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.

Good point @itsgettingweird on the up curve we hadn't added in care home deaths so Italy and UK were more directly comparable.

I guess with unhindered exponential growth the upswing of the curve is v similar assuming deaths are recorded in a similar manner. The downside of the curve is much more a reflection of gov action - or inaction - around lockdown, test track and trace and treatment. Even if our curve is now elevated above Italy as we are including care home deaths the shallowness or steepness of the decline represents the effectiveness of gov policy.

BigChocFrenzy
The measure of PPE shortages is deaths:
18 deaths of medical personnel [in Germany] not even doctors, is very low, below the working population average

Not necessarily - what were the ages of the medical staff infected/who died in Germany, their general state of health/ethnicity? At least 2 doctors who died of Covid-19 in the UK were aged 79, 2 more aged 76 and another described as being in his 70s - many more were in their mid-late 60s with pre-existing health conditions or younger and obese.

Germany's RKI daily situation report from 29th April says this;

"Thus far, 9,180 cases with a SARS-CoV-2 infection have been notified among staff working in medical facilities as defined by Section 23 IfSG. Among the cases reportedly working in medical facilities, 72% were female and 28% male.The median age was 41 years. Hospitalisation was reported for 407 cases among staff working in medical facilities with information available (4.4%). Due to missing data on occupation in 38% of cases, the true proportion of cases working in medical facilities may be higher."

www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-04-29-en.pdf?__blob=publicationFile

It is more likely that they were infected at the supermarket etc than at work.

Equally true in the UK - community transmission, religious worship...

hospital doctors have said for several weeks that they have plenty of PPE

Article from Germany yesterday;

'Masks are in short supply': "How coronavirus has hit Germany's frontline health workers."

"Since the start of the pandemic, Germany's Robert Koch Institute (RKI) for disease control, says 20,400 workers from hospitals, doctor's practices, emergency services and nursing homes are confirmed to have contracted coronavirus, making up around eleven percent of all those infected."

"However, this could be the tip of the iceberg as there are thought to be many more infected."

"A total of 894 people who work in the health sector have had to be treated in hospital, while at least 60 have died after becoming infected by Covid-19 reported the Suddeutetsche Zeitung on Tues May 19th. An estimated 19,100 people have recovered."

"Every day since mid-April, an average of more than 230 doctors and nurses have been infected with coronavirus, the SZ reported."

"In a survey conducted recently by Marbunger Bund, the association responsible for representing doctors, 38 percent of those questioned said they lacked protective equipment."

"The German Nurses Association share similar experiences"...

www.thelocal.de/20200519/masks-are-in-short-supply-how-coronavirus-has-hit-germanys-healthcare-frontline

The target was always tests not people. The number of tests are counted, the number of people tested are also released. I don't think these are mistruths.

The testing was clearly inadequate, particularly in the early days. It seems much better now. It's opened up to many more people, GP friends are being tested weekly and asymptomatic care residents and workers are being screened.

New York Times - Excess Mortality Tracker

Has country graphs comparing total deaths for 2020 (red line)
vs several previous years (thin grey lines)
and a historical average (thick blue line)
(averaged over how many years available per country)

https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html?auth=login-email&login=email

In Britain, which has recorded more Covid-19 deaths than any country except the United States,
more than 130,000 people have died since mid-March

• 57,000 more people than usual, and about 16,000 more than have been captured by official death statistics.

New York Times - UK vs France

The grey lines are years 2010 - 2018 / 2019

This is another source that shows there was no Spring heatwave killing people in France in suffiicient numbers to affect the France / UK excess deaths comparison

how, not good news for type 2, from that paper, surely?

The measure of PPE shortages is deaths:
18 deaths of medical personnel [in Germany] not even doctors, is very low, below the working population average

^*Not necessarily"

Yes, necessarily:
when only 18 medical staff die in a country of 83 million, then any PPE shortage is not having a significant effect^

The RKI is the public health institute, not the statistics institute, so although it has nearly all current data, it always warns it may not be complete

Hospital doctors treating COVID patients have the space suits and have been saying for weks they have adequate PPE.
Some of the other 400,000 doctors treating non-COVID patients here did not

The measure of performance is total deaths
In the UK, the deaths of medical personnel also don't look higher than in the general working population.

The performance issue în this pandemic is what happened to the rest of the population:
the excess deaths

@NeurotrashWarrior

Death 3 times as likely if type 1, a bit less if you’re type 2?

I am concerned @NeurotrashWarrior because we were previously told that being Type 1 wasn’t in itself a risk factor but it would seem to be the case, although of course age and comorbidities feature.

NewAccount testing ICU staff is fine as part of a program of testing all hospital staff, but it does seem likely they would have the lowest infection rate

Does anyone have any info about when antibody test data would be released, especially for London ?

I would assume that antibody test data would be grouped separately from the swab tests in the daily briefings

btw, anyone know why we have "unavailable" for the number of people tested ?

It says there's a problem with the data collection systems and ir will be corrected.

BigChocFrenzy
do we know whether in fact there has been an increase in the number of pensioners (with underlying health conditions?) returning to the UK because of Brexit...?

This was one of my three queries from yesterday which you dismissed out of hand. I know we're not supposed to refer to posts from other threads, but you have previously posted on numerous occasions that you were worried about pensioner expats in the EU - access to healthcare/cost of health insurance after Brexit, and the NHS potentially having; "100s of 1000s of expensive pensioners suddenly added to their responsibilities."

