To question the stats and facts

[Yolo2]

I'm puzzled by several stats/ facts related to death rates and the R rate.

(1) Death rates - we do tens of thousands of tests a day. Let's say 80,000 average. Generally you need to have symptoms to be tested. About 6000 a day are positive. So the vast majority of people with symptoms do not have the virus. So why are doctors allowed to put Coronavirus as a cause of death on death certificates of untested people just because they had Covid symptoms? Seems mad.

(2) Surely factors like number 1 will contribute to us having one of the highest death rates in Europe? In addition, it sadly has been reported that BAME people are far more vulnerable to dying from covid. Isn't the UK one of the most diverse countries in Europe? Should this not also be considered as a factor in our high death rates? Same with obesity. Why all the outrage at the government without a proper analysis of this. I think the government have made mistakes but we didn't run out of beds and lockdown comparatively early compared to other countries. Is it really the government's fault if we do have a higher number of deaths at the moment (I really am not a fan of the government at all by the way. Just don't see they have done anything worse than other countries. Other countries are blaming their governments for the same failures as ours so it's not unique to UK)

(3) The R rate. In Scotland, it's been reported that the R rate is likely to be higher than the rest of the UK, apparently because its at an earlier stage on the curve. I don't understand this. It therefore locked down at an earlier stage in the spread of the disease as it locked down at same time as UK. Aren't we being told countries which locked down earlier would be able to control the rate of infection and the spread much more easily, and therefore the R rate? So why would Scotland's R rate now be higher?

AIBU to be puzzled by all of the above? Or am I missing something here?

This isn't intended to be a debate on how well the government have handled the crisis. Genuinely interested in what I see as either anomalies or missing information in the debate.

I can only respond to point one as I am currently mulling that over. I started showing symptoms on Monday, tested yesterday (Weds) results just come back as negative.

It seems that somewhere between 10 and 20% of tests are coming back positive. Why is this when people are only being tested when displaying symptoms? So either the tests (generally self administered) are actually just rubbish for whatever reason or actually it is ripping through society like we are being told.

I really don't know what to think at the moment, but as it currently stands the testing is potentially doing more harm than good. The NHS basically then advises people to stop self isolating, so I could have it yet I am being given the green light to go out and about.

"it is not ripping through society"

I'm with you on the Scotland thing. It makes no sense.

They were just talking about this on the midnight news Yolo2, mascotte. It’s not really an answer to your question but Professor Ian Diamond said that the R number had probably fallen to as low as O.4 across the UK a couple of weeks ago. It had risen again recently because of the rise in the number of infections in hospitals and care homes. From what I’ve gathered about Scotland (living in England), rates of infection and transmission are really variable. Most of the cases are in Glasgow and the Clyde, care homes and hospitals but it’s much less common in other parts of the country isn’t it? I do know that health inequalities mean that Glasgow will be more affected than many areas

I found this article in the New York Times a couple of weeks ago. It explained that the R number goes up and down in peaks and troughs based on when the infection first appeared:

^www.nytimes.com/2020/04/23/world/europe/coronavirus-R0-explainer.html^

www.nytimes.com/2020/04/23/world/europe/coronavirus-R0-explainer.html

The UK is behind Italy but Scotland is behind London where it appeared first. When it first started, most of the cases were in London but as time has gone on the number of new infections in London are now less than in the rest of the UK.

When you cut through all the shit, recall that we are an island nation. Unlike say Spain, Italy or France we still have passport controls for visitors from the EU. Of almost all larger nations, we should have been best placed to contain it.

I'm not interested in what they say any more about testing apps, containment, PPE et al.
It is inexcusable that we are the most affected country in Europe and #2 in the world.

We aren't the worst country in Europe though. We might have the most deaths but we have, for example, more than 20 million more people than Spain. We do have more deaths but that would be expected if we have a higher population. Per million of the population, we aren't number 1. Agree with your point about us being an island - we could have contained it but WHO advice was not to close borders. My points 1 and 2 would also suggest that there are reasons for us being/ looking worse. Some countries also not including care home deaths - which is obviously a huge omission. I think there is far more to these stats to be uncovered. Again, I'm not a Tory voter and supporting the government. But I don't think they are necessarily to blame for the death stats.

