How many lives are we actually saving

[Baaaahhhhh]

An interesting read from the BBC, and a question that I have been wondering about since the ONS released figures last week.

www.bbc.co.uk/news/health-51979654

Article talks about the effect of different scenarios on the number of excess deaths ie: over and above what would be expected, and versus other seasonal illnesses like normal flu.

Without control of this disease, the lights will go out. Literally.

How much of modern life, hospitals, prisons, heated homes and cooking facilities, water quality monitoring, checkout and electronic payment facilities at the supermarket, depend on electricity?

That's just one massive impact if too many younger, key workers become very unwell, never mind deaths from coronavirus. It will be deaths from other causes.

The thing is, you can't make public policy on the basis of the risks to an individual. You have to look at the bigger picture and put aside the emotion. Nobody wants their loved ones (or themselves) to die but I don't think the fact that I am a higher risk because I'm on immunosuppressants or that my 90 year old grandfather probably wouldn't survive should drive what happens at a national level.

There are degrees of lockdown. In Hubei province, food shops were delivered to a strict timetable. Even mild cases of Covid were treated in hospital to protect the rest of the household and homes were disinfected. Much more severe, but I think for a shorter period of time with ultimately less effect on the economy presumably.

This government's inept lack of action caused me more anxiety and the thought of the NHS potentially being unavailable to look after people requiring sudden unexpected treatment also causes anxiety. (And downright fury)

Surely the job of a government is to look after its population and make people feel as safe as possible. If that's not what its main function what is what should it be?

This is interesting too

link.medium.com/38gg7Igsn5

The same professor spoke on a bbc podcast

www.bbc.co.uk/programmes/p087n42r

None of the scientists I know (they include people who work in this field and those who are seconded to do vaccine research) are thinking lockdown is the right way. The government panicked and followed the Europeans for fear of the numbers, unless a vaccine is developed we will all catch it, not the most pleasant 2 weeks of my life but for most people like me it's quite mild and I now want to get on with my life, at least half the people I know have had the symptoms

I don't think people have really grasped how the economy wouid completely fail if a pandemic's exponential grow ASW was unchecked.

It wouid make the current level of hardship seem like nothing, as everything wouid cone to a standstill (literally if national grid affected, near literally for other scenarios)

And death rates would rocket from other causes, as next to no medical attention wouid be available.

@PicsInRed exactly, I wouldn’t underestimate the impact of that kind of scenario deteriorating into civil unrest and anarchy. We’ve already seen isolated cases of people carrying out incomprehensible actions likely due to a loss of all hope and the inevitable psychological impact of that.

Society is a thin veneer masking some pretty vicious animalistic tendencies. We have heaps of evidence attesting to this. The riots in 2011 were a tiny glimpse of what people are capable of and more recently the needless chaos caused by panic buying.

Most people wouldn’t think they’d be a part of it but ultimately people’s hands are forced when they find themselves swept up in it.

@mynameiscalypso, if it was just two people affected then no policies would be considered but as it happens you and your father are part of a group that make up a significant portion of the population and your simultaneous downfall would have far reaching consequences.

@Gin96 absolutely - hindsight is a wonderful thing!

I would note that using current figures isn’t an argument to dispense with distancing measures right now. These are numbers reflecting lockdowns and distancing measures across a number of countries. I think it needs to be acknowledged they look relatively low because whole countries have took pretty drastic measures and those figures would be different, if only for certain time periods, if no one had.

FWIW I don’t believe the official China figures either simply because they were ground zero and would have not been collating figures before they identified they even needed to be looking for something. In the future I expect these to be revised and show a much clearer picture of how this virus looks unchecked.

A couple of threads from people who have read that Bristol paper (the one with the 6.4% figure).

mobile.twitter.com/FergusPeace/status/1245978651151060992

mobile.twitter.com/JKSteinberger/status/1242584908385726465

Society is a thin veneer masking some pretty vicious animalistic tendencies. We have heaps of evidence attesting to this. The riots in 2011 were a tiny glimpse of what people are capable of and more recently the needless chaos caused by panic buying.

Most people wouldn’t think they’d be a part of it but ultimately people’s hands are forced when they find themselves swept up in it.

