Daily numbers, graphs, analysis thread 16

[BigChocFrenzy]

Welcome to thread 16 of the daily updates

Resource links:

Uk dashboard deaths, cases, hospitals, tests - 4 nations, English regions & LAs
MSAO Map of English cases
[[https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/909430/Contain_framework_lower_tier_local_authority__14_August_2020.pdf
Slides & data UK govt pressers
UK added daily by PHE & DHSC
R estimates UK & English regions
PHE Surveillance report infections & watchlists every Thursday
ONS England infection surveillance reports
ONS UK death stats released each Tuesday
ECDC rolling 14-day incidence EEA & UK
Daily ECDC country detail UK
WHO dashboard
Worldometer UK page
Plot FT graphs compare countries deaths, cases, raw / million pop
Covidly.com world summary & graphs
Plot COVID Graphs Our World in Data test positivity etc

We welcome factual, data driven, and civil discussions from all contributors 📈 📉 📊 👍

Hi @littleowl1, thanks for your hard work on Covid Messenger, it's a really valuable resource. I've recommended it to everyone I know.

I've been watching Leeds climb into the top three over the last week. Had you considered also ranking places on a cases per 100,000 basis, instead of on raw figures which tend to overrepresent the big cities?

Little, it was a pub in Stanley.

We were staying nearby at the time. And went to barnard castle...

www.bbc.com/news/uk-england-tyne-53794351

[quote MRex]@Nellodee - it is not possible to confirm how many household members get infected, because testing at the wrong time can deliver false negatives, particularly in asymptomatic people. Previous studies have all shown similarly much smaller infection risk for children than for adults, I'd personally put less faith in them than antibody studies because of false negative results and the difficulty of knowing who was infected first, but here you go: www.ecdc.europa.eu/en/covid-19/latest-evidence/transmission
-Age-stratified analysis showed that the secondary attack rate in symptomatic children was 4.7% compared with 17.1% in adults (≥ 20 years of age) [56], and that the probability of infection in children was 0.26 times lower (95%CI 0.13-0.54) than in elderly people (≥ 60 years of age) [57].-

A raft of studies have said from day 1 that children are less likely to be infected, less symptomatic and less likely to transmit the virus. Children under 11 particularly that's the case; teenagers and young adults slightly more likely to catch and transmit the virus, but still less likely than older adults. Time and again each study comes to the same conclusions. Yet you continually want to refute them. Why?[/quote]
A direct quote from the research cite:

A recent report from US provides additional evidence of the role of children and adolescents in transmission. This study reported an overall attack rate of 44% among attendees (i.e. children, adolescents and adults) of an overnight camp where a teenage staff was the index case [60]. The age-stratified attack rates were 51% among those aged 6-10 years; 44% among those aged 11-17 years and 33% among those aged 18-21 years [60]. Asymptomatic infections were observed in 26% of those with available test results and symptom data[60]. These findings indicate that children and adolescents can spread efficiently the virus, particularly in an indoor and overnight setting.

Durham is doing extra testing because of a pub outbreak: www.bbc.co.uk/news/amp/uk-england-tyne-53794351.

@whatsnext2 - that report was also discussed here in full. There have been a great many reports and there has been a lot of research. When the majority say one thing and there are a couple of outliers, that should be used for clarity over specifically riskier interactions (from the US example - the overnight stay, shouting and singing indoors, and possible inconsistency of mask usage in particular). Those risky factors causing a problem has no bearing on other children from different settings being infected less than adults, it's ok to actually be pleased that some things are lower risk.

Nicola Sturgeon:
R in Scotland now probably > 1 and could be up to 1.4

@cathyandclare

Hi Cathy, yes I have considered including case numbers per 100,000. In fact its been an ongoing internal debate. Here are my thoughts.

In lots of scenarios I prefer cases per 100,000. But I also think there is a tendency to assume that rebasing the data per 100,000 somehow makes areas (and data) comparable. And that it somehow makes all areas comparable. Which I don't agree with.

It's probably a very long and boring post to go into all the details but I will touch on a few elements.

