Am I missing something? (covid related)

[IamAporcupine]

Apologies if there is thread about this already.

So the number of new cases is rising rapidly, I get that.
But if you look at the number of total deaths is flat as a pancake.

As far as I know, hospitals are doing OK, no inminent risk of overwhelming the NHS, and a big proportion of the affected cases are relatively mild or even asympomatic.

Again, I know health workers in Spain and France who were up to their noses in April but are absolutely fine now, even though they are a couple of weeks ahead and their 'numbers' are rocket high now too.

I must be missing something because I really do not understand why the panic about 'the new cases', surely the important figures are hospital admissions and mortality?

If hundreds of thousands of people are all ill at the same time it could cause havoc for the NHS, essential services and the economy..

I mean ill enough to have to stay off work or to seek medical help.

Also, there are potentiallong term effects, which not enough is known about at the moment.

My understanding is there is a lag. A lag before people getting a bit ill become very ill (remember our PM wasn't admitted to hospital for quite a while after he got covid) and a knock on lag when hospitals get fuller, so other people stay away, and they get so full that they can't fit covid patients in unless they're blue in the lips etc.

So my understanding is we're at the beginning of the snowball now where things get worse and worse for a bit. Hopefully the experience the Drs and health workers gained in March, April, May will enable them to treat people quicker and more effectively this time and reduce the death rate significantly.

My other feeling is that even though number of cases looks like similar numbers to last time, I think we're testing many more people, certainly many more people with mild symptoms. So where eg last time 1000 new positive tests might be the illest people in hospital and their immediate contacts, now its closer to anyone with any symptom. So before we 'knew' 1000 out of say 20,000 real cases, whereas now we 'know' 1000 out of say 5,000 cases.

Numbers completely made up but hopefully they illustrate my point

I think the concern is that now we have high numbers and rising. Most of those affected are in the 20-29 year old bracket and so the infection rate does not lead to high hospital admissions. However, as the 20-29 year old spread it into other age brackets which is inevitable we will then see the increase in hospital admission. Chris’s Whitty explained it in his briefing yesterday. It’s really worth a watch if you can get it on catch up / iPlayer.

Sorry I meant to attach a chart, here it is

Because, as we all saw earlier on the year when we wondered what all the fuss was about in March then over 1000 people died every day in April:

New cases lead to hospital admissions and deaths as sure as night follows day.

Death numbers are about three weeks behind case numbers. That’s because it takes about three weeks for people to fall ill, need hospital treatment and then go on to die.
The worry is that if we let cases rise over say the next month, the deaths that follow could be huge. The R is fairly high suggesting possible exponential growth

You're missing the rise in death rates - from 0.1 to 04 per 100,000 in the last 10 days. France and Spain followed similar trajectory, and their rate (which were 0.1 a couple of weeks before that) are now 0.9 and 2.4

If we waited until our rate were that high before we acted, it would be much harder to get them back down (compare dto preventing them rising). Do you actually want another lockdown? Because you seem very ready to risk IME by ignoring the beginnings of a second wave but being disinclined to take steps now when it can still be prevented.

@ChavvySexPond - well obviously not, see the above graph.

Also, in April doctors had no idea how to treat a case, whereas now there is more knowledge and resources

I must be missing something
The PM's speech earlier. He told us hospital admissions are increasing.

What you're also missing (to be fair, so is Boris) is info on the potential long-term lung, heart, or brain damage. Long Covid patients include many who had initially mild cases that didn't require hospitalisation. At this stage we don't know enough about it and therefore it's wise to be cautious.

Perhaps the main thing however is the whole point of taking action is preventative. We wait until hospitals are full up and everyone's off sick, then it's too late.

@Oly4 - if it's just becuase we are 3 weeks behind, what about Spain?

Probably lots of possible and combined reasons. We are testing more people so more positive tests but not necessarily as many actual cases. Lag between infection and hospital admissions and death. More younger people than older people catching it in recent months. Summer and outdoor activities reducing severity. Reduced viral load because of masks meaning milder cases. Better treatment as NHS learn more about it.