I agree there is potential for pockets of civil unrest but i think it is only within a tiny minority. Criminal gangs and extreme political activists for example.

The only situation I can think of where there might be widespread civil unrest/riots would be severe food shortages, such as we saw in England in the late 1700s and early 1800s and which resulted in widespread rioting. But we do not have serious food shortages and any shortages would be dealt with by the kind of rationing we saw in, and just after, WW2.

Some people did go hungry in WW2, especially in urban areas, and there are reliable accounts of that happening but overall it was a very successful strategy. People did understand and comply with rationing. But we are far from a rationing situation ATM and hopefully that will continue to be the case

But we are far from a rationing situation ATM and hopefully that will continue to be the case

Amen to that.

I’m cautious of ruling anything out at the moment though, there’s no one alive today who was an adult in 1918 which is the closest comparison we have and therefore so much is an unknown. We’re a very different society to the one that existed even fifty years ago. I don’t know if we’re cohesive enough as a country to push the reliance on compliance too far.

Yes, my attitude would be completely different if it was affecting children. Mind you, even then the logical worst outcome is if it was affecting young adults the most. They are the ones we should most protect for survival of the species.

The thing they've missed in this is the improvement to people's health through pollution reducing

@Goldencurtain that is one of the positives out of this, I think Mother Nature has paused for a sigh of relief 😊

@dkl55 there's a really good transcript of a podcast he did here - riskytalk.libsyn.com/transcript-of-coronavirus-understanding-the-numbers

Professor David Spiegelhalter is a statistician who works on risk at Cambridge University. Here are some key points from the podcast -

So people have said - in fact, Neil Ferguson, the head of the Imperial University modeling team, said in evidence to the parliamentary committee last week that he thought maybe two thirds of deaths were people who would probably have died reasonably soon anyway! So, there's a couple of issues about that. First of all it means, perhaps, that when we come out with this, we'll find that the number of excess deaths in the country over the year might very well not be excessive. It might look just look like even an average flu season in terms of the extra deaths.

This is the crucial thing, this is what I dread at the end of this. If these lockdown measures are effective, and the aim is, as has been made explicit, is to try to keep the deaths below 20,000. If that happens, and people may look back at the end of the year and say, "oh, well, not many extra people died anyway", then the accusation will be made that therefore, we didn't need to do the lockdown, which is not a logical consequence! It's only as low as 20,000 because we have taken these measures.

the crucial thing - and people do forget this, even though it's been emphasized again and again, by the Imperial modellers and everybody - is that in the end it’s not a matter of saving the lives of some old vulnerable people who are going to die soon anyway. It's the fact that if you didn't do that, if you didn't bring in these measures, you know, the NHS would be just totally overwhelmed, particularly as it’s short staffed. It's going to be touch and go, I think, anyway, whether it can deal with it.

Regarding personal risk, he says in explanation of the diagram included in the BBC article: essentially if you get Covid 19, the risk of dying is very roughly equivalent to the risk you'd normally have over the whole year: it packs a year's worth of risk into the few weeks that you've got the disease. And that kind of puts it in perspective, what it shows is that this is a relative risk, whatever risk you've got, at the moment, it ups it enormously for that short period, if it's three or four weeks, then maybe that's 15 times your normal risk. And so we can really understand why frail, vulnerable people are at such high risk, why it's so dangerous for them because they're at risk anyway and suddenly it shoots up, they get a whole year's worth, you know, in less than a month.

His perspective on COVID-19 is really valuable and I'd urge you all to read the transcript or listen to the podcast if you can.

Don't worry the Tories are quite experienced in the delicate balance of unworthy lives vs economy.

www.rsm.ac.uk/media-releases/2017/new-analysis-links-30-000-excess-deaths-in-2015-to-cuts-in-health-and-social-care/

I’m cautious of ruling anything out at the moment though, there’s no one alive today who was an adult in 1918 which is the closest comparison we have and therefore so much is an unknown. We’re a very different society to the one that existed even fifty years ago. I don’t know if we’re cohesive enough as a country to push the reliance on compliance too far.

Yes very different, we have social media but it's a double edged sword. Great for facetime and keeping in touch with our family/friends and for the rallying of community projects but also a potential conduit for trouble causers, conspiracy theory agitators, dissent and even, God forbid, that old fashioned word, insurrection.

