Daily numbers, graphs, analysis thread 6

[Barracker]

Welcome to thread 6 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.

That is really interesting, Reallybadidea. I was particularly struck by:

"Among the doctors, the specialties involved were surgery (five cases), general practice (four), emergency medicine and medicine (each two), and one each from histopathology, geriatrics, neurorehabilitation, paediatrics, and psychiatry. There were no anaesthetists or intensivists identified.

Among the nursing staff, specialty was not always mentioned, but none were described as intensive care nurses. There were no deaths of physiotherapists reported."

Sadly it bears out what I've been worried about - the ITU workers (nurses, anaesthetists, intensive care doctors) have had PPU from the start. The "ordinary" doctors and nurses haven't.

I accept this may be coincidental.

And 119 is far too many, particularly as the vast majority are under 70 and so fall into categories with lower mortality rates.

And having read to the bottom, there is no doubt that BAME people are seriously over-represented.

I don't know what ICU staff in the UK wear,

but in Germany, the TV usually shows them in these fully enclosed green suits with hoods, air hoses etc
like spacesuits in some dystopic Irish scifi movie.

I'd have thought that any infection to those staff comes from going to the supermarket etc, not their ICU work

So far there have been 14 COVID-19 related deaths among staff working in "medical facilities," which are defined as hospitals, outpatient clinics and practices, dialysis clinics or outpatient nursing services

I don't know the numbers for hospital and the numbers in the other locations

John Burn-Murdoch@jburnmurdoch (FT)

NEW: Wed 22 April update of coronavirus trajectories

Daily deaths
• Still too early to say if US has peaked
• UK daily deaths have peaked
• But descents look much slower than ascents
• Successes in dark blue: Australia, Norway, Austria

Why do I say UK daily deaths have peaked?

New chart:
week-on-week change in daily deaths.

This gets rid of weekly reporting patterns and asks, are more people dying than at same point last week?

In UK, blue bars mean we’re now seeing fewer deaths than same day last week.

Now back to cumulative deaths:
• US death is highest worldwide and still rising fast Chart with upwards trend
• UK curve still matching Italy’s
• Australia still looks promising

New case series in JAMA examining 5700 patients hospitalized with COVID-19 in the New York City area. Outcomes were assessed for 2634 patients.

•320 (12.2%) required mechanical ventilation
•88.1*% of those requiring mechanical ventilation died

jamanetwork.com/journals/jama/fullarticle/2765184?guestAccessKey=28639c30-edee-405e-9618-1be71e09426b

Had a look to do re BAME NHS worker figures and can’t find overall percent. First 10 deaths were BAME frontline healthcare workers and BMA commented. But can’t find a more recent collation.

The BME percentages of patients need to be matched by age profile too- there are many fewer BME pple in the over-70s general population and this will increase the disproportion

To add to Aramox's point, BME percentages of patients also need to be standardised by geography - London, as the most obvious example, has a much higher proportion of BAME.

Thanks Big choc for explaining that sentence; it's very odd.

Radio 4 said earlier nhs are recommending that all take 10mg of vit d daily during the summer we may not be getting as much sun as normal. They cited bones and muscles.

I actually think my kids are getting more but I can certainly imagine many aren't.

@Alwayscheerful
Thanks for posting that FT chart! It doesn't show 50% of Covid19 deaths happening in care homes though. It shows that the FT estimate that about a quarter of 'excess deaths' (a more complicated concept than it seems at first sight) are occurring in care homes and they have then assumed that they are linked to Covid19.

Very strong arguments for oxygen therapy as a first step as opposed to ventilation.
So, technically, people could monitor themselves using an oxymeter and raise the alarm as required. But how accurate is such a device? For example, wouldn’t asthmatics or smokers have a constantly lower reading? How would they know what their ‘normal’ levels are to start with for accurate self assessment? Or should anything under x% be viewed as critical? I don’t fully understand how the device works.

The Lancet has also recently published a study looking at rates of infection among front line healthcare workers and support staff who are not patient facing www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30970-3/fulltext

They found that there was no significant difference between the two groups. Their conclusion is that PPE is therefore adequate and that infection amongst healthcare workers is probably mostly community rather workplace acquired.

