Daily numbers, graphs, analysis thread 5

[Barracker]

Welcome to thread 5 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
Google mobility stats

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

John Burn-Murdoch@jburnmurdoch (FT stats geek)

NEW: Wed 15 April update of coronavirus trajectories

Daily deaths:
• US & UK may be peaking.
Doesn’t mean battle is won, but very good news if true

• Successes in dark blue:
Australia, Norway, Austria locked down early => gentle slopes

Now cumulative deaths:
• Nonetheless, US death toll now highest worldwide and still rising fast

• And UK curve still matching Italy’s
....
daily new cases:
• Feels increasingly safe to say daily confirmed infections in US have peaked

• UK is testing less, so less sure

• New cases falling in four countries that acted early:
New Zealand, Australia, Norway, Australia
...
Now subnational region daily deaths:
• NY daily deaths may be peaking (notwithstanding change to their methodology)

• London too may be around peak deaths

• NY may be peaking, but daily deaths still trending up in many US states
....
New narratives emerging today:

1. Many Western countries hitting their peaks

Doesn’t mean "mission accomplished", does mean things are working.
What it means for lockdowns remains to be seen.

Focus here will switch to excess all-cause mortality, underreporting of covid deaths.

Communications failure - waste of resources & time

inews.co.uk/news/health/coronavirus-hospital-ventilator-programme-machines-quality-intensive-care-2539791

The UK’s homegrown hospital ventilator programme risks failing to produce machines suitable for treating coronavirus patients, according to the head of the Faculty of Intensive Care Medicine.
.......
“If we had been told that that was the case, that the ventilators were only to treat a patient for a few hours.
we’d have said:

‘Don’t bother, you’re wasting your time. That’s of no use whatsoever."

Some just released CDC (USA) info on demographics:

Of the cases, a majority are in the 18-44 and 45-64 age ranges
73% of the cases fall between 18-64
90,619 cases are those over the age of 65
80% of the cases listed under white are over the age of 65
34% of the cases listed in the 45-64 age group are black or African American

edition.cnn.com/asia/live-news/coronavirus-pandemic-intl-04-15-20/h_0b44dc6272827f07df3286679995840e

Full CDC link: www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html#demographic-characteristics

I think that CNN summary is completely wrong re: 80% of white cases being over 65.

But the black or African American total of 31% (v 12.6% gen pop) is in line with what we’re seeing here.

Does underreporting really matter in the short term?

I think it does, because if they are only reporting hospital deaths, but people are only being taken to hospital if deemed critically ill, but lots of people are being denied admission to hospital as not ill enough but then very quickly die at home, then we absolutely need to know that, because then the hospital admission guidelines are not fit for purpose.

@PearPickingPorky which according to the guardian article upthread has been noticed in London.

I think under reporting numbers also gives a false rosier picture.

Suddenly changing the reporting method now would mean we wouldn't be comparing like for like but the numbers could be backdated.

New study in Nature Medicine estimates that nearly half of covid-19 transmission occurs in the 2-3 days before any symptoms, and peak infectiousness is around the day that symptoms start.

Substantial presymptomatic transmission would reduce the effectiveness of control measures that are initiated after symptom onset, such as isolation, enhanced hygiene or use of face masks for symptomatic persons.

This is why rapid diagnostics & wide community testing of people who are symptomatic AND those who are pre-symptomatic or asymptomatic w/ exposure to known cases- is critical. If we have to wait for symptoms to start, we get too far behind.

www.nature.com/articles/s41591-020-0869-5

BigchocFrenzy I find your insights about the German health system facinating. Interestingly in normal times this does not translate in to greater life expectancy. Indeed one of Italy's problems was it's long life expectancy and therefore it's relatively large pool of older people.

BigchocFrenzy I find your insights about the German health system facinating

Me too. The contrast between the response here and there is quite stark and it is interesting, and sobering to think about why that is.

Checking in, thanks Barracker

Pocketem, that's also why they're telling us to wash hands and not touch faces. And mask wearing to limit transmission if you are coming down with it.

From that study the only way to reduce mass outbreaks currently is to limit social interaction.

I'm a bit when K Stramer is saying to publish an exit strategy; I think he's just jumping on a bandwagon.

"in normal times this does not translate in to greater life expectancy."

Yes, a health system can only do so much - there are some very unhealthy habits here !

e.g. more smoking than in UK, rolls stuffed with salami & cheese for breakfast, daily sausages & beer, big wodges of creamy cakes & pastries ....

It appears to confirm what is being said in the media, most of the deaths are in the big cities. The further you get away from London in particular, the fewer deaths.