I think when we talk about our local areas, areas we are familiar with, the absolute number of cases is more valuable.

If you are familiar with an area (eg where you live), you are familiar with the demographic, the population density, you have a general and innate sense of what the fabric of your community is like. You have an awareness of household size, ethnicity, of how spread out homes are, of how people socialise and how they live and intermingle day-to-day. Of how likely the community is likely to comply with safety guidance. All of these elements effect covid transmission rates and covid risk.

And when you read the absolute number of cases in your area, you are aware of all these elements and that absolute number means something to you; you naturally interpret it on the back of all the knowledge you have about your area.

Rebasing per 100,000 of population, i feel, risks people thinking that it is the only way to think about case numbers and the only way to think about risk. And that it is somehow a more authoritative way to assess risk. Which is not always true.

The fabric of your area and community has a huge bearing on what case numbers mean and what risk they present.

For example, the following two hypothetical scenarios have the same case rate per 100,000 but the local risk is very different:

1. 50 cases per 100K in a large, remote, rural area where houses are spread out massively and average occupants per household is low

2. 50 cases per 100k in a built up, high rise, incredibly dense population area of inner London - a geographically tiny area with a prevalence of high rise apartment block buildings and people living cheek by jowl where average occupants per household is high

Same case rate per 100k. Very different risk though.

So I find, when comparing/discussing areas I don't know much about, per 100,000 of population is a valuable rebasing tool to give a quick-and-dirty side-by-side comparison.

But when thinking about areas I know something about, then I prefer absolute numbers; I find them more valuable. I feel I lose some of their intrinsic value by rebasing them.

On that note, I think there is an argument for including the per 100k of pop in the top 10 table in the daily email alerts as there will undoubtedly be areas in there unfamiliar to recipients. So, yes actually, I will add that to my to do list. It might take a week or two though.

I would love to hear your thoughts. It is something I have been asked and I may change my mind in the future, or maybe add it at the bottom below all the absolute numbers.

Its an ongoing consideration.

Do you think ppl would prefer per 100K for their local area?

@MRex I firmly believe children should go back, the comparative risk from poverty, obesity, mental health etc etc means that to sequester a generation indefinitely is impossible.

However, to do so blindly is also wrong. Most of the research was done during school closures, and now, we are just taking part in another big experiment. I hope it works better than the care home one.

There is no evidence that cases in school are more than a reflection of community levels, a consequence of those levels, not a driver.

Schools in areas of high infection will naturally have higher numbers of students and especially staff that are infected,
but there is no evidence that they transmit more than the same groups of people would if schools were closed

• barring a complete local lockdown

Schools have been back ft for weeks now across much of Europe and in other countries e.g. up to nearly 5 weeks in parts of Germany, where cases are slowly falling atm
Any relaxation of SD measures contributes something to R, but schools seem to have contributed much less than e.g. opening the hospitality, leisure or travel sectors

There is plenty of evidence that infected children transmit the virus much less than infected adults do, the younger the child, the lower the transmission risk

Actual transmission, as distinct from just having virus in the body, is greatly increased by coughing, sneezing etc but children are far more likely than adults not to have any symptoms

Considering risks vs benefits to society as a whole, keeping schools open ft should be a priority.
If need be, as winter comes, some restrictions can be reimposed on adults' activities

Do you think ppl would prefer per 100K for their local area?

I wouldn't, I live on the border of two areas and work in a third, the demographic for these three areas are massively different. I agree that absolute numbers have more value when you know the area.

@whatsnext2 - I've said nothing about schools and their risk in relation to that report, do you want to do a quick re-read of my actual comments?

