Something I can't work out......

[TellerTuesday4EVA]

I had this discussion with DH today and we're still puzzled, so any opinions/insight.

At the peak of the virus there was around 5/6000 new cases per day day and in the high hundreds of deaths per day. Now there's around 1000 cases per day but only around 10 deaths. What has changed?

Obviously it's a good thing less people are dying but why is the number now so much lower per 1000 cases than it was?

DH said the new cases are younger people who are then recovering but surely younger people were more at risk of catching it at the peak given they'd be out & about more & coming into contact with more people than the elderly generation.

I just don't understand why the number of deaths is a much lower ratio to the number of new cases than it was previously.

Because there wasn't just 5000/6000 cases a day at the peak it was estimated 100,000.Its nowhere near that now. For many reasons including circulating in young people the deaths are much lower now.

Lots of elderly people have already died. They were the most likely to. There are better treatments now, more SD, less viral load and more asymptomatic people being found (remember at the peak they were only testing those in hospital!).

As already been said, we'll never know the true numbers at the peak due to lack of testing.

At the peak they were only testing people sick enough to be in hospital. Where there were 5/6000 cases a day, that was just the really sick people. It didn't include all the people with less severe symptoms who didn't require hospital treatment.

Possibly because people were only tested when they were really sick. Now people with mild symptoms are also being tested so we’re seeing a truer picture of infections and presumably a truer death rate as a %

There was very limited testing capacity at the start so only people with pretty severe symptoms were getting tested and those with mild symptoms didn't. Now they are sending testing vans to supermarket car parks and just asking people to have a quick test before they get their shopping. So they are testing lots of people and many of them are symptom free

There are variants between the virus, and it's possible the less lethal version is the dominant one at the moment.

Or, the theory was - earlier in the outbreak - that the 'viral dose' you had could affect how severe the disease was (a reason why HCPs, who might be repeatedly exposed to people with a high viral load, got it worse). New version of this theory, emerging in France, where masks are routinely worn with high degree of compliance, is that the dose that people are receiving is much lower because of social distancing and mitigations and so the disease is also less serious.
(Disclaimer, thus is a hypothesis under discussion, not yet an evidenced procedure. But because of plausibility, it has been attracting attention)

We just weren’t testing anywhere near enough at the peak. Typically only those in hospital with obvious symptoms. Now we are testing anyone who asks because they feel mildly unwell as well as random tests.

Lots of lots of the most vulnerable in society died at the peak. The rest are now mainly shielding and taking huge precautions. Typically those who are now being infected are younger and many are asymptotic as well.

We have better treatment and more staff available now. At the peak unless you were very ill, you were left at home to cope. Now there is treatment from a much earlier stage and many don’t need it.

I don’t believe there is a concrete answer at the moment but speculation usually includes a younger demographic are the majority of new cases, the understanding of how to treat covid is getting better, there’s a couple of theories about viral load being important or the possibility there’s a weaker strain in circulation.

Remembering back to springtime people were generally avoiding the NHS and the capacity to test just wasn’t there so there’s also the fact that we are now picking up more cases than we were before meaning we have a better grasp on how many mild(er) cases there are. At the end of March the ZOE project predicted there were an approximate 1600000 active symptomatic covid cases which wasn’t reflected in the confirmed/excluded in the tested case numbers. At the point testing became more widely available we were still seeing deaths from cases that would have been ongoing for a couple to a few weeks.

The upshot is comparisons with peak covid are little more than guesswork because testing capacity wasn’t like for like.

Anecdotal, but I pass a mobile testing centre twice a day. People queuing used to be all ages and I suspected there were a lot of health workers. Now I'm seeing 90% young people (twenties).

massive ramp up in testing

coronavirus.data.gov.uk/testing

so the case numbers are not really comparable.

1st April just under 12,000 tests , 26th August (most recent date on the dashboard) 186,000 tests

Lockdown, social distancing, shielding the vulnerable, improving PHE supply; protecting care homes; better understanding of a novel coronavirus; improved treatments to name but a few reasons.

Lot of info also in the weekly PHE surveillance reports www.gov.uk/government/publications/national-covid-19-surveillance-reports

I mucked that sentence up! It should read that the predicted symptomatic cases weren’t confirmed or excluded with an official test.

There wasn’t as much testing, so the figures weren’t true

I think it's dying out. Whether that's by human intervention or by some other cause I don't know, but I know that I'm sick of hearing about it.

@Howallergic I do hope you're right..!

There was an article in the Guardian last week by a doctor who thinks they have got better at treating it - they know what to do more now and how it behaves.

The real no of cases was much higher. 4m people have had it. Over 3months that would be 45k a day (obviously it's not as it peaked). 42000 died out of that 4m.
I would say 1% die (average of all ages).
So 10 dying a day would be 1000 infected. But it is more than that as you say due to them being younger.

But also
Older people were kept in care homes so 100% of the ones who needed o2 or icu died.
They also lost lots of younger people who needed o2 but couldnt get treatment.

At the beginning, they were only detecting 1-2% of cases. There were really hundreds of thousands of cases a day, we just didn’t have the testing capacity to show it.

Now, they’re detecting around 40-60% of cases, according to scientists’ estimates. So there are far fewer cases than in the period just before lockdown.

Many people with mild or asymptomatic cases weren't tested early on, it was only those seriously ill that were tested. In reality there was probably 10s of thousands mildly infected during the peak but we wasn't testing anywhere near enough then.
The number of cases have now been consistent for the past couple of weeks but the deaths and those seriously ill in hospital ( 1 death reported and 60 on ventilators today) are remaining low also. The mild/asymptomatic cases were always there we just wasn't aware of them in regards to the official numbers.

My thoughts on this are

At the beginning the virus was allowed to spread freely, everyone was at risk, the only people tested were those sick enough to be admitted to hospital, so in reality there was probably 12,000ish cases per day.

Now we have more testing and those with milder symptoms are being discovered. There would still have been those numbers at