Germany has only got 3% lower obesity than us.

Of course the government is to blame. We've seen fuck up after fuck up.
There is no issue with care homes - wrong.
PPE - don't get me started.
Herd immunity - no comment.
15000 people per day still coming in with NO checks - utter folly.
At the beginning of March, the WHO said that countries need to "Test, test, test". We didn't bother.
Contact tracing - don't make me laugh.
NHS Nightingale - you know what, I could spend all night listing examples of where the government got it wrong.
They are definitely culpable.

Looks like it's affecting BAME communitues worse in Europe too.
www.ft.com/content/5fd6ab18-be4a-48de-b887-8478a391dd72

Per million population we are nearly one of the worse. Which is quite bad enough I'd say.

It's not being political (unless someone wants to make it that way) to say how badly we're handled it. We cocked it up. Badly.

One of the biggest reasons our death rate and total number of deaths is so high is because we weren't treating patients. They were being left to die at home or only admitted to hospital at a stage less likely to survive. Early treatment is key. We also didn't get enough PPE for our frontline staff. They're more vulnerable than many to Covid because the high viral load.

Of course it's not all the fault of the current government. They messed up but they also inherited a NHS that's been underfunded and mismanaged for years.

The priority now is to focus on sorting out the mess. We can't go back.

I’m not a Tory. But I largely agree with you comments.

Numerically we have the highest number of deaths. But it is nonsensical to look at this number alone. Deaths per population, population and density/diversity must be considered. Not all countries have included community/nursing home deaths. It is true that some results feed a false negative, but clinically through imagery and pathology it is possible to diagnose covid19 without a positive result. I actually think our government is being transparent about the figures due to these reasons, therefore this needs to be taken into account.

People that come through the boarders which have dramatically reduced are asked to self isolate? Is it ethical to hold these people against their will? Do we live in such a nanny state that people cannot do as they are asked?

Nursing homes, that’s a tricky one. How do we stop the spread in nursing homes? Ask the staff to stay in and self isolate with the residents away from their family? For minimum wage? Who’s responsibility is it to supply PPE for private homes/domiciliary care which are essentially businesses?

Herd immunity is essentially the only option if we don’t find a vaccine.

The nightingale hospitals, IMO, will be utilised when we released lockdown and experience a second wave.

There are lots of questions to be answered. I do not automatically slaughter the government because it’s futile without a sound understanding of the facts.

Where is the evidence that supports the suggestion that patients are not being treated and left to die at home?

I'm a little surprised that politics has been brought into this.
I'm an active card-carrying member of the Conservative party and I'm the one arguing most strongly that the government has fucked up.
Because they have.

The evidence is they died at home. Or in hospital, having only been admitted at a stage when survival was less likely.

The official advice was (is still?) to stay at home until your lips turn blue.

All the research and evidence so far suggests early treatment is key. Which makes sense. Dealing with anything earlier generally tends to be best.

The government have done badly - yes (and so have many governments - it's not just the UK!) But there are other factors here - hence my original post

Point 1- testing is presumably happening in many cases when symptoms are cough and temperature. It’s understandable that in many cases those symptoms would often not be caused by Coronavirus. That doesn’t mean that where someone has died of a Coronavirus like disease it is likely to be something else. In other words, the fact that Coronavirus may look like other diseases in mild cases (the majority of all cases and therefore the majority of tested cases) does not mean that there are lots of other diseases which may equally be causing c-19 like deaths.

Point 2 I don’t think it’s thought the BAME death rate is due to white people being especially resilient but due to BAME people being over represented in jobs that involve exposure to the virus.

@Disquieted1 I don’t think that being an island automatically makes you better placed to close borders. London is a bit of a hub for international travel. It’s much easier to close your borders when you don’t have many people passing through/who are by nature very international/a large number of foreigners. Then there is the Chinese angle. Countries that have been most successful at suppressing it have heavily restricted travel starting with travel from China. Boris was too keen on a trade deal with China (not to mention British people love to cry racism) so that was a bit of a no go.