Already from a Lancet study on Vitamin D:

A number of hospital-based treatment trials have been registered to date, but it may prove challenging to detect a signal for vitamin D supplementation in severe COVID-19 for two reasons. First, patients tend to present to hospital in the hyperinflammatory stage of the disease, so it might be too late for them to benefit from any antiviral effects induced by vitamin D supplementation. Second, it could be hard to show the effect of a micronutrient over and above dexamethasone, which has potent anti-inflammatory actions and now represents the standard of care in severe disease. Prevention of SARS-CoV-2 infection also represents an ambitious target, given the highly infectious nature of the pathogen. Perhaps the best hope for showing a clinical benefit lies in a population-based trial investigating prophylactic vitamin D supplementation as a means of attenuating the severity of incident COVID-19, to the extent that it is either asymptomatic or does not result in hospitalisation. The design of such a trial should be informed by findings of meta-analyses of randomised controlled trials of vitamin D to prevent other acute respiratory infections, which suggest that the intervention would work best when given in daily doses of 400–1000 IU to individuals with lower baseline vitamin D status.
Pending results of such trials, it would seem uncontroversial to enthusiastically promote efforts to achieve reference nutrient intakes of vitamin D, which range from 400 IU/day in the UK to 600–800 IU/day in the USA. These are predicated on benefits of vitamin D for bone and muscle health, but there is a chance that their implementation might also reduce the impact of COVID-19 in populations where vitamin D deficiency is prevalent; there is nothing to lose from their implementation, and potentially much to gain.

Thanks @littleowl1 for the detailed post. I think you're completely right, both are useful- I tend to use the MLSO for my local area ( rural) but we're in the Leeds area, which is big, so we're bunged together with many, many different demographics. I think you're right that raw numbers are vital, just wondered about per 100,000 too. But it's not a complaint, I don't want to detract from your excellent service!

I take Vit D and also boosted my oily fish intake, as prophylactic measures

This may reduce likelihood of the virus taking hold, or having symptoms, or at least of the more severe symptoms,
but if I should get seriously ill, I'd expect actual proven meds - if any - not just more vitamins

MP warning about test capacity has "evaporated" in NE England:

"At the latest count we only have enough tests to start in the morning at 8 o’clock and completely run out by 10"

www.theguardian.com/politics/live/2020/sep/03/uk-coronavirus-live-quarantine-portugal-covid-19-latest-news?page=with:block-5f50e55d8f086d7ec33347bc#block-5f50e55d8f086d7ec33347bc

I don't know whether the NE were given fewer test kits / 100,000 population or whether they have been using them up more quickly than other areas,
either because of higher infection rates or lower criteria to obtain tests

@cathyandclare Thank you

little just to say a big thank you from me too. I'm finding your emails really useful.

Sorry if I’ve missed this elsewhere on this fast moving thread, but do any of you know who are the people currently dying from this? I don’t mean literally of course, that is a private tragedy for their families, but demographics, job type, locations, race, sex - would all be of interest. I can only see total deaths data or much earlier studies. I’m not sure if there are younger people now dying from this or not - or even being hospitalised, or if these are mainly milder cases. Thank you.

I can say that in Scotland last week (after schools had been back and kids were sent home and asked to test) we heard of one person looking for tests being told the nearest available was in Northern England.

Now, pure speculation on my part, but there may have been Borders people going to nearby NE England centres.

Cathyandclare a lot was posted in one of these threads early on re vitamin D, I wont repeat it all. The intervention studies are, as far as I know, not happening in this country. However there are several elsewhere. BigChocFrenzy "if I should get seriously ill, I'd expect actual proven meds - if any - not just more vitamins" - a misunderstanding of how an intervention study would work. It's normal clinical care + vitamin D v normal clinical care + placebo.

@UntamedShrew - that's all tracked weekly in the surveillance report, there are charts in the first document at this link: www.gov.uk/government/publications/national-covid-19-surveillance-reports.
Age, sex and ethnicity are shown for cases, hospitalisation, deaths and seroprevalence. See pages 6, 10, 11, 15, 21, 24, 26, 28, 32, 35.

Thank you! That’s very helpful

@SallySeven

I can say that in Scotland last week (after schools had been back and kids were sent home and asked to test) we heard of one person looking for tests being told the nearest available was in Northern England.

Now, pure speculation on my part, but there may have been Borders people going to nearby NE England centres.

It's still a hefty drive to Gateshead! 2 hours at the least.