Daily numbers, graphs, analysis thread 9

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Welcome to thread 9 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.

BigChoc do you have similar figures for Germany regarding hospital admissions and the number of patients still on ventilators for comparison with ICU stats in UK. It would be interesting to see whether protocols are similar.
How long is the average stay in ICU?
How long are patients ventilated for?
What percentage of admissions need ventilation?
Average ages?
It would be useful to see if differences explain the discrepancy in death rates. Lockdown may well have influenced infection rates overall but Germany treatment protocols appear to be having a positive outcome in patients who develop severe form of infection.
There is obviously international sharing of data and protocols.

I got that page to work momentarily. Not as far as all the input though. I wonder if it's crashing.

Apart from this threads (Thanks to all!!!) and the RKI site, I use these sites for Germany (probably known to the statistics experts on here): Death rate is slightly above average for this time of year.

experience.arcgis.com/experience/478220a4c454480e823b17327b2bf1d4 - the corona dashboard

www.data4life.care/de/corona/covid-19-statistik/ - statistcal data from various sources

www.destatis.de/DE/Themen/Querschnitt/Corona/_inhalt.html - - the national office for statistical data

We've had two localized outbreaks one in Leer - a socially distanced celebration that got out of hand (70 in quarantine) and one in Frankfurt/M. a Baptist service - they didn't keep a list, which will be expensive.

Do they publish an equivalent document to ICNARC?

Anyone here understand immunology and vaccine production?

MARS and SARS are both Coronovirus. If we develop a COVID-19 vaccine that works, will that make it easier to make vaccines against other MARS and SARS viruses in the future? Or would other Coronovirus vaccines have to start back at square one?

@oralengineer
would this help?
de.statista.com/statistik/daten/studie/1108578/umfrage/intensivmedizinische-versorgung-von-corona-patienten-covid-19-in-deutschland/

It would be interesting to know rates for HCPs with direct contact with patients, and with those currently not working due to childcare, underlying conditions removed . I wonder this because a relative working in an ICU is reporting high levels of staff sickness much higher than would be seen in a normal population.

Excellent question fate. I have no idea of the answer but it's definitely genomics data that would useful to know - especially about any similarity if the RNA of corona viruses.

Thanks I found the figures I needed for EU and UK combined on covid19-surveillance-report.ecdc.europa.eu/
The graph for severe hospitalisation does appear to be roughly similar to the ICNARC figures with regard to age. Suggesting that the EU as a whole has a similar approach to ICU admissions.

@FATEdestiny I think the problem is that in order to create and test a vaccine you need it to be around to test it.

SARS for example nothing can happen until a SARS outbreak occurs. I think you can make sure it is safe but not whether it works. There is a MERS vaccine ready to be tested I think

Adrian Hill who is running the Oxford Vaccine has said they only have a 50% chance of success simply because transmission is lowering and they may not have enough data to get a result as to whether it works or not

unconscious bias against treating the oldest

I am not sure I agree with this. Putting Covid aside for a moment, the majority of NHS treatment is spent on the oldest. At present my FIL is in hospital following a heart attack. He had a stroke 20 years ago, and survived, and apparently also had a previous heart attack he know nothing about. They were prepared to do a triple heart bypass, but unfortunately he is not sufficiently strong to undertake several house of anesthesia. He would probably die under anesthesia, he will probably die soon without the operation. He is coming home.

So, the first baseline was to treat, in fact the first treatment was an angiogram, but no stent was provided as his arteries are shot. So, IME, all treatment is available, but is only used if appropriate. So back to Covid........

Another nc so as not to out; Dh had a very interesting chat with a friend of his who is an nhs manager last night.

artus one thing he did say is that "no one actually working in icu in the U.K. has actually died from it yet." (Which I thought was odd as I'd thought there had been?)
More / better ppe? Viral load?

He also said their trust sourced materials and a factory and made their own gowns.

Their trust also tested all (non symptomatic) hcp workers in the hospital earlier on in the pandemic and 20 out of 400 had it.

Long time lurker...

@bingbling that's supported by the hsj report

"those working in the high risk specialties of anaesthesia and intensive care appear to be under-represented"

"the absence of certain workforce groups among those who have died, while welcome, is also notable. Anaesthetists, intensive care doctors and by association nurses and physiotherapists ...

... It is therefore notable that all of these groups are completely absent from the data set."

www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analysed/7027471.article

Masks
And surely if covid were around earlier then those people would have been in icus back in dec/jan and they have found hospital patients. This would have been long before masks. So you need to look back to jan/feb dr deaths with pneumonia.

Also if say other coronavirus do confer some immunity then hcp and teachers etc would be most exposed and boosting their immunity.

..re the risk website ...it works on chrome and not on safari , so maybe try a different browser ?

Also if say other coronavirus do confer some immunity then hcp and teachers etc would be most exposed and boosting their immunity.

Is that a current thought?

I have wondered if anyone has looked at chest X-rays taken in jan/ Feb. I believe it had a characteristic pattern?

They probably dont even need to look at all xrays
Deaths
And people in twice as long as expected.
And younger people hospitalised for breathing difficulties especially maybe people with high bp and diabetics.
And also anyone in hospital a month after a cruise or who died on or after a cruise..
Or within 4 weeks of a flight.