I'm also intruiged by Sky news reporting that Bame deaths making up 19% of the total is similar to the proportion of BAME individuals within the population when The Guardian comes to a completely different conclusion! www.theguardian.com/world/2020/apr/22/racial-inequality-in-britain-found-a-risk-factor-for-covid-19

They say that it represents a 27% increase

Regarding vit D... anecdotal but I was diagnosed as deficient last year despite every school day being outside for 1-1.5 hours (unless raining but wouldn't get vit d then anyway) so I think people underestimate how hard it is to get enough.

I heard that on Radio 4 NeurotrashWarrior and wondered if it was a stealty way of increasing people's vitamin D intake in the light of speculation that it could possibly have a protective effect against the virus. In a "we don't know but it's worth a punt and costs us nothing" way.

I'm not being sneery by the way, I've increased my intake as a almost zero-cost measure for me.

This is a short video hearing from the doctors and nurses in the main Luxembourg hospital Covid 19 ward. Much better than the voice of a journalist.

In French and Luxembourgish with ENGLISH sub titles.
A tough watch but some interesting facts as well as emotions.

luxtimes.lu/health/40494-inside-a-covid-19-hospital-ward

Just anecdotally in my department in my trust, there is some instituational racism in that the BAME health care workers are underrepresented in senior managment roles and are therefore more likely to be frontline or patient facing at an older age than those of a white british background.

This would obviously translate into a greater risk of Covid infection. The key terms are "speciality doctor", "staff grade" or "associate specialist" these are non training grades eg: not leading to a consultant post and are widely used for "service delivery". This often means high work load and little recognition. I think this experience is not in anyway unusual.

Vitamin supplements having so little D in them doesnt help.
Realising my kids ones have 2.5-5 rather than the recommended 10. And only ones with 10 seem to be drops (which mine wont have due to taste).
Also none added to eg wheetabix etc.
Aside from CV we need to up uk levels across the board.

Ny also found minorities over represented.

Agree with pp re the staff being exposed to large dose when moved to a ward. And yes lets get on with AB testing them.
Surely they can actually take their blood to analyse they dont need a test ......

I was diagnosed as deficient last year despite every school day being outside for 1-1.5 hours
This is why I have an issue with the advice to wear sunscreen all the time, because it hinders vitamin D production. I actually try not to wear it unless I'm going to be in the sun for a prolonged period

Comparing countries is fraught with risk.

If you lock down later, you will have more deaths. Out cases were doubling every 2.5 days (roughly) pre lockdown, so even a 5 day delay will quadruple the number of eventual deaths.

In addition, R0, both pre and post lock down, will be massively affected by population density. Other factors, such as culture (Japanese don’t touch much, normally, for example) will also have an influence.

Clearly, we will eventually need to somehow compare approaches and draw lessons from this pandemic, but it will take time to get much meaningful, especially from country comparisons.

@hopefulhalf I haven't checked recently but of the first doctors who died, they were variously:

A GP who owned his own practice
Another GP who owned his own practice
A transplant surgeon
A heart surgeon
A consultant geriatrician
A breast tissue specialist with no direct patient contsct
An ENT volunteering in A&E
A retired doctor working voluntarily

Nobody obviously dogsbody type jobs

I agree that does'nt obviously fit. Most of the Italian medics who died were GPs. I guess they meet so many more people, so risk of infection is bound to be higher.

They found that there was no significant difference between the two groups. Their conclusion is that PPE is therefore adequate and that infection amongst healthcare workers is probably mostly community rather workplace acquired.

Anecdotally (from an intensivist) they've observed that of frontline NHS staff getting ill now, the vast majority are very mildly unwell. Much earlier in the pandemic, they were seeing seriously unwell ENT surgeons, colorectal surgeons and anaesthetists. They think that this could be because PPE is stopping, or at least reducing the infectious dose. Whereas in the early days, those specialists were performing aerosolising procedures without appropriated PPE on people not suspected of having CV and could have had a massive infectious dose.