Daily numbers, graphs, analysis thread 4

[Barracker]

Welcome to thread 4 of the daily updates.

Resource links:
Worldometer UK page
Financial Times Daily updates and graphs
HSJ Coronavirus updates
Johns Hopkins Coronavirus Resource Centre
NHS England stats, including breakdown by Hospital Trust
Covidly.com to filter graphs using selected data filters
ONS statistics for CV related deaths outside hospitals, released weekly each Tuesday

Thank you to all contributors for their factual, data driven, and civil discussions.

Chap on Radio 4 earlier this evening was saying that new legislation for certifying death ( doctor doesn't have to be present and funeral directors can now certify ) might mean that due to lack of certainity there might be a reluctance to give Corona as cause of death .

How much more unreliable can our figures get ?

Do we know by the % increase in deaths in hospital? There are still a reasonable number of negative tests. Could it be that Covid 19 deaths are being picked up due to False Negatives? I guess the fact that many are admitted to hospital at least after symptoms began this is quite possible?

And is it possible to tell how many deaths are actually occurring in nursing homes? CV and non CV

*not being picked up

What do you put it down to BigChoc? Is it all to do with the higher percentage of testing? And if so, how has that made a difference?

Hoping that the rest of the world can learn from Germany if still possible.

8th April is still looking like the peak, but current deaths are not far behind, it's a slow decline.

I think Germany is doing "better" because of testing and contact tracing. They have a large number of companies producing and reading tests; getting into testing large numbers of people and concentrating on repeat testing and ensuring to trace everyone linked to an outbreak.

www.weforum.org/agenda/2020/04/it-was-the-saltshaker-how-germany-meticulously-traced-its-coronavirus-outbreak/ is an interesting read - it seems they meticulously contact traced, isolated, followed up with further testing etc. Everything we would all wish to do now had it not got out of contol and become impossible due to the large numbers involved.

They also apparently had a very good pandemic plan www.spectator.co.uk/article/how-germany-has-managed-to-perform-so-many-covid-19-tests

Of course it helps that they had the most ICU beds per head of population in Europe, and so could scale medical treatment up more easily.

Chic

There are a variety of factors why the German death rate is so low but it is primarily due to the low average age of contracting the disease. The initial infections in Germany were skiers returning from Italy and Austria, primarily young and fit. Of course it has not stated that way but, nonetheless, the average age of infection is 49 in Germany vs about 62 in Italy and France.

Germany has also tested lots and has superb medical facilities. But I think that age is the primary factor.

Are there any reliable stats for the age of the deceased in the UK? I know they say each day ages range from 25-102 for example but other than that nothing. Is that being withheld on purpose to stop people breaking the lockdown?

surely one reason the age is lower is because they have done lots of testing? If France / Italy tested minor cases then their average age would come down too?

I also suspect that a larger % of UK population has been infected, even though Germanys numbers are higher.

Random,

I was thinking the same as you but I have read more about the skiers...

@peridito

I thought there were two separate requirements and the role of funeral directors is only one of them.

So the new regs allow for
i) Funeral Directors to inform the Registrar of the death in place of the family doing so
and
ii) the Medical Cause of Death can be certified by a Doctor without that Doctor seeing the patient in certain circumstances

www.bma.org.uk/advice-and-support/covid-19/practical-guidance/covid-19-death-certification-and-cremation-during-the-coronavirus-pandemic

and

improvement.nhs.uk/documents/6590/COVID-19-act-excess-death-provisions-info-and-guidance-31-march.pdf

@rtp9 www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2020/04/COVID-19-total-announced-deaths-14-April-2020.xlsx

52% 80+
40% 60-79
7.6% 40-59
0.8% 20-39
0.07% 0-19

Real total for 80+ will be considerably higher when you add in care homes - at least 60%

The 7.6% figure is the one, essentially, causing the issues, as it's far higher than for seasonal flu. Children are not at risk at all (for non-insane values of 'at risk'.)

Yes it's the 40-59 age group, and the "healthy" over 60-70s who are being affected most relative to seasonal flu. Those are also the most likely to be to told to go home and self-treat and only ring the emergency services if they are about to die

When do you think we will hit our peak?

Chazs - sorry for misleading ! You're right of course .

Though I think the point about not seeing the deceased and not confirming covid infection might still hold .