Would be interesting to see antibody results of anyone in those categories plus having been in wuhan after oct last year.
Couldveasily have cirulated in unis for eg only becoming a problem when students return in uk for xmas. Or in pubs frequented by students.

No dentists have died of Covid. Many worked beyond lockdown but as they routinely wear excessive PPE to do aerosol producing procedures they may well have been sufficiently protected. Again regular exposure to multiple doses of viruses may well have boosted immunity. Certainly throughout my career I have suffered less and less respiratory infections each year. This is a common observation throughout the profession. Early in my career I caught everything.
I did have Covid like symptoms in early Feb along with many colleagues. But since no antibody test is widely available cannot test.

There is now interest in Tcell involvement as an alternative response. Low Tcells observed in very ill so possibly Tcells may be the bodies primary defence with antibodies formed in only some individuals. Only time will tell.
Big positive today from Astrazenica CEO who has pledged 100million doses of new vaccine to UK. This is at cost, they are not looking to make profit. Interestingly he suggested that infection rate is dropping rapidly so vaccine may be too late to be effective. Do they know something we don’t? Vaccine will be manufactured here with excess going to EU. I would think that they are counting on Covid becoming endemic so will recoup profit from future production and sales.

OralEngineer Mass testing in German via a network of over 200 labs found more mild cases, especially with early testing of frontline health workers
This meant their health could be monitored early

Also, mass contact tracing helped find more cases (and also reduce them spreading infection)

Everyone confirmed positive has daily phone monitoring,
to check they haven't left the house - heavy fines & possibly even jail if so -
but also to check progress of symptoms

Then biggest difference in treatment in Germany is probably the so-called "Corona taxis":

When someone has more than mild symptoms, then they receive regular home visits from a health team dressed in spacesuit-type PPE, in the "Corona taxis"

Patients are given checks for blood O2, BP, heart etc
If they have breathing difficulties OR low blood O2 and have not yet (noticed) breathing problems then they are admitted to hospital for O2 treatment

We had hospital specialists in articles and on the TV saying how important it was to treat such symptoms as early as possible, to avoid deterioration

Hospitalisation was reported for 18% of cases

https://www.rki.de/DE/Content/InfAZ/N/NeuartigesCoronavirus/Situationsberichte/2020-05-23-en.pdf??__blob=publicationFile

COVID patients have always been a small % of occupied ICU beds, so free capacity has always been about 40%, even with COVID ICU patients from France, NL, Luxemburg

These show occupation stats for ICU in the 16 German states
( patient numbers differ slightly in the 2 screenshots, as RKI stats are slightly behind and some patients have since been discharged)

Doubts over Oxford vaccine as it fails to stop coronavirus in animal trials

Is that this vaccine ?

https://www.telegraph.co.uk/global-health/science-and-disease/doubts-oxford-vaccine-fails-stop-coronavirus-animal-trials/

Cases & deaths have been declining for some time here too

For several days now, just a few 100 new cases and deaths have been in double digits

• only 14 deaths yesterday, weekend but still lower than last WE

Reopening of restaurants (outdoors), gyms (not pools), hairdressers, schools (partial) over the last few weeks has not yet caused significant spikes

A few hotspots have arisen in some states in care home, meat plants and a DPD centre,
but - as Merkel's agreement with the states - these were locked down locally, when some exceeded the 50 / 100,000 new cases within 7 days.

We have 4-day and 7-day national R-numbers, but these are affected by the hotspots and the low numbers,
so even though these are 0.83 and 0.89 resp. there probably won't be public concern so long as the new cases continue low.

Currently, no plans to rein back the relaxations, but social distancing remains
e.g. 1.5 m distance, compulsory mask wearing in shops & public transport,
keeping mask on while my hair was cut, restricted spaces in gym class

I don't know whether foreign holidays to low infection areas will be allowed

• or whether tourists will be allowed in later this year from selected countries.

Probably not unless the virus does "disappear" over summer

• no evidence or explanation yet why COVID would be seasonal, so if it does drop to v low numbers everywhere, that would probably be due to SD

@BigChocFrenzy yes that's the one. There was a response to that article from the vaccine group - they said that the monkeys still having the virus in their noses was inevitable due to the excessive viral load they had been given to test the vaccine. So actually, that trial was successful in that despite exceptionally high viral loads, no macaques got pneumonia or severe illness.
The vaccine group are saying that it is the human trials where it could fail, most likely because there isn't enough covid around to test it.

But do Germany have an equivalent data set to ICNARC to compare ICU outcomes. It would be interesting to see whether ICU treatments results in the same outcome.
I have no doubt Germany has done a better job with early infection but have they had different outcomes for those who have severe infection. And how many people have yet to leave ICU. The UK data is good for looking at critical care outcomes.
The data available is great for population overview but the ICNARC is an excellent tool to see how ICU are doing. I have heard from colleagues that every effort is being made to avoid intubation because of the high death rate and that intensive oxygen therapy is preferable because it avoids the long term damage to the lungs from mechanical ventilation. But the real problem lies in multi organ failure have Germany been able to predict multiorgan failure and if so what treatments are they using preventatively.