Exit strategy predictions

[edwin_m]

I suppose it depends on what measure you're looking at. On a risk assessment you typically have two columns - severity and likelihood. Often a risk will be accepted if the severity is high but the likelihood low, e.g. driving a car there is a risk of death but the likelihood is low. This would be why we didn't lock down for SARS-1 and Ebola.

With COVID19 what you've got is moderate severity (<1% death risk, which is significant but not as high as the other two diseases under discussion) but high likelihood. This gives a figure high enough to make mitigation necessary - hence the lockdown.

In this case the severity affects the likelihood - inversely. SARS and Ebola would strike people down quickly so didn't have much chance to spread themselves before the patient went into relative isolation. Both were therefore controllable by specific anti-infection measures which didn't have a widespread impact on other activity - the likes of temperature measurement of travelers for SARS and strictly controlling contact with those who were obviously displaying Ebola symptoms.

Covid is far less specific in its symptoms and some, at least, are highly infectious at a time when they are not displaying any. Hence the need to effectively assume everyone is infectious, and the far wider impact on general activity.

6862 has posted much the same thing as I was writing this.

There was an interesting debate on Channel 4 last night between prominent scientists, who communicated some very good points effectively (at least to me, though I have more scientific background than a lot of people would). I think the key message was that we need a lot more information particularly on the rate of infection of the general population, before we can hope to formulate an exit strategy - and a study into that has been announced this morning. In this respect at least, I agree with the government that we shouldn't say much about what might happen and when, because we just don't know yet and to do so would cause public confusion and raise false expectations. There are other questions to be answered on why we have got into this situation, but those won't help to get out of it.

I think the lack of that information is why this thread is somewhat going round in circles.

 

[HH]

I suppose it depends on what measure you're looking at. On a risk assessment you typically have two columns - severity and likelihood. Often a risk will be accepted if the severity is high but the likelihood low, e.g. driving a car there is a risk of death but the likelihood is low. This would be why we didn't lock down for SARS-1 and Ebola.

With COVID19 what you've got is moderate severity (<1% death risk, which is significant but not as high as the other two diseases under discussion) but high likelihood. This gives a figure high enough to make mitigation necessary - hence the lockdown.

I don't disagree with anything you've said here, but my measure would have to be deaths. According to Johns Hopkins, that's 183,559 so far for covid-19, and we know that's understated because for many countries only hospital deaths are included in the official stats. There's also the fact that most deaths so far are in the Western Democracies with strong healthcare, whereas Ebola deaths were largely in West Africa, which is clearly not as well-placed to deal with viruses.

A more comparable pandemic would be H1N1 Flu in 2009 (swine flu) that caused around 284,000 deaths. However, as this was a variant on a know flu strain, developing a vaccine was relatively rapid (and perhaps more importantly success would have been expected from the off) and the death rate per infection was much lower (0.02%). I think it's clear that, unchecked, covid-19 would cause a lot more deaths than H1N1.

 

[Bletchleyite]

So far around 10,000 people have Covid on their death certificates. Since January around 30,000 people have alternative influenza like illness (ILI) on their death certificate. Covid still has some way to go to catch up with this years very mild flu season, of course the Covid deaths have all come in a short period so far. Then there’s the problem of death with/from Covid.

I got sad news today that my remaining great aunt is in hospital with a severe stroke, she is still alive but it is not believed she will regain consciousness. This isn't something I wanted to hear, but at 90 it wasn't unexpected, and the upside is that it was very quick (certainly I personally want to be fine but old then one day just keel over and die, not live in a home for many years - she was living at home and looking after herself and her dog just fine with occasional family visits and them dropping off her shopping once the shielding started).

If she is tested and tests positive for COVID (doubt they will, but if they did), she'll be down on the figures, even though this seems clearly not to be a COVID death in reality.

