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Hi Palerider, Re the graph of new cases, do you know how the number of cases is established, has that changed since the outbreak began, and what is the impact of continuing increases in testing capacity?Yesterday it was announced that England will be going back into lockdown. But I am not convinced we are getting this completely right and the long-term impact of care home restrictions is beginning to show.
The issues around the science of SARS-COV2 are complex, but the end target for policy makers is about protecting healthcare facilities from being overwhelmed versus economic cost of lockdown to quote Prof Neil Ferguson, Imperial College, London:
“We can say that these sort of policies will have this sort of effect, broadly on the epidemic trajectory, but it’s up to policy-makers to determine whether the benefits of that in terms of health impact are worth the economic cost.”
Anyway, after a very brief look at most of the evidence out there the reality is that what follows over the next few months is one of uncertainty rather than anything that is convincingly true or for that matter false. Two things were always a certainty: a second wave was inevitable as the first lockdown was eased and secondly lockdown is a very blunt instrument with little in the way of resolving infection rates long term -SARS-COV2 does not behave that way.
Now there has been mention of a chap called Dr Mike Yeadon, who has given some compelling opposite arguments and he does make some valid points. Out of interest he wrote an article in the Daily Mail last week (Yeadon, 2020) the link can be found in the reference section at the end of my rhetoric. What he says about the studies at Stanford are supported by Prof Ioannidis (Ioannidis, 2020) in his paper, I quote:
“based on the currently available data, one may project that over half a billion people have been infected as of 12 September 2020, far more than the approximately 29 million documented laboratory-confirmed cases. Most locations probably have an infection fatality rate less than 0.20% and with appropriate, precise non-pharmacological measures that selectively try to protect high-risk vulnerable populations and settings, the infection fatality rate may be brought even lower”
Inferred predicted mortality rates have ranged between 0.2% upwards to 1.4% dependent on which scientific group has published. At best we can say that predicted mortality is in the range of 0.2% to 1.4%. Hopefully, it will be the lower figure stated by Ioannidis (2020).
Now, the whole ethos of the Scientific Advisory Group for Emergencies (SAGE) is based on modelling SARS-COV2 penultimately to aid decision making around NHS resources more than anything else. This is because there is nothing else to offer at present other than expert care for those who become seriously unwell -that is the stark reality. The only tool anyone has globally in their toolbox to support healthcare providers is lockdowns. I got a bit fed-up with hearing the words ‘the science’ and ‘the scientists’ so I looked at what SAGE says about its work. SAGE has a number of studies it has openly published online, one of significance is by Ferguson et al (2020) which states:
“the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over. For countries able to achieve it, this leaves suppression as the preferred policy option”
What they mean by suppression is of course lockdown. These models are a crude representation of a natural phenomenon SARS-COV2. One of which is initially based on a previous study by Danon et al (2009) which looks at the effects of movement of hosts as opposed to the behaviour of disease itself. This is where the crunch comes because this kind of approach brings with it considerable uncertainty (Holmdahl & Buckee, 2020).
A paper by Lourenço et al (2020) gives a very convincing argument that it would be reasonable to expect deaths to be less in the second wave than the first wave. Is that assertion possibly true? If so, then the modelled prediction is wrong.
Below is a graph showing the trend for SARS-COV2 infection rates from April 2020 to date. A larger peak is seen in the current second wave of rates of infection
View attachment 63400
Below is a graph showing deaths from SARS-COV2
View attachment 63401
As can be seen, so far, the trends for infection rates are higher in the second wave, but the trend for deaths is lower than the first wave. What happens next is a point of argument between different scientific groups, but some groups are looking at the actual science of the virus and immunity (which to me holds more persuasion) but our guiding light (erm glimmer) is mathematical modelling to try and predict what are essentially unknowns. So, the result of SAGE is the following image that we were shown yesterday:
View attachment 63402
So, we have a graph that represents the different predictions from different groups, but this graph does not show a complete representation of the whole story. If Lourenço et al (2020) are right in their assertion of a lower death rate along with the assertion by Ioannidis (2020), then I will be scratching my head trying to puzzle out the above graph.
So, is any of this geared to how people are affected in care homes? In short, the only significant point of any of this has been about protecting the NHS, in particular intensive care beds, because of the possibility of being overwhelmed. I do not think any of us disagree with that, even though it seems to me there is some considerable uncertainty involved -best to be safe than sorry.
