Daily numbers, graphs, analysis thread 10

[BigChocFrenzy]

Welcome to thread 10 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

We welcome factual, data driven, and civil discussions from all contributors 💐

"There is some conversation on Twitter about it right now"

There needs to be a proper response with data and sources, from named experts in the field,

if the sampling in the paper is not representative

I am very wary about Twitter responses:
Some can be excellent informed quick reaction
but some is from the old "it's just flu" brigade still grinding their axe - which includes a few scientists

Derby I've been reading estimates by epidemiologists that flu IFR = 0.044%
i.e. when we include estimated number of cases, so the mild & asymptomatic cases too, as for COVID

Don't have the links atm, but I must look

I’ve been interested in Sweden’s approach throughout.... Interesting how figures have been presented on worldometers recently. It reports a relatively low number of infections 200-300, and then in the small hours just before it rolls over to the next day, they add another 1,000+! Spin maybe?

Given the UK is testing extensively now, the fact Sweden’s infection numbers are similar to ours, and we’re nearly 7 times the size, and given the UK is still considerably above other European countries, it doesn’t bode well for Sweden. I imagine they’ll be shut out of travel zones for a while!

I've been reading estimates by epidemiologists that flu IFR = 0.044%

Yes, the much quoted 0.1% is too high in general.... it only approaches that in the very worst of seasons (Spanish flu excepted!) and i believe 2017-18 was the worst for around 30 years.

Some can be excellent informed quick reaction
but some is from the old "it's just flu" brigade still grinding their axe

Yes, some will stop at nothing to twist the stats to show its “just the flu”.

@BigChocFrenzy

"There is some conversation on Twitter about it right now"

There needs to be a proper response with data and sources, from named experts in the field,

if the sampling in the paper is not representative

I am very wary about Twitter responses:
Some can be excellent informed quick reaction
but some is from the old "it's just flu" brigade still grinding their axe - which includes a few scientists

I understand your reticence, but in this case it's not just people being reactive - it's people who have actually read the original study in Italian, and the subsequent amendment put out by the Bergamo Health Agency, (as well as a statement by the Mayor) which said that most of those in the study were from the worst-hit areas and already under quarantine. They have already corrected the misconceptions caused (which seem to have arisen thanks to a mistranslation by Reuters).

500,000 for, Whitty, Vallance, Ferguson was a conservative worst case scenario for doing nothing

• which of course no sane country tried

The 250,000 was for taking some measures, but not lockdown
Roughly equivalent to what Sweden did

However, we see that Sweden has high multiples of death rate / million of its Scandi / Nordic neighbours
and still is not showing the sharp decline now that all countries with lockdown had, just a much slower decline

Serology studies there suggest not a very high % infection either - their "Whitty" estimated about 20% recently, far from herd immunity

Deaths / million:
481 Sweden
103 Denmark
59 Finland
45 Norway
29 Iceland

It is likely that the UK without lockdown would also have a multiple of its current deaths
250,000 instead of 60,000 looks possible, but we'll never know

BigChocFrenzy it is on @AdamJKusharki twitter feed and it concludes that the samples were from healthcare workers and people in quarantine so you would expect it to be significantly higher than the general population.

Whitty and Vallance referred to a similar number as the "reasonable worst case" scenario

Yes, I remember this and I think it was absolutely the right message back in March. However, just as you said, now we know much more about C19. IFR may not be 0.9%. The spread pattern for C19 is very different from the seasonal flu. It appears we should be able to keep R factor below 1 operating a "90% (or even 95%?) economy".

However, a meaningful percentage of people in the UK seem stuck in March 2020 and appear to believe we are still facing the choice between 500,000 deaths (which was never the baseline case - even with the old "mitigation / herd immunity" strategy) and a full lockdown. The "stay home" message really screwed up some people's mental state. Of course, C19 is not flu but it is not the reason to barricade yourself (and your children) at home until the vaccine. Unfortunately, some people seem to be doing just that.

On that twitter thread:

"A more random sample from one of the worst-hit areas nearby (where COVID-19 killed 1% of the population!) found only 37% seroprevalence."

Even if we assume 50% are immune, including wild guestimate of T cell activation,
that would mean 2% death rate locally ? - high % of retired people living there ?

Death rates may need to be considered on a regional rather than national basis,
say population demographics, population density, health service spare capacity etc

.... and % infected

Probably a high % infected means people can get several loads of virus within a few hours, so become more seriously ill
Also, any health service will be overwhelmed by a sufficiently high number of people requiring O2 etc

That's where modelling comes in

Some positive news rolling average of hospital deaths has dropped below 100 mobile.twitter.com/ganeshran/status/1271434895504617472 . This could change tomorrow but is a symbolic milestone

"500,000 deaths (which was never the baseline case - even with the old "mitigation / herd immunity" strategy"

Back when we knew nothing about clusters, the importance of O2 etc, that 500,000 was "reasonable worst case" from the CMO, in the knowledge he had then
Not "the most likely" but also not the wildest and he's not the type to panic

It is unclear if it included any mitigation measures at all

The UK shouldn't face 500,000 deaths any more, because scientists have far more knowledge of effective measures and have built up systems for mass testing and contact tracking
The worst I'd expect is facing another 50,000 this winter - an order of magnitude less

The govt will presumably keep some measures, which would allow maybe 90% of the economy to resume - and ft schools -
but would reimpose more if ever cases became exponential

Note:
It is not just government regs which hammer the economy, but also the behaviour of consumers.