What you've also got with people in that position is, let's say she caught COVID 3 months ago and died as a result of that, that has just moved a given death 3 months earlier. So we might well see, along those lines, a reduced general death rate once this is over, because a fair number of the people who would die over the next 12 months of age related issues are dying now of COVID instead.

 

[Bletchleyite]

I don't disagree with anything you've said here, but my measure would have to be deaths. According to Johns Hopkins, that's 183,559 so far for covid-19, and we know that's understated because for many countries only hospital deaths are included in the official stats. There's also the fact that most deaths so far are in the Western Democracies with strong healthcare, whereas Ebola deaths were largely in West Africa, which is clearly not as well-placed to deal with viruses.

A more comparable pandemic would be H1N1 Flu in 2009 (swine flu) that caused around 284,000 deaths. However, as this was a variant on a know flu strain, developing a vaccine was relatively rapid (and perhaps more importantly success would have been expected from the off) and the death rate per infection was much lower (0.02%). I think it's clear that, unchecked, covid-19 would cause a lot more deaths than H1N1.

What's probably better is not talking simplistically in a way that might be misinterpreted, e.g. of a "mild" or "severe" disease, but being more specific, e.g. "a disease with mild symptoms but a relatively high level of infectiousness", as for instance you might describe the common cold.

(20% or so of colds are coronaviruses, speaking optimistically for a second wouldn't it be nice if the process of developing a vaccine for SARS-CoV-2 produced a vaccine for that! )

 

[HH]

What's probably better is not talking simplistically in a way that might be misinterpreted, e.g. of a "mild" or "severe" disease, but being more specific, e.g. "a disease with mild symptoms but a relatively high level of infectiousness", as for instance you might describe the common cold.

Well it's mild symptoms for most, but not for some. I know that those getting stronger symptoms are largely made up of people with other health issues, but surely our beloved PM puts paid to the idea that only those with pre-existing health issues are at risk?

 

[Bletchleyite]

Well it's mild symptoms for most, but not for some. I know that those getting stronger symptoms are largely made up of people with other health issues, but surely our beloved PM puts paid to the idea that only those with pre-existing health issues are at risk?

You might want to re-read my post you quoted, I specifically referred to the common cold in that description, not COVID19.

 

[takno]

I suspect the OP was meaning that while these diseases are severe for people who are infected by them, they are so deadly that the carriers die quickly (especially in the case of ebola, you start bleeding uncontrollably) and so the disease can't keep up sustained transmission for a long time. The reason why this current virus is so 'succesful' is that it isn't really very likely to kill, or even completely incapacitate, the vast majority of people it infects, so they can carry it around for days/weeks and infect a load of other people in that time. So for the average person, this disease is not severe, but overall its effect on a population of individuals seems to be greater.

What I meant is that that reason we treat pandemics seriously is that they have the potentially to be globally absolutely massive events. It's not at all inconceivable that a pandemic could come along and wipe out 10% of the world's population, debilitating many more for months at a time and leaving large scale long-term effects on the body, cutting down people in their prime in a way that would make the continuing function of society difficult or impossible. If we didn't respond quickly and effectively to Ebola or if it had had a combination of its deadly effects and a slightly slower onset, then it could absolutely have been such a pandemic. This is a pandemic which is spreading very effectively, but gives every sign of killing less than half a percent of people. The sad deaths are very heavily concentrated on people who, while they are very much still people and are important, are less often key to the future functioning of society and often have few years of quality life ahead of them anyway. In the context of how bad pandemics can be, this just isn't the big one.

In comparison the death toll from lockdown-induced factors such as lack of cancer screening, stress and lack of healthy living, and increasingly global-scale hunger, has the potential to dwarf the death rate from the disease. We should have locked down international travel earlier, tested and traced earlier and harder, and probably done the initial month of lockdown while we figured out the seriousness and prepped for treating it at scale. Beyond that, if we don't get over this situation soon I think we are looking at a self-made global disaster that will kill millions have a catastrophic effect on respect for government and international cooperation.