So how do we now deal with the care home situation and visiting? I think this requires more debate, because although none of us would disagree with another lockdown if it serves the end with which it is intended, we may find ourselves disagreeing with care home restrictions on visiting for much longer.
DANON, L., HOUSE, T. & KEELING, M. J. (2009) The role of routine versus random movements on the spread of disease in Great Britain. Epidemics, 1(4), 250-258. Available online: https://pubmed.ncbi.nlm.nih.gov/21352771 [Accessed 01/11/2020].
FERGUSON, N., LAYDON, D., NEDJATI-GILANI, G., IMAI, N., AINSLIE, K., BAGUELIN, M., BHATIA, S., BOONYASIRI, A., CUCUNUBÁ, Z. M., CUOMO-DANNENBURG, G., DIGHE, A., DORIGATTI, I., FU, H., GAYTHORPE, K., GREEN, W., HAMLET, A., HINSLEY, W., OKELL, L., VAN ELSLAND, S. & GHANI, A. (2020) Report 9: Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Imperial College COVID-19 Response Team. Available online: https://post.parliament.uk/models-of-covid-19-part-2/ [Accessed 30/10/2020].
HOLMDAHL, I. & BUCKEE, C. (2020) Wrong but Useful — What Covid-19 Epidemiologic Models Can and Cannot Tell Us. New England Journal of Medicine, 383(4), 303-305. Available online: https://www.nejm.org/doi/full/10.1056/NEJMp2016822 [Accessed 01/11/2020].
IOANNIDIS, J. P. A. (2020) Infection fatality rate of COVID-19 inferred from seroprevalence data. Bulletin of the World Health Organization, 1-37. Available online: https://www.who.int/bulletin/online_first/BLT.20.265892.pdf [Accessed 01/11/2020].
LOURENÇO, J., PINOTTI, F., THOMPSON, C. & GUPTA, S. (2020) The impact of host resistance on cumulative mortality and the threshold of herd immunity for SARS-CoV-2. medRxiv, 2020.07.15.20154294. Available online: https://www.medrxiv.org/content/medrxiv/early/2020/10/01/2020.07.15.20154294.full.pdf [Accessed 30/10/2020].
YEADON, M. (2020) Three facts No 10's experts got wrong: DR MIKE YEADON says claims that the majority of the population is susceptible to Covid, that only 7% are infected so far and virus death rate is 1% are all false. Mail Online. Available online: https://www.dailymail.co.uk/news/ar...DON-Three-facts-No-10s-experts-got-wrong.html [Accessed 30/10/2020].
Cases are established by confirmed test results (not forgettting the possibiloty of false positives). I was just looking at todays total since the beginning with a total of 1.03 million confirmed cases up till todays count and 46,717 deaths in the UK, which puts our overall mortality in the UK at 0.045%.Hi Palerider, Re the graph of new cases, do you know how the number of cases is established, has that changed since the outbreak began, and what is the impact of continuing increases in testing capacity?
Thanks @lemonbalm I know exactly what you mean -but telling myself I should be thankful I have hot water etc begins to wear thin after 9 months almost. You know there is a great passage of writing in The Boy, The Mole, The Fox and The Horse where they talk about a glass half full or glass half empty and the boy says 'I am lucky to have a glass at all'Sorry you're feeling so asterisky @Palerider . At the beginning of lock-down, I used to call mum's care home every day. I tapered off gradually and call about once a week now. If I get to talk properly with one of the carers I know well and mum's been calm and cheerful, it buoys me up but, if she's not (particularly if I can hear evidence of that in the background) , or nobody has time to talk or even answer the 'phone, I feel dreadful. It does shape our world. I suppose that's just part of loving them. "Tomorrow's another day" became my mantra when I was visiting, even though sometimes I didn't really feel like having another one.
I hope you feel better tomorrow.
When I'm in the shower in the mornings, I think of things I have to be grateful for (clean hot water, cup of tea first thing, blah blah blah). It's probably incredibly, annoyingly positive and cheerful of me to say it here right now, I know, but it really can make you feel better.
May you overcome the dry period lifes mysteries bring. Let us all come home after this long weary path