Yes its the 835 people in the 40-59 age group that is causing the issue because that could be anyone

I would say though that as a percentage of deaths it is likely to be lower given the care home issue

I think as well though the younger ages is probably far more reliable - my Nan died just before this kicked off and it wasnt that clear what actually killed her she died with at least 3 separate infections and at the top it says frality due to old age

Excess deaths are running about double the registered deaths due to COVID-19

I posted this on another thread. This bar chart shows the weekly comparison of deaths from previous years to this year and, for me, is the best way to illustrate that people are dying from Corona directly or from CV19 directly exacerbating an underlying condition.

ShootsFruitandLeaves.

Thank you. That’s exactly what I was looking for. I can see why they are not broadcasting it as it really isn’t an illness that will get many under 30’s in good health.

peridito
Yes I think medics might be quite circumspect about the “died of” v “died with” if you have a patient with an already complicated medical history that they hadn’t examined.

Chic, Larry The early cases were young, as in several European countries - returning skiers from Italy

• but the infections soon spread quickly to all ages, just like elsewhere in Europe

So no, age is not the main reason for Germany's low death rate
Unless people stop thinking it was just "luck", then the UK will suffer badly in this and the next pandemic too

The reasons are due to:
. competent leadership - Merkel, her Cabinet, the govts of the 16 federal states, the 401 district health authorities -
. well-resourced health and public care systems - because all parties have agreed for decades that taxes must pay for this -
. all of them working together surprisingly smoothly

Prep

• Germany had a pandemic plan and - unlike the UK & US - the human resources and labs etc in place to carry it out

• Back in January, on hearing about Wuhan, German research institutes worked to develop a reliable test that used ingredients that Germany could manufacture in such quantities

• Merkel early on ordered 10,000 ventilators from the largest German manufacturer, just in case, then boosted orders to every other manufacturer once the emergency became clearer
  PPE too, not enough, but more than the UK

Testing

• Germany is testing 500,000 people per week

This is enabled by the vast network of laboratories across the country,
together with the capacity of the large pharmaceutical industry to create huge amounts of the testing kits

Track & Trace

• An army of public health staff interview each infected person to find their contacts and test them too

Once German cases got too high to do this thoroughly, they started missing too many infections,
which is probably the main reason deaths here have been rising more quickly the last few weeks
However, slowing the curve early on, still pays off now

• Each confirmed person was ordered to stay home, no exceptions and monitored to check on this Heavy fines and even jail for anone breaking this,

Monitoring

• Health teams monitor each case regularly for prompt treatment of any symptoms;
  They visit the more serious ones regularly and admit to hospital as soon as breathing problems start

• Germany has many thousands of trained local public health officers, ideal for track & trace, which the UK also had, but chose to nearly abolish

Health Resources

• German has more doctors, ICU beds hospital beds than any other country in Europe
  3 x the UK by population

• COVID patients are treated as early as they need, including hospital admission for any breathing problems
  This significantly improves outcomes, according to hospital doctors interviewed here

• Health rationing has never been a part of the German system, so there was a large spare capacity
  Merkel & co quickly ordered more beds, staff and training (which the NHS did too, but later)

BigChocFrenzy, wow, so that’s pretty clear then!

The UK used to have a superb system for tackling epidemics,
but it was thought there would never again be dangerous epidemic diseases like polio, TB etc

So the old isolation hospitals were closed,
the numbers of experienced public health officers were decimated
the network of local laboratories were centralised into just a few huge ones

That's under all parties btw - decisions made over decades

Above all, the planning and rehearsal was not taken seriously
and the limited plans there were assumed only a v bad flu;

No plans were made for a disease that was infectious for days before symptoms,
had 10-20 x the flu death rate
and no vaccine

Even the rehearsal for "bad flu" in 2016 showed the NHS and public health couldn't cope,
but this finding was totally ignored and swept under the carpet

The UK has a high quality pharmeutical / chemical industry and high quality manufacturing,
but these superb resources were not called into action until very late

The government seemed to assume that private industry would spring into action without being given instructions or purchase orders

What I regard as "Pandemic Fighting by Fridge Fairy"

Even UK specialist suppliers of ventilators etc who offered help, were ignored for weeks

• not our sort of people ?

John Burn-Murdoch@jburnmurdoch (FT stats geek)

NEW: ahead of tonight’s main thread, some fresh analysis of the factors that do and do not appear to influence the pace of countries’ covid-19 outbreaks.

First, for the per-capita brigade:

There is only a very very weak relationship between population and covid death toll

How about population density, or a similar metric: the number of major, dense, urban areas in a country?

Same result: very very weak relationship

But lockdown timing exhibits a much stronger relationship.

Countries that locked down earlier in their outbreaks subsequently had much lower daily death tolls than those that locked down later
(accounting for when outbreaks began)

Lockdowns, and their timings, matter.
Who knew?