 

[HH]

The jury is still out...

It all depends how long the virus circulates at this level for and how virulent it remains.

So far around 10,000 people have Covid on their death certificates. Since January around 30,000 people have alternative influenza like illness (ILI) on their death certificate. Covid still has some way to go to catch up with this years very mild flu season, of course the Covid deaths have all come in a short period so far. Then there’s the problem of death with/from Covid.

It’s a very difficult situation. it’s not clear cut that the current response will be viewed as proportional when we look back on this.

I don't know where you got the 10,000 figure from. Our official, hospital only, deaths from covid-19 number is 18,100 and it is known that there are many thousands of deaths in care homes that are not part of these figures. If you are looking at morbidity rates, then they are both lagging and inexact; we will not know the overall picture for some time.

Nor do I agree that the jury is still out. We have seen a great example, thanks to President Trump, about what can happen if you are even more lukewarm in your response than we have been in the UK. Things here have gone better than they should have, based on government policy, because a majority of people have taken things into their own hands. How long it circulates is up to us, but so far there is no indication that this is a virus that mutates rapidly to a less virulent form; nor would I expect it to, as it has no problem with spreading as it is.

 

[Mogster]

There is also the issue of deaths indirectly caused by the lockdown and the the effects on quality of life.

Screening programs for conditions like bowel and cervical cancer are pretty much suspended. Normally routine operations like cateract surgery and joint replacements are also suspended and even if they were re-started now the backlog will take months to clear.

 

[HH]

You might want to re-read my post you quoted, I specifically referred to the common cold in that description, not COVID19.

No, I read it fine. I was pointing out that you cannot say that the symptoms of covid-19 are mild.

 

[Mogster]

I don't know where you got the 10,000 figure from.

The BBCs analysis of this weeks 10 day ONS statistics which include community deaths.

 

[HH]

There is also the issue of deaths indirectly caused by the lockdown and the the effects on quality of life.

Screening programs for conditions like bowel and cervical cancer are pretty much suspended. Normally routine operations like cateract surgery and joint replacements are also suspended and even if they were re-started now the backlog will take months to clear.

I know this very well as I had cancer surgery just before the lockdown started. I've not had a single one of my follow up appointments (or my appointment for a scan related to an earlier cancer operation) since. I do think the policy here is mistaken, but hopefully it won't kill me.

 

[HH]

The BBCs analysis of this weeks 10 day ONS statistics which include community deaths.

But you said the number was those who had covid-19 on their death certificates - not even remotely the same thing.

 

[Bletchleyite]

No, I read it fine. I was pointing out that you cannot say that the symptoms of covid-19 are mild.

Please do quote the post where I said that.

 

[6862]

What I meant is that that reason we treat pandemics seriously is that they have the potentially to be globally absolutely massive events. It's not at all inconceivable that a pandemic could come along and wipe out 10% of the world's population, debilitating many more for months at a time and leaving large scale long-term effects on the body, cutting down people in their prime in a way that would make the continuing function of society difficult or impossible. If we didn't respond quickly and effectively to Ebola or if it had had a combination of its deadly effects and a slightly slower onset, then it could absolutely have been such a pandemic. This is a pandemic which is spreading very effectively, but gives every sign of killing less than half a percent of people. The sad deaths are very heavily concentrated on people who, while they are very much still people and are important, are less often key to the future functioning of society and often have few years of quality life ahead of them anyway. In the context of how bad pandemics can be, this just isn't the big one.

In comparison the death toll from lockdown-induced factors such as lack of cancer screening, stress and lack of healthy living, and increasingly global-scale hunger, has the potential to dwarf the death rate from the disease. We should have locked down international travel earlier, tested and traced earlier and harder, and probably done the initial month of lockdown while we figured out the seriousness and prepped for treating it at scale. Beyond that, if we don't get over this situation soon I think we are looking at a self-made global disaster that will kill millions have a catastrophic effect on respect for government and international cooperation.