I am not talking about 100s of 1000s of British pensioners returning to the UK because of Brexit fears, but why did you regard my query as ridiculous in view of your previous posts on the subject? Should I assume that while you were worrying about British pensioners abroad, they were not in fact worrying about themselves?

Sorry I didn't notice the adjusted for part which changed the raw data considerably:

Adjustedforage,sex,deprivation, ethnicityandgeographicalregion,peoplewithType1andType2diabeteshad 3∙50(3∙15-3∙89) and 2∙03(1∙97- 2∙09) times the odds respectively of dying in hospital with COVID-19 compared to those without diabetes, attenuatedto2∙86and1∙81 respectivelywhenalsoadjustedforprevioushospitaladmissionswithcoronaryheart disease,cerebrovasculardiseaseorheartfailure.

(Not sure why the spaces have gone)

I think it's saying, overall more with type 2 are sadly dying but with a number of co-morbidities, when adjusted for this the risk is roughly the same if a little more for type 1?

Type 2 is generally lifestyle related so this makes sense.

What we also have to consider wrt current daily deaths,
in particular wrt any decicion to lift UK lockdown,
is how many of those deaths are of people in ICU who have been there for weeks

imo, that should not affect the UK decision, because some might be of infections from several weeks ago

e.g. There are over 1,100 people still in German ICU and although to date "only" 27% of ICU patients have died,
it is likely that there will be a higher % of deaths among those who have been there the longest
That's not going to affect any decisions here about further relaxation of measures.

"why did you regard my query as ridiculous in view of your previous posts on the subject?"
do we know whether in fact there has been an increase in the number of pensioners (with underlying health conditions?) returning to the UK because of Brexit...?"

Clavinova This is not a Brexit thread
So I expect I was referring to something else, related to COVID

re healthcare for UK pensioner emigrants:
those issues have been settled in the WA, which is now an international agreement
(the Westministenders debate was during the long uncertainty about whether there would be a WA)

Any existing private or state health insurance should cover COVID,
so no UK expat of any age in the EU should worry about needing to return for NHS treatment

That's not a very good explanation in my opinion.

Any existing private or state health insurance should cover COVID

I am not talking about COVID illnesses - pensioners may have returned to the UK last year or the year before.

Bbc news headlines are 1/3 of hospital deaths linked to diabetes.

Does anyone have risk data for different age groups with conditions like diabetes ?

e.g. is someone with diabetes under 45 still at lower risk than say a fit person of 60-65, who may also still be working ?

imo, when it comes to classifications for "clinically vulnerable" or "shielding" wrt returning to work, or even leaving the house,
it should be on the basis of overall risk
i.e. must be age-related

https://www.bbc.com/news/health-52726328

Although the threat of coronavirus is still low for most diabetic people, diabetes was linked to a third of virus deaths in England from 1 March to 11 May, NHS England research shows.
High blood sugar levels and obesity add to the risk.

But age is a bigger risk factor.

One being that we haven't yet tested 100,000 people per day. I'm not even sure we've reached 80k people. Obviously this means approx 140k people we've missed a week for 3 weeks - 420k people in total we could have tested. That itself would have given us more statistical data re numbers of positives, R number, clusters and hopefully more of an ideas how many people in the population have been infected as a total.

It really doesn't matter except to bickering politicians.

In general for statistical purposes you need to quadruple the number of tests to get double the accuracy. This is not cost-effective.

Clearly 5000 tests daily was utterly inadequate, and you need to sample a reasonably large number of people to get an idea of what's going on. And if you strip out medics and ill people, then the numbers informing our population estimates won't be anywhere near 100,000. But they don't need to be. Exit polls work with 10,000 people or so. National political polls perhaps 2500

Anyway 80,000 Vs 100,000 isn't really a meaningful distinction.

More important is sampling, in that you need to know who is and isn't infected and where they are. Not the Chinese approach of testing millions of people and locking them up if they test positive, but rather given a large population of infected that are mostly asymptomatic, to try to figure out who is infected.

The real testing failures occurred in March. It is not clear why other countries were so much more agile than we were. But a more nimble NHS would have saved tens of thousands of lives.

"Ramping up testing" isn't a lie. But the action of ramping up is useless without it having some kind of purpose in data collection to inform our next steps

Have you read the government's testing pillars? Published in early April. Purpose is clear.

With diabetes I expect there's also significant risk to how well managed you are and how much you also look after yourself.

I know that a friend who developed type 1 in his late 30s has always been very outdoorsy and got very into long distance cycling. The consultant at the hospital was actually studying his response and management as he was so well managed when after diagnosis due to the exercise. Same area/ hospital that did a lot of research into v low calorie and fitness helping to even potentially occasionally cure type 2.

@BigChocFrenzy

Diabetes data here: england.nhs.uk/publication/type-1-and-type-2-diabetes-and-covid-19-related-mortality-in-england/

A concern for Type 1s as I agree with the above posts, we were lead to believe that Type 1 in itself wasn't really a risk factor.

Risk seems to double for about every 7 years of age,
but so far the increased risk of any single comorbidity has been listed as much lower

However, this is from NYC as of 12 May, where deaths with underlying conditions are a v high % within all age groups:

https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-daily-data-summary-deaths-05132020-1.pdf

These data include cases in NYC residents and foreign residents treated in NYC facilities.
This table shows only confirmed deaths.

A death is considered confirmed when the person had a positive COVID-19 laboratory test.

1 "underlying illnesses" include Diabetes, Lung Disease, Cancer, Immunodeficiency, Heart Disease, Hypertension, Asthma, Kidney Disease, and GI/Liver Disease.