Daily numbers, graphs, analysis thread 8

[Barracker]

Welcome to thread 8 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.

As an observation I think that hazard ratios in general are a joy for tabloid journalists.

It's like if 10x as many people who ate bacon daily died of cancer then you'd stop. But it turns out to be 10% or something which is kinda dull if it's 10% of 1 in 100 or whatever. Of course on a population level as a government it probably makes sense to reduce these various risks but on an individual level it's rarely that exciting.

I mean Americans might be incredibly fat, have expensive health care, etc., But it doesn't make that much difference to their life expectancy.

Also a lot of the time developing countries may suffer low life expectancy because of things like infant mortality and road accidents. These take off lots of years of life, whereas dying from bacon cancer won't happen if it does till you are relatively old. 🥓

"the single biggest factor in covid-19 death since only a small % of the population has been infected is whether you have been infected."

That is cricial

Another reason why it matters whether 5% (likely) or 35% (v. unlikely) have been infected
and whether those claiming "everyone will get it" as a justification for "get on & live with it" are correct

"natural immunity"

Could be full resistance or only partial
A few people apparently without symptoms may take some weeks to develop them, or may require a high viral load before symptoms are noticeable.

It's something that could take several years or even decades to find out
unless maybe scientists make a breakthrough in understanding COVID and discover a genetic mutation in humans that would prevent COVID latching on

e.g. HIV resistance is via the Delta 32 mutation, which causes the genetic deletion of part of the CCR5 gene, so the HIV virus can't latch on, or is v unlikely to.
but < 10% of the population have even partial resistance like this.

Office for National Statistics (ONS) @ONS

One in eight households (12%) in Great Britain has no access to a private or shared garden during the #coronavirus lockdown,
according to our analysis of Ordnance Survey map data

http://ow.ly/SVkD50zFTFo

The percentage of homes without a garden in England is higher among ethnic minorities.

A survey by Natural England shows that
Black people are nearly four times as likely as White people to have no outdoor space at home

http://ow.ly/QmTZ30qFSQY

Even comparing people of similar age, social grade and living situation (area, and with or without children), those of Black ethnicity remain less likely than those of White ethnicity to have a private garden.

Our technical paper explains further http://ow.ly/kePK30qFSRM

Older people – who are at greater risk of severe illness from #COVID19 and advised to stay at home as much as possible –
are among those most likely to have access to a garden
< only 8% of those aged 65+ have no access to a garden >

http://ow.ly/DJE530qFSTu

The Delta 32 gene mutation is a recent discovery based on observations of HIV spread over 35 years and the ability to map genomes. We have no way of knowing if the population has a favourable gene mutation for Covid at this stage.
The pattern of comorbidities suggests that impaired immune systems is a causative factor such as age, diabetes, pregnancy and medical immunosuppression. So you are more likely to be infected but there must be more subtle modify factors when it comes to morbidity. We know sex is very significant and the ratio does suggest a link to genes.

Actually we do know that having two X chromosomes is a definite advantage!

Yes the Y chromosome is a bit shitty and vestigal. Whereas two full-length redundant backup X chromosomes is much better than one.

Looks like women catch it just as much as men
and probably that young people 20+ catch it as much as middle-aged or elderly

The really big differences are in the severity - and death rate - if infected
Main factors being

1. Age
2. Sex - hooray for those two X-chromosones

I agree that it may take decades before we find how many of those who never caught COVID were just lucky - or not unlucky -
and how many might have had had partial or full resistance / natural immunity

Particularly if only a small minority of the population have antibodies by the time a vaccine program has been carried out

I've often read teachers on MN quoting that about 30% of their number have conditions that put them in the "vulnerable" or shielded category wrt COVID

Does that include a lot of pregnancies, or is it exaggerated ?
because it is much higher than the estimated 15% for key workers as a whole

Teachers in England have average age 39, younger than in most countries

www.cambridgeassessment.org.uk/our-research/data-bytes/the-average-age-of-teachers-in-secondary-schools/

Office for National Statistics (ONS))@ONS*

Our #coronavirus roundup looks at characteristics of key workers.