I think for a pandemic to wipe out say 10 % of the world's population it would likely have to come on the back of other factors that have largely weakened the population, or the infrastructure that supports it, or it would have to occur in a part of the world that is already threatened by other natural phenomena (drought, famine etc.). Obviously in the Middle Ages there were plagues that killed a sizeable percentage of the population (but in those cases there were doubtless other health factors at play). So I suppose a plague pandemic could kill large numbers again, but it would have to have the optimum combination of individual deadliness and 'spreadability' - a combination that thankfully doesn't come along very often. In the case of this virus, the transmission side of things is obviously highly effective, but thankfully most people survive it.

This is all just my personal view on it, no particular scientific insight (I am a scientist but in a completely different field!).

 

[HH]

Please do quote the post where I said that.

I didn't say you did...

 

[Domh245]

If she is tested and tests positive for COVID (doubt they will, but if they did), she'll be down on the figures, even though this seems clearly not to be a COVID death in reality.

I'm sorry to hear about your Great Aunt, I hope that it is quick and relatively painless for her. However, my understanding is that if she was tested and it came back positive, unless it was a contributory factor she wouldn't be counted as one of the figures. It's death because of COVID19, not deaths with

What you've also got with people in that position is, let's say she caught COVID 3 months ago and died as a result of that, that has just moved a given death 3 months earlier. So we might well see, along those lines, a reduced general death rate once this is over, because a fair number of the people who would die over the next 12 months of age related issues are dying now of COVID instead.

This is a very good point and whilst I suspect in theory it holds up, the other damage caused by our response may not allow this to play out.

Well it's mild symptoms for most, but not for some. I know that those getting stronger symptoms are largely made up of people with other health issues, but surely our beloved PM puts paid to the idea that only those with pre-existing health issues are at risk?

Just because someone is outside of the at risk groups doesn't mean that they are immune from catching it. Even then, Boris isn't completely out of the risk free zone - he's a 55 year old male so he's in one of the higher risk groups, but he is also a bit larger than some which won't help, and that's assuming there are no other underlying conditions that aren't mentioned. Boris was just particularly unlucky, but it doesn't change the fact that the virus is pretty low risk to a large part of the population

If we didn't respond quickly and effectively to Ebola or if it had had a combination of its deadly effects and a slightly slower onset, then it could absolutely have been such a pandemic.

Another thing that probably prevented Ebola becoming a pandemic was the fact that there's not much international travel from West Africa in the same way there is from China. It took hold in West Africa and was quickly locked down there with only a handful of cases making it out where people had specifically gone to assist the fight. SARS-COV-2 originating in China meant it quickly spread and established itself worldwide.

 

[takno]

I'm sorry to hear about your Great Aunt, I hope that it is quick and relatively painless for her. However, my understanding is that if she was tested and it came back positive, unless it was a contributory factor she wouldn't be counted as one of the figures. It's death because of COVID19, not deaths with

The three figures I've seen in use for the UK are death in hospital after testing positive, COVID mentioned on death certificate, and Overall mortality in excess of the average for week-of-year. It's extremely likely the deaths in hospital figure includes a lot of people who died of something else, or would have died of something else within a short timeframe. Death certificates are likely to sway on over-reporting - if you see a death in a nursing home right now where difficultly breathing was reported it would seem logical to include it as a contributing factor, which would appear in the lists.

Once we have a few more weeks of data to look at and can exclude factors like the differing date of easter, the overall mortality rates are probably the most interesting ones. Even then we may be seeing a sudden loss over a few weeks of people who would have sadly died earlier from flu in a more aggressive flu season, or would have sadly died a little later in the year from other health issues. The annual, or at least semi-annual death rates will be more instructive, but only in retrospect - the data will necessarily be too late to make the decisions we need to make on lockdown.