Restaurants have been open here for weeks, but numbers are still massively down

• customers are 90% down even at my fav regional award-winning restaurant in the next town which has a huge beer garden outside

They have been forced into takeaways, which cuts out tips, most drinks and was never in their business model.

In my gym which opened 16 May, numbers still way down

Many shielded and even vulnerable here are still sticking to the essentials of school and work;
the important grey Euro of the retired is staying home a lot

This is after 9k deaths in an 83 million pop and after weeks of deaths in single or double digits

Excellent overview of all the vaccines in development, what is involved
and the stages that are being combined to save time

www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html

Hopefully results will help reassure staff and parents:

PHE: Study launched to monitor prevalence of COVID-19 in schools

www.gov.uk/government/news/study-launched-to-monitor-prevalence-of-covid-19-in-schools

I re-read the paper last night 500k was with no actions at all - neither mitigation nor suppression. Mitigation had a number of possible options (from case isolation through to shielding over 70s) & suppression more still (up to 5 months of lockdown followed by more cyclical lockdowns). I’m not sure why people are so fixated on 500k since doing absolutely nothing at all was never an option.

a meaningful percentage of people in the UK seem stuck in March 2020 and appear to believe we are still facing the choice between 500,000 deaths (which was never the baseline case - even with the old "mitigation / herd immunity" strategy) and a full lockdown. The "stay home" message really screwed up some people's mental state.

^ absolutely this - 500k was never the baseline.

@Laniakea

I re-read the paper last night 500k was with no actions at all - neither mitigation nor suppression. Mitigation had a number of possible options (from case isolation through to shielding over 70s) & suppression more still (up to 5 months of lockdown followed by more cyclical lockdowns). I’m not sure why people are so fixated on 500k since doing absolutely nothing at all was never an option.

Indeed. It seems to assume we would have all just wandered around not changing our behaviours at all for months, whilst people dropped dead around us. Given the amount of voluntary actions being taken well before lockdown - and the affect they had - this was clearly ridiculous.

iirc 250k and 150k deaths with different sets of mitigation measures but not lockdown

However, with current knowledge and systems, the UK is not facing either
My guestimate is that a 2nd wave would not exceed 50k unless the govt & public abandon all sense

• but there may well not even be a 2nd wave in winter .... as it's not the damn flu

We need to distinguish between facing a novel virus in March when unprepared and knowing v little about it,
compared to the current situation of massive research by scientists around the world.

Obviously, the death rate of about every disease in history has been much reduced once we know more about how to deal with it, both wrt public health measures and medical treatment.

Looking back at SAGE documents, the fear messaging was indeed "driven by science" but now we have got to deal with unintended consequences of being too persuasive.

assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/882722/25-options-for-increasing-adherence-to-social-distancing-measures-22032020.pdf

Options for increasing adherence to social distancing measures 22nd March 2020

Perceived threat: A substantial number of people still do not feel sufficiently personally threatened; it could be that they are reassured by the low death rate in their demographic group (8), although levels of concern may be rising (9). Having a good understanding of the risk has been found to be positively associated with adoption of COVID-19 social distancing measures in Hong Kong (10). The perceived level of personal threat needs to be increased among those who are complacent, using hard-hitting emotional messaging.

Comparison of rolling 7-day deaths / million for countries which include care home deaths

The UK is continuing weeks of lower deaths, although not dropping as sharply as others who locked down earlier

Sweden is showing much less of a drop than all these countries which locked down
and has the highest 7-day deaths / million

Belgium includes any death with even a sniff of COVID, so still tops cumulative deaths / million,
but their COVID deaths are nearly the same as their excess deaths, unlike most countries which have a big gap.

Boris's "many more families are going to lose loved ones" chilled the blood
which was effective, but difficult to unchill

Merkel's "this is serious; take it seriously" got the message over effectively

• German compliance was as good as Brits

However, as posted, people here are back at school & work, but not back as consumers to the same extent.
Hence her massive stimulus package, nearly 4% of GDP, to coax people into spending again

The r rate still high according to the guardian

There has been an article in today's FT that has shown a couple of graphs on economic activity. While Germany might not be fully back to normal, it seems to be leading the way. UK is lagging behind.

on.ft.com/2B5J73m

even if the Bergamot figures are not a random sample it gives an idea of what happens when the virus runs free. If their quarantine had not been effective the rest would probably have gone down in much the same numbers. Remember that some people seem to get it without developing antibodies too so the numbers infected were possibly higher.

Locking down does not necessarily mean we will avoid large numbers of deaths, it may simply spread them over a longer time period. If everyone returned to normal then would be a rising number of infections and eventually more deaths, but with a lower fatality rate thanks to improved treatment. Lockdown is a breathing space and you flatten the curve but you dont eliminate excess deaths until you eliminate the virus, find a good treatment or develop a vaccine.