However we are moving into winter now and cases eventually pass from young socialisers to older generations so dont get too hopeful.

Also, in April doctors had no idea how to treat a case, whereas now there is more knowledge and resources
I think that's doing drs and nurses a disservice. They know how to treat respiratory illness but not when the hospital if full to capacity.
There is still no treatment/cure and we are approaching winter. The NHS struggles every winter due to cuts and so we also need to slow things down to take that into account.
The ons said for every 1 diagnosed case here are 4 not tested so it shows community transmission is happening fast

Thanks @MoggyP, when looking at those graphs I posted I could not see any increase in mortality, hence the question.

I definitely do not want another lockdown, and I am not ignoring a second wave which is clearly happening. What I am saying is that, it would seem that this second round is quite different from the first one, so it might need to be dealt with differently?

[quote IamAporcupine]@ChavvySexPond - well obviously not, see the above graph.

Also, in April doctors had no idea how to treat a case, whereas now there is more knowledge and resources[/quote]
New cases happen a month or so before new deaths.

So we can only see the cases now.

And we know what's going to happen because we all lived through it in March and April.

And yes the doctors know more now.

But the deaths will still happen as a result of those cases going up.

It's "the iron law of geometric progression"as the PM puts it.

Exponential curves always look like nothing. Until they're not.

but ChavvySexPond - look at the curves for Spain, if this second wave was exactly the same as March/April, shouldn't their number of deaths have gone up much more by now?

In march we were comparing people who got tested because they were hospitalised. What you were seeing was what proportion of hospitalised patients went on to die. Now we are comparing people who have tested positive non hospitalised cases with people who go on to die.

Here is another graph from worldometer, UK projections. Exponential growth with cases (and deaths) doubling every week means we will be up to March levels of deaths in December. The purple line is based on a lockdown in December, red is a continuation of current restrictions.

Spain which is a few weeks ahead of us is currently recording 150-250 deaths a day. The case curves for March for Spain and the UK will not be accurate as testing was substantially lower so it is not accurate to look at the ratio of cases to deaths over time.

What I am saying is that, it would seem that this second round is quite different from the first one, so it might need to be dealt with differently?

Not really, it's still a readily transmissible virus which causes severe enough illness to knock adults off their feet for 3 or so weeks (typical case) hospitalises many, leaves others with long term consequences (stroke, lung damage) and of course is directly lethal to some.

We have some improved treatments, so the death rate might be a bit lower - which will look good (as it is one of the main countable things). What we don't count is the full range of effects.

How readily it passes between people is a characteristic of the virus, and that hasn't changed. All we can do to control the spread is to reduce the amount of contact between people

Death numbers and hospital admissions are increasing.

We are also beginning to realise that “long Covid” is equally as much of a problem so need to stop the spread to reduce the amount of people who even though their infection was seemingly mild end up with long term debilitating side effects

I hope the death rate will be lower.
Everyone is more aware. And
hopefully Covid positive patients are no longer being discharged to care homes!

Plus we are testing much more, however much of a shit show that is. It's not just those in hospital already who get the tests.

Another part of the problem is absenteeism in NHS staffing (due to more community transmission among families) which will affect all services, not just Covid-related ones

And care workers and general fatigue and exhaustion among frontline health and social care staff along with the usual winter pressures.
But some of the people who stood and clapped them a few months ago from the comfort of their home wont bother complying with any measures as they have "had enough and are fed up"

As far as I know, hospitals are doing OK

Well, they are doing OK right now , but numbers of inpatients are increasing, and the number of patients in ICU beds are increasing, and staff absence owing to self isolation and confirmed cases are increasing.

I very much hope we won’t see deaths increasing at the same rate now we have some new treatment pathways (although they are also increasing slightly), but we’re clearly heading for a very rough winter in terms of bed occupancy and staff shortages.