10.6M people (33% of the workforce) were employed in these occupations

An estimated 15% of key workers had health conditions leaving them at moderate risk from #COVID19

http://ow.ly/x49I30qGk5u

An estimated 15% of key workers had a health condition which leaves them at moderate risk from the coronavirus (COVID-19).

Of those at moderate risk, a higher proportion of these had heart, blood pressure or blood circulation problems (6%), followed by chest or breathing problems, asthma, bronchitis (5%).

I don't know the actual stats so this is anecdotal I'm afraid (although I think the unions have been throwing some numbers about). Most teachers are probably talking about their own experiences in their schools.

Teachers do tend to be:

• more predominantly women (particularly primary)
• as you note, younger than most European countries (because we can't keep hold of them) so more likely child bearing age
• teachers are one of the most unhealthy professions along with medics; terrible work-life balance. I typically work a 60-70 hour week in term time but without the salaries that enable us to outsource eg cleaning our homes to someone else. So we drink, smoke and eat junk. And have high levels of stress and therefore high blood pressure. There has been proper research on this in recent years, it always gets write ups in the union magazines, but I dont know how to link it on my phone.

Secondary schools I'd expect fairly typical levels of vulnerable despite slightly skewed lower age because of these factors. Primary schools when you factor in TAs who are often older women in their 50s and 60s you would easily expect to see a third vulnerable/shielding.

The government in their wisdom has decided to tell vulnerable (as opposed to shielding) staff to 'work from home if possible' (clearly not if you're a year 1 TA!) otherwise tough, go in. No social distancing expected (rightly, in early years), no PPE allowed (yes, allowed - not 'not required', actually 'teachers should not be wearing masks or gloves'). I can see why staff are scared.

In addition, I would imagine that the heads and teachers most concerned about staffing levels ie those with a high % of shielding staff are the ones most likely to post.

There's also a lot of confusion about who is in the 'shielding', 'clinically vulnerable' etc groups, at least in part due to England, Ireland, Wales and Scotland each having different guidelines.

Just anecdotally, I know two teachers who were exempted from going into school to look after children of key workers at the beginning of lock down due to their asthma. And a TA whose son has asthma, so her family is shielding

Not sure how this will play out once schools require higher numbers of staff to go in.

#shootsfruitandleaves
Thank you so much for that analysis it's just what I was looking for, I really appreciate your time

Two interesting bits of info I got from experts on the Jeremy Vine show on radio 2 (apologies if they're not new to you):

Re death rates, the rather horrible term 'harvesting' which refers to the frail elderly who would have died during winter flu season, but as we had a very mild winter, those deaths instead occur later in the year (i.e. some now).

Also there was a discussion about Covid-19 on death certificates, and a doctor explained that there are 3 sections on a death certificate relating to cause of death. I can't remember the exact names, but the first is main cause of death, the second is contributing cause and the third other conditions the patient had. CV could be put in any of those three sections. Which I think is why some of the graphs etc say deaths 'with' CV not 'of'.

This has probably been posted already but this interview with Nobel Prize Winner, Prof Michael Levitt from Stanford is really interesting. He explains in it why he thinks the Ferguson model is wrong - basically it assumed a higher growth rate over a longer time period than he finds is supported by the data.

https://www.theguardian.com/world/2020/may/17/hospital-patients-england-coronavirus-covid-19

Senior figures at several NHS trusts have confirmed to the Guardian that a senior official at NHS England said in the briefing, held by telephone conference in late April,

that the rate of hospital-acquired Covid-19 infections was running at 10% to 20% and that asymptomatic staff had caused some of the cases.

Senior doctors and hospital managers say that doctors, nurses and other staff have inadvertently passed on the virus to patients
because they did not have adequate personal protective equipment (PPE)
or could not get tested for the virus.
....
More recent research among staff in the hospitals run by a leading NHS trust in the north of England found that
7% had coronavirus but had no symptoms, and thus posed a risk to patients.

I registered a death where Covid-19 was I feel rightly first cause of death pneumonia second frailty 3rd.
Whereas I wouldn't have said frailty was a factor he was doing well, until he got Covid. And the pneumonia came from the Covid. Will they also count that death as a frailty death?