 

[Bletchleyite]

I'm sorry to hear about your Great Aunt, I hope that it is quick and relatively painless for her. However, my understanding is that if she was tested and it came back positive, unless it was a contributory factor she wouldn't be counted as one of the figures. It's death because of COVID19, not deaths with

Are you sure? I was under the understanding that it was deaths with.

 

[Bantamzen]

I'm sorry to hear about your Great Aunt, I hope that it is quick and relatively painless for her. However, my understanding is that if she was tested and it came back positive, unless it was a contributory factor she wouldn't be counted as one of the figures. It's death because of COVID19, not deaths with

My understanding is the opposite, that the ONS figures are of deaths with Covid not as a result of?

 

[Domh245]

I may be confusing it with the death certificates! It does seem like the daily announced hospital deaths are anyone where they've tested positive which does seem like it'll over-represent the numbers, but I suppose that they don't test everyone, only those they suspect have it.

 

[Domh245]

My understanding is the opposite, that the ONS figures are of deaths with Covid not as a result of?

ONS is where COVID is stated on the death certificate, meaning that it has to be suspected to have played a role in that persons death, indeed in the guidance it says: "You should also enter any other diseases, injuries, conditions, or events that contributed to the death, but were not part of the direct sequence, in part two of the certificate. The conditions mentioned in part two must be known or suspected to have contributed to the death, not merely be other conditions which were present at the time. " - ie on the death certificate it'll state something like "Interstitial pneumonitis as a result of COVID 19, diabetes mellitus having been a factor"*


*paraphrasing the example from the official guidance, pg 6

 

[AM9]

Ok. So your proposal is to keep the lockdown in place for several years until there's absolutely zero risk of anyone catching the virus?

There will always be an element of risk in life. Long before anyone had heard of COVID-19 you ran the risk of catching potentially serious illnesses off anyone you came into contact with but we all took that risk because the benefits of doing the things we enjoyed outweighed the risks of us becoming ill. For the sake of the economy and for people's quality of life we need to lift the lockdown and get businesses open again as soon as the risk is down to a manageable level.

Not at all, - there is obviously (hopefully) a point in the future where many activities, essential for normal life can be pursued with the risk adequately managed. A warning that you might get infected isn't managing the risk as it wouldn't give weight to the risk to everybody else that visitors to the pub would expose everybody else that they have close social contact with, whether deliberately of inadvertently.
Unfortunately for those who have chosen a career in pubs and rely on it for an income, drinking isn't one of those activities essential for normal life, - except in the mind of an alcoholic of course.

 

[Meerkat]

Loss of match day revenue is not awful for Premier League clubs. TV and commerical revenue make up the vast majority of their revenue. In the lower leagues the loss of match day revenue can be compensated through ifollow* income and an increase in solidarity payments from the Premier League. The Premier League and Football League can afford to be run without fans in attendance at matches. The legal side of broadcasting additional Premier League matches in the UK is unlikely to be insurmountable, its in Sky and BT's interest to reach a deal.

*For the benefit of anyone who isn't aware, all football league matches not broadcast on TV are streamed on ifollow, which is run by the football league clubs. Matches at 3pm Saturday are only streamed for international fans but the blackout law could be temporarily lifted by Parliament. Its a flat rate of £10 per match, 1 device only.

If matchday income isn’t important why did Spurs spend a billion quid on a new stadium?
I don’t think EFL could survive without matchday income- the watching fee would be less than gate charge, they wouldn’t get all the booze, food, and hospitality money, and I doubt how many would pay to watch sat at home on their own rather than meeting up with their mates (which is half the appeal)

Indeed, moves to try and recruit dental nurses for hospital work, probably aircraft stewards and other people in customer facing positions who can't otherwise work at the moment.

They are all helpers - we can’t magic trained nurses and doctors up

Impossible to do most of these things without being in each others air space for a lengthy period of time and hairdressers (for example) have a lot of hot air circulating. Can't see these being in phase 1.