We see the clap for NHS being criticised now from some quarters but I think they miss the point. Yes it's an appreciation of the emergency services but it's also a powerful way of bringing communities together for the greater good, even if only for 10 minutes once a week. I've talked to neighbours I have never even seen before. Asked if they need anything and they me.

I think this kind of morale boosting is essential right now. Something everyone can be involved in because seeing how under pressure our emergency services are, I imagine a lot of us are feeling a bit useless at the moment and frustrated that we can't do more to help. A gesture yes, but it's certainly cohesive and also reminiscent of the kind of community rallying we saw in WW2.

Strange feeling to be comparing our current situation to all out war, but still

I wonder if some posters opinion would be different when their children were much more likely to suffer from this virus instead of the elderly? Would they risk the lives of their (healthy) children to soften the impact on the economy?

This ignores the fact that most of us have parents and other loved ones in the 'at risk' age group who we care very much about!

Interesting read thank you for sharing.
I wonder if it will increase chances of dying from other causes- heart attack, stroke, cancer etc because nhs is so stretched and normal treatment and are operations cancelled .
Pity government couldn't have found all this money earlier for nhs funding.
The economy matters but nothings more important than health.

The Office of National Statistics publishes weekly death rates. The most recent it published (week ending 20th March) showed 100 extra deaths that week compared the the average of the past 5 years. I will be keeping an eye on this - I think we need to be better aware of the cost vs benefits of the lockdown. We need to ask the difficult questions.

The thing is though, with quieter roads you won't have the usual number of road traffic deaths, lower pollution levels they say has reduced deaths too.

So, what would the death rate be if life was running as normal and COVID19 was going through the population? You would then have extra deaths from normally treatable conditions like heart attacks and surgical emergencies that were caused by lack of access to ITU.

By the time you see this happening it's too late to take action.

for most people like me it's quite mild and I want to get on with my life

Breathtaking selfishness. Also short-sighted as there's no returning to the life we had before for a long time in any possible world-what you want is irrelevant.

I would not believe a word you say about all the scientists you supposedly know and their paraphrased views. Scientists who favour the Swedish approach aren't plentiful, for obvious reasons. You're highly unlikely to be acquainted with a clutch of them to quote when the notion takes you.

If you end the lockdown, you would be asking doctors to deal with larger numbers of ill patients. They wouldn't be able to care for those patients or other patients either. They would get sick and die themselves, in sobering numbers.

You simply don't have the freedom to choose that for them. They've said that they're not prepared to deal with the virus and they're overwhelmed as it is. You may be happy to wish a number of vulnerable, desperately ill people on overworked medics but you'd need them to be willing. Otherwise you're making decisions that no one should make for someone else, aren't you.

“Evidently, lots of people find such reasoning deeply cynical during a time of national crisis, when our instinct is to protect the elderly and the vulnerable. But the economic damage being done by the lockdown will also cost lives. According to Philip Thomas, a professor of risk management at Bristol University, if GDP falls by over 6.4 per cent over the next two years as a result of prolonged economic inactivity, more lives will be lost than saved thanks to rises in poverty, violent crime and suicide. We’re already beginning to see the first signs of this in Southern Italy, where civil unrest is breaking out because people cannot afford to buy food.”

www.telegraph.co.uk/news/2020/04/03/cancelled-criticising-lockdown-now-ever-must-hold-government/amp/

Why do so many people have such a polarised view of what the approach should be?

On one hand there are the people that seem to advocate the necessity of saving a life at any cost. In the real world there is an economic assessment that takes place of the value of saving a life, NICE uses around £20k per remaining year of life. If we spend £billions now there will be as a consequence lives lost in the future as we cannot afford to invest in the nhs, in social care or other vital services.

On the other hand there are those that say let the virus run its course. This will result in cases that far outweigh what the nhs can cope with. Even Sweden is not fully following this path as some social distancing is taking place and large events are cancelled.

All countries will end up treading a narrow path between these two approaches and sometimes changing track slightly when the case numbers allow. People in general have a very poor understanding of risk and we therefore have to trust in the epidemiologists and other researchers to make the best decisions on our behalf. www.health.harvard.edu/newsletter_article/the-psychology-of-risk-perception