The government in their wisdom has decided to tell vulnerable (as opposed to shielding) staff to 'work from home if possible' (clearly not if you're a year 1 TA!) otherwise tough, go in. No social distancing expected (rightly, in early years), no PPE allowed (yes, allowed - not 'not required', actually 'teachers should not be wearing masks or gloves'). I can see why staff are scared.

As noted above, 'vulnerable' people are not likely particularly significantly more vulnerable than anyone else, and a 'non-vulnerable' male teacher of 55 is many times more likely to die than a 'vulnerable' female teacher of 25 with asthma.

There's evidence in fact people with asthma are at lower risk of death.

teachers are one of the most unhealthy professions along with medics; terrible work-life balance. I typically work a 60-70 hour week in term time but without the salaries that enable us to outsource eg cleaning our homes to someone else. So we drink, smoke and eat junk. And have high levels of stress and therefore high blood pressure. There has been proper research on this in recent years, it always gets write ups in the union magazines, but I dont know how to link it on my phone.

Well they would say that wouldn't they? In fact for men doctors/medical professionals have THE lowest mortality, along with teachers and managers. For women teachers are also very much less likely to die than average, as are female medical professionals.

www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30193-7/fulltext

Also smoking is associated with manual work. Teachers are usually found to have the lowest smoking rates of all jobs.

www.vapour.com/latest/industries-with-the-highest-and-lowest-smoking-rates/

The lowest alcohol-related death rates in women were found in education jobs

pdfs.semanticscholar.org/05d2/e1bc8273fb2ae1ea4c4e9c36a7a12d3078e8.pdf

The death total in the Ferguson model is close to Whitty's "reasonable worst case"

• which is what I would expect any govt to listen to from their CMO, but is not necessarily the most likely COVID outcome

Whitty - and probably Ferguson - were at that time taking figures from Italy,
which is what they had available at the time

imo, even if Ferguson's model had never existed, the CMO estimating possibly 80% infected at up to 1% death rate,
is not something a government could just gamble wouldn't happen

• if they lost such a gamble, not just the govt but probably the party itself would be destroyed

Masks are far more common in schools on the continent

Staff and pupils in Germany are allowed to wear masks if they wish,
which imo is a sensible compromise

Children don't seem to be alarmed by this
However, masks are common generally here - mandatory in shops, taxis,public transport etc

Also school starts here at age 6
and pupils with SEN, LDs or even physical disabilities requiring staff help are educated separately in specialised schools (as used to be the case when I was at school in the UK)
about 400,000 pupils in total here

Measuring excess mortality: the case of England during the Covid-19 Pandemic
INET Oxford Working Paper No. 2020-11

https://www.inet.ox.ac.uk/files/6-May-20-Muellbauer-Aron-Excess-mortality-in-England-vs.-Europe-and-the-COVID-pandemic.pdf

EuroMOMO produces the most systematic comparative tracking of excess mortality in Europe.

Of the 24 countries or regions covered, England had the highest peak weekly excess mortality in total,
and also for the most vulnerable age group (the over-65s),
and, strikingly, for the 15-64 age group.

For the last group, which should be less at risk,
the relative record for England is nearly 3 times worse than the next worst- ranked country, Spain
(German data suggest mortality well within the normal range).
......
Generally, there was a collective failure in preparedness across the public health system,
especially for testing capability and adequate supplies and distribution logistics of personal protection equipment for health workers.

https://www.theguardian.com/business/2020/may/17/how-england-found-itself-at-the-foot-of-the-covid-19-league-table

At its peak it was 2.8 times worse than the weekly peak in the next worst country, Spain,
around four times worse than France and Belgium,
and more than five times worse than in Italy.

I registered a death where Covid-19 was I feel rightly first cause of death pneumonia second frailty 3rd.
Whereas I wouldn't have said frailty was a factor he was doing well, until he got Covid. And the pneumonia came from the Covid. Will they also count that death as a frailty death?

Currently 95% of deaths where covid-19 is mentioned, covid-19 is given as the underlying cause.

5% therefore involve covid-19 but that is not the underlying cause.