Other countries have released these businesses early - AIUI the thinking is there are very few customers at one time, so if the barber cleans properly it’s ok.

There are other issues as well. I am concerned about other health conditions. It is now establish that many screening for cancers and other conditions has effectively stopped as has treatment. How many deaths from that? I had to go to A&E yesterday (don't ask!) and was in and out in 45 mins, how many heart attacks or strokes are happening with people not wishing to go to A&E resulting in deaths.

Trouble is this is either/or - if you bring back all the capability for non Covid care you reduce your Covid capacity and can’t release lockdown as quickly.

 

[yorksrob]

Not at all, - there is obviously (hopefully) a point in the future where many activities, essential for normal life can be pursued with the risk adequately managed. A warning that you might get infected isn't managing the risk as it wouldn't give weight to the risk to everybody else that visitors to the pub would expose everybody else that they have close social contact with, whether deliberately of inadvertently.
Unfortunately for those who have chosen a career in pubs and rely on it for an income, drinking isn't one of those activities essential for normal life, - except in the mind of an alcoholic of course.

It will be a very dull existance if we can only partake in those activities "essential to human life".

 

[Bantamzen]

It will be a very dull existance if we can only partake in those activities "essential to human life".

Very dull indeed, in fact pretty much most of what we undertake in our normal lives could be deemed as "not essential". I'm thinking some folk need to be careful what they wish for...

 

[Meerkat]

Very dull indeed, in fact pretty much most of what we undertake in our normal lives could be deemed as "not essential". I'm thinking some folk need to be careful what they wish for...

But then we just claim it has affected our mental health, which apparently then allows you to do much more!

 

[yorksrob]

Very dull indeed, in fact pretty much most of what we undertake in our normal lives could be deemed as "not essential". I'm thinking some folk need to be careful what they wish for...

Indeed. Arguably the current lockdown provides "all that is essential" for human life.

 

[Bantamzen]

If matchday income isn’t important why did Spurs spend a billion quid on a new stadium?
I don’t think EFL could survive without matchday income- the watching fee would be less than gate charge, they wouldn’t get all the booze, food, and hospitality money, and I doubt how many would pay to watch sat at home on their own rather than meeting up with their mates (which is half the appeal)

Many smaller clubs simply wouldn't survive, especially if the PL agrees a deal to air all remaining matches live on free-to-view TV.

But then we just claim it has affected our mental health, which apparently then allows you to do much more!

But then is good mental health essential for life? How would human society be if we just did the very basics? Would it become more or less cohesive. Plenty of studies have been done on humans in isolation that probably shed some light onto the matter

Indeed. Arguably the current lockdown provides "all that is essential" for human life.

I'd say it still offers more than "the essentials". I mean we can still use the internet for example, or do some gardening, or paint a wall, or read a book. None of with could be said to be "essential".

 

[Chester1]

If matchday income isn’t important why did Spurs spend a billion quid on a new stadium?
I don’t think EFL could survive without matchday income- the watching fee would be less than gate charge, they wouldn’t get all the booze, food, and hospitality money, and I doubt how many would pay to watch sat at home on their own rather than meeting up with their mates (which is half the appeal)

I said it wasn't awful for Premier League clubs to lose match day revenue, not that it wasn't important. Spurs built a new stadium at huge cost because increases revenue and will pay for itself in the long term. However, they can still go for months or even a season without match day revenue, especially if the rights to Premier League matches not currently broadcast in UK are sold (only 200 out of 380 matches are broadcast in UK). There are many Premier League Clubs where match day revenue accounts for only about 20% of revenue. For Liverpool it is barely over 25%. TV revenue is a much bigger income stream. For the Premier League the financial incentive is to get the matches played if at all possible, in order to avoid paying back £762m of TV money for this seasons matches not yet broadcast. Most Premier League clubs share of that is comparable to an entire seasons match day revenue.