I’m usually very anti government but it’s actually not clear to me that they have done that badly so far. I think it will take a lot of work in years to come to work out why our death rate is worse than other countries.

They are reporting people dying 'of' it, rather than people dying 'with' it.

Due to the classification of Corona being a pandemic, they have to report if someone dies and testing positive.

It may not have been Corona that killed them, could have been a stroke/heart attack/car accident/brain hemorrhage, but if they tested positive for Corona, they must state they had it.

It's misrepresentative

@minettechatouette Most tests are carried out when someone is ill enough to be hospitalised, so I think the point still stands. It's not just a cough and temperature at that stage. People are very often very unwell with similar symptoms but it's not Covid. So untested deaths being attributed to Covid must be skewing the figures. Re BAME, jobs do seem to be seen as one possible factor but a much bigger factor, from what I'm reading, is the prevalence rates of certain underlying illnesses in the BAME population - which make COVID more dangerous. It is the case that some illnesses are far more prevalent in some ethnicities than others. Plus there there is an unknown factor which can't be explained yet, which is pushing up BAME deaths.

So why are doctors allowed to put Coronavirus as a cause of death on death certificates of untested people just because they had Covid symptoms?

This is a tough one. I can see that it would be misleading to not put it as a cause of death if it seemed to the doctor it was a cause, an obvious example would be a patient from a care home with other confirmed cases and classic signs on ct/xray. On the other hand, as you say only a very small % of tested patients have it so there does seem a high chance the doctor could be wrong.

I'm not sure what the answer is.

It works both ways.
There have been people with confirmed Covid where the cause of death has been recorded as heart attack or stroke. Yet Covid is known to cause heart attacks and strokes. Some dementia patients in care homes had cause of death recorded as dementia. Even when Covid was known to be widely spread in the care home.

I also agree that it's pointless to compare countries at this stage. When you consider factors like population density, numbers travelling to and from (and from where), age, obesity, health care system, possible susceptibility or immunity related to race, different ways of classifying covid deaths, whether care home deaths are included, number of tests performed, criteria for getting tested, and a hundred more. Talk about comparing apples to oranges.

Some countries, eg, Indonesia, did not lock down particularly early or strictly and have factors like high population density that you'd think would mean the virus would run rampant there - but it doesn't seem to be. It just seems like luck which countries are badly affected. Or are those countries not reporting cases and deaths? We just don't know.

Death rates - we do tens of thousands of tests a day. Let's say 80,000 average. Generally you need to have symptoms to be tested. About 6000 a day are positive. So the vast majority of people with symptoms do not have the virus. So why are doctors allowed to put Coronavirus as a cause of death on death certificates of untested people just because they had Covid symptoms? Seems mad.

@Yolo2, the govt figures we get daily and currently are saying there is just over 30,000 deaths only include those who tested postive in hospital and since 29 April in the community too. The ONS weekly excess death rates, which has a lag of 11 days, so their latest update at start of this week was reporting on excess death rates to 24 April, includes also those where CoVid 19 is mentioned on the death certificate in some way even if not all tested positive. For an idea of how this effects the numbers, for death rate figures on 24 April, ONS writes:

In England, including deaths that occurred up to 24 April but were registered up to 2 May, of those we have processed so far, the number involving COVID-19 was 28,272; the comparative number of death notifications reported by DHSC on GOV.UK was 21,399 and NHS England numbers, which come from the same source as DHSC figures but are continuously updated and for deaths in hospitals, showed 19,033 deaths.
Also as toffee says it cuts both ways as some argue without a positive test doctors are v reluctant to mention CoVid so only will when it is strongly suspected and even then it will be described as died with Coronavirus not of.

The two attached screenshots show the different testing methods and what is included and is taken from the latest ONS update, it’s from table 1 near the end of the update , but I couldn’t fit it into one screenshot. www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/articles/comparisonofweeklydeathoccurrencesinenglandandwales/uptoweekending24april2020

@Yolo2, sorry slight correction to the above, ONS figures above are not excess deaths but figures based on all deaths registered involving COVID-19 according to death certification, whether in or out of hospital, for England and Wales. I believe ONS also separately look at excess death stats. The point remains the govt death rate figures are only those who tested positive in hospital and in the community.