It follows that as deaths with the primary cause of cancer are slightly down (except for women's cancers) covid-19 is currently the primary cause in some people that have other causes and who would have died anyway.

In the case where this person would be expected to eventually die of causes 'Symptoms, signs and ill-defined conditions' (inc. frailty), and they have now died of covd-19 it follows that we expect to see a fall in deaths in this category. Instead there is a large rise, which suggests covid-19 is being under-diagnosed.

The ONS says

"We define a pre-existing condition as any health condition mentioned on the death certificate that either came before the coronavirus (COVID-19) or was an independent contributory factor in the death. Where only COVID-19 was recorded on the death certificate, or COVID-19 and subsequent conditions caused by COVID-19 were recorded, we refer to these deaths as having “No pre-existing conditions”.

So the death could be recorded as:

1
(a) Disease or condition leading directly to death: 'Pneumonia'
(b) other other disease or condition, if any, leading to I(a): covid-19
(c) other other disease or condition, if any, leading to I(b) frailty due to old age

Or with 1(a)/(b) only and also

2Other significant conditions : frailty due to old age
Contributing to death but not
related to the
disease or condition
causing it

assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877302/guidance-for-doctors-completing-medical-certificates-of-cause-of-death-covid-19.pdf

www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/methodologies/measuringpreexistinghealthconditionsindeathcertificationdeathsinvolvingcovid19march2020

If there are no pre-existing conditions, that is, the coronavirus (COVID-19) is the only mention on the certificate, or COVID-19 is the lowest mention in Part 1 and there are no mentions in Part 2, the main pre-existing condition is “none”.

If COVID-19 is in Part 1 and there is only one pre-existing condition, either below the COVID-19 in Part 1, or in Part 2, that is the main pre-existing condition.

If COVID-19 is in Part 2 it is excluded from the analysis, since it cannot be a pre-existing condition relative to itself.

In other words if someone dies from 'pneumonia' due to 'covid-19' due to 'frailty' then 'frailty' will be the main underlying condition

and if they die from 'pneumonia' due to 'covid-19' and fraility is in part 2 as a contributing factor, then that will also be the main underlying condition.

If there are multiple underlying conditions, they will consider both the 'main' and the others. But clearly, it's not 100% exact.

@Eyewhisker

The Ferguson model undoubtedly had flaws... The model was applied in mid-March to a situation we knew little about... It’s easy with hindsight to criticise, but actually, whatever it’s flaws, it’s figures of what would happen if Covid was given
a free run have stood the test of time so far when compared to actual data I believe.

The closest we have to allowing the virus to spread in barely controlled manner are NYC and Bergamo. Both these places locked down (albeit it too late to allow a significant portion of their populations to be infected) but has they not, it’s common sense to think their death tolls would have been significantly higher still.

Extrapolating NYC deaths to the UK and you get 165,000 dead. Do the same do Bergamo and you get 350,000 dead. I’d argue that the 250k and 510k figures in the Imperial study compare well to this real data.

My mum is an ex smoking exFE teacher who had a heart attack at 50-60yo. And now has copd.

I dont see how that few people are vulnerable as 8% are diabetic and 10-11% asthmatic. Obviously some crossover.
Also as vulnerable are SD and wfh we cant use the % of deaths that were asthmatic except maybe wuhan or maybe italy.
That research about long lasting covid had many asthmatics though so i guess they are catching it. And suggested at risk of long illness. Possibly ventolin is protective certainly they eem to use asthma meds on covid and a nebuliser. Are steroids an anti inflamatory as well as affecting immune system?

One of the issues with the Ferguson model is that it was for influenza and so showed closing schools as a significant factor in spreading the virus. This is true for flu but the evidence, including from the WHO, is that this is not the case for Covid. It also seemed to assume that only government imposed measures had any impact and did not take into account voluntary changes in behaviour, which is why it’s numbers are so wrong for Sweden.

Compared to flu, Covid seems more likely to spread at large social events, where there is talking or singing loudly in close contact but much less likely in school settings as children seem less able to transmit the virus. It would at least be good for Imperial to update their modelling based on new info about this virus.