modelling quoted in the original version! No wonder the author deleted the reference to that discredited modelling. Of course the death rate has accelerated further since 3 April. Hospital deaths alone now total more than 12000, and even if we assume no more than 10% extra in care homes and the community, the excess death total is already more than double the UCL worst case of 6900, and still rising at nearly 1000/day.

The updated version still quotes the old Imperial College modelling of 16 March, which predicted the lockdown would restrict UK deaths to 20000, but I think it is now clear that that figure will be exceeded by a large margin, even if the lockdown is kept in place for months.

The issue the article fails to bring out is that removal of the lockdown would likely result in the Covid-19 death rate reverting to exponential growth, whereas on the other hand the deaths caused by a continued lockdown, due to mental health issues etc., would grow at a much slower rate.
A figure over a singular week without any context is of little use in determining much more than how many deaths took place in that week. What it doesn't tell us how many of those people wouldn't have seen Christmas in any case. It is quite possible that in a couple of months time the weekly deaths will be significantly below the typical value because the people who would have died in those weeks actually died in the week ending the 3rd April. In such a case the number of excess deaths over a number of months will be much lower than the sum of the weekly excess deaths (as in many weeks there will not only be no excess deaths but a lower than expected number of deaths) and it is the figure over a number of months that is more important (as sad as bringing any death forward however slightly is, the level of tragedy is much lower if most of those who died only had weeks to months to live in anycase).
 
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Starmill

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This debate is certainly worthy, but it is premature. Decreases in restrictions cannot be considered until after the first peak in cases, which is likely to be a stretched period of time in itself, and remains unknown if we're there yet.

To me it seems very noteworthy that the attitude at the top of government in Ireland is markedly different, and more reassuring, as well as the policy related to the suppression being significantly more effective.

To my mind, the most serious of the tragedies in our Covid-19 response lie in the early deaths of patients in hospital for unrelated reasons who caught a hospital acquired infection, care home residents who acquired the infection there, or essential staff (especially in healthcare and transport) who were likely infected while at work. Some people who have died in these categories lived normally, free or almost free from symptoms of their existing health conditions, or without any existing conditions at all. These deaths severely shame us as a country.
 
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takno

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This debate is certainly worthy, but it is premature. Decreases in restrictions cannot be considered until after the first peak in cases, which is likely to be a stretched period of time in itself, and remains unknown if we're there yet.

To me it seems very noteworthy that the attitude at the top of government in Ireland is markedly different, and more reassuring, as well as the policy related to the suppression being significantly more effective.

To my mind, the most serious of the tragedies in our Covid-19 response lie in the early deaths of patients in hospital for unrelated reasons who caught a hospital acquired infection, care home residents who acquired the infection there, or essential staff (especially in healthcare and transport) who were likely infected while at work. Some people who have died in these categories lived normally, free or almost free from symptoms of their existing health conditions, or without any existing conditions at all. These deaths severely shame us as a country.
There was an interesting thread on Twitter yesterday contrasting the actions taken in Ireland and attributing the higher death rate in the UK entirely to them. Unfortunately, while it was interesting and compelling it was wildly and disturbingly unscientific. I mean it was written by a history lecturer, but even in that context it was bad. You can't take took two wildly different countries in terms of population density, initial infection rates, ethnic makeup and other factors, and say they are basically the same except for a week difference in lockdown time, and then claim that the week's delay was therefore entirely responsible for all of it.
 

hooverboy

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There was an interesting thread on Twitter yesterday contrasting the actions taken in Ireland and attributing the higher death rate in the UK entirely to them. Unfortunately, while it was interesting and compelling it was wildly and disturbingly unscientific. I mean it was written by a history lecturer, but even in that context it was bad. You can't take took two wildly different countries in terms of population density, initial infection rates, ethnic makeup and other factors, and say they are basically the same except for a week difference in lockdown time, and then claim that the week's delay was therefore entirely responsible for all of it.
I don't think it can be entirely attributed to the approaches that individual countries have taken,although it has certainly got a bit of effect,
places like london and bicester village etc are tourist magnets for the chinese,in a way that dublin is not, so you have additional opportunities for transmission in these cases.We saw this in italy at the beginnings of their crisis,it was the lombardy region that got hit first and hardest.It just so happens that region is home to all the high fashion outlets so cherished by tourists with big wallets.

Population density is also a factor.
A lot of ireland is rural.
 

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Schools would return after the summer break.

Actually, I think schools certainly shouldn't go back before September. Especially considering the fact that children are super-spreaders.

I know there has been some discussion in the media recently (or pressure) to try and get them re-opened, but I can tell you now (as someone who currently works in a primary school and sees it how it is). There's no way social distancing can be enforced with a full cohort in attendence. That's not due to any lack of good intention, but simply the buildings themselves, the size of classrooms and the classes they normally contain would not permit anyone to stay 2m apart. To put it simply, three weeks ago we had 20 key-worker children in attendence and they had to be distributed between two different classrooms to keep them all adequately 2m apart. That was two out of seven classrooms used! How on earth we are supposed to space out 220 of them, is beyond me (that's before we think about the staff). Likewise, getting 4 and 5 years olds to actually stay 2m apart every minute of the day, not going to work.

I suppose the only other way is to take certain year groups on certain days, but then this has the knock-on effect for child-care provision for parents who have children in different years.

With regards to your idea about an app on everyone's smartphones to track whether they had been in contact with the virus or not, well specifically regarding children and phones in school settings, most primary schools, if they let children take phones in, usually collect them as part of normal safeguarding protocols. Can't speak for secondaries with regards to this.
 

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I suppose the only other way is to take certain year groups on certain days, but then this has the knock-on effect for child-care provision for parents who have children in different years.

That's better than a knock-on for ALL parents, of course.

It will be impossible to do anything if we have to dig through everything to see if it's scrupulously fair. There will have to be a lot of "good enough" going on. That's true of the lockdown itself - a friend pointed out, probably correctly, that if you had a "no exceptions" immediate lockdown you could actually wholly wipe the virus out - but that would require literally no exceptions - everyone inside their house, windows closed, if you don't have food you starve, if you need medical care you die for the greater good. That sort of thing could never happen in the UK, and even China didn't quite go that far.
 

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Well I suppose our school would do 'family' groups to get round that one. But I guess it would mean at best children would only be going to school part time, once a week or so. Really depends on the size of the school and the space within it and the staffing levels.
 

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Well I suppose our school would do 'family' groups to get round that one. But I guess it would mean at best children would only be going to school part time, once a week or so. Really depends on the size of the school and the space within it and the staffing levels.

Yes, it will rather depend on the school and other venues they can call on. You'd have to get rid of breaktimes in their current format, same with everyone gathering in the hall for lunch and probably traditional PE as well. So in secondary schools, certainly, that's potentially the hall and sports hall/gym repurposeable for extra classroom space, and potentially Portakabins on the playground too. You could also use other venues off-site e.g. community centres and University buildings - there was a severe fire at my school when I was in year 10 which took out about 10 classrooms and to work around that years 10 and 11 had a term of having school at the local university, which worked because their terms are much shorter.
 

Mat17

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I suppose those ideas could work. We have already scrapped breaktimes and lunchtime in the hall.

I suspect secondaries will be in a much better place to find work around solutions, based simply on the fact that they are generally much larger establishments. Currently redundant university campuses though would be a good idea, plenty of space there.
 
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