The information is very interesting, thank you

Bigchoc

There does need to be an exit strategy soon, all this is costing £billions and people are losing their business and jobs. Tax rises will have to be enormous, probably including VAT

Coronavirus: The four factors that will decide when the UK's lockdown can end

https://news.sky.com/story/coronavirus-the-four-factors-that-will-decide-when-the-uks-lockdown-can-end-11969844

A slowing admissions rate suggests the rules are helping, but death rates from some regions are rising.
.......
There are four main measures to consider:

the rate of infection
numbers of confirmed cases of the coronavirus
hospital admissions
new deaths
....
The figure that has been dominating the headlines is daily reported deaths,
but this is likely to be the last of the four measures to show the impact of lockdown.

WHO Director-General's opening remarks at the media briefing on COVID-19

https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19--13-april-2020

The new strategy summarizes what we’ve learned and charts the way forward.
It includes six criteria for countries as they consider lifting restrictions:

Luxembourg.
Lockdown measures are slowly lifting as from Monday when building sites,, DIY and Hardware stores will reopen.
It will also become compulsory to face cover from Monday with the entire population +/- 600,000 receiving face masks next week from the 6 million stockpile that is available for this.
Quote

• Prime Minister Xavier Bettel and Minister of Health Paulette Lenert confirmed on Wednesday that face masks will become mandatory on Monday.

Face masks have to be worn in all spaces where the mandatory 2m physical distance cannot be respected. This for instance includes supermarkets, other stores, and public transport.

For the time being, "alternative" face masks are also allowed. This includes homemade masks or scarves.

Luxembourg's Ministry of the Interior and Syvicol, the trade union representing municipal authorities, are organising the distribution of actual face masks.*

@starlightgazers
I am unsure about doing links but this might help you find the article.

Luxembourg
This is the summary in English of yesterday’s press conference announcing phased UNLOCKING starting next Monday 20th April.

A detailed announcement is due today from the Ministry of Education on how the return to school will be handled in May.

today.rtl.lu/news/luxembourg/a/1502064.html

Merkel explained why planned relaxation of measures in Germany can only be done slowly and cautiously:

Germany's R0 is currently about 1.0
If it goes up to 1.1, i.e. by 10%, the health system reaches ICU capacity in October.
If it goes up by 20%, it reaches capacity in July.

https://mobile.twitter.com/KristinaFassler/status/1250486433263034375
(Merkel speech video)

Coronavirus: Significant social distancing needed 'until vaccine found' www.bbc.co.uk/news/uk-52308201

The UK must keep a "significant level" of social distancing until a vaccine for coronavirus is found, a scientist advising the government has said.
Prof Neil Ferguson told the BBC there was "little leeway" to relax measures without "something... in their place" - such as testing and contact-tracing.

Not sure what that means in practice.

They've said from the out set; there will be an in off type approach. I suppose enough to get the economy going again and then cut off infection rate.

The ONS looked at nearly 4,000 deaths during March in England and Wales where coronavirus was mentioned on the death certificate.

Have you seen this? Latest bit of breakdown from ONS:

In 91% of cases the individuals had other health problems.
The most common was heart disease, followed by dementia and respiratory illness.
The average number of pre-existing conditions in those who died was 2.7.

Actually good news for the majority of us. I know, I know, bad news for many, but......

Can anyone help shed some additional light on this from the ONS?

www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsinvolvingcovid19englandandwales/deathsoccurringinmarch2020

Particularly, a lot of people dying have underlying health issues

But it's not totally clear to me if a lot of people dying have underlying health issues because they are older anyway or if the proportion of people dying with say underlying asthma is actually greater than the occurrence of asthma in the population at large ( and actually, separating asthma from other chronic respiratory conditions is quite hard with this report ) ( ok asthma greatly interest me personally!) ( and it's very common)

And I guess it would be nice to see the impact for shielded asthma people vs vulnerable asthma people vs population as a whole ( ditto diabetes and any other condition where there is some apparently arbitary assignment of people to categories )

Perhaps I am asking for too much given they are only looking at a few thousand deaths?

I'm beginning to suspect that the exit strategy will involve a period having passed during which the NHS hardened up, including a spread of the virus among NHS workers to provide an increased level of immunity, people understanding that their habits need to be different including working from home, social distancing, and hygiene measures, and importantly people understanding that we have to accept a rising level of deaths in the context of sub-par medical treatment in exchange for keeping a functional economy.

I think it relates to people changing what they're willing to accept. This decade's version of There Is No Alternative but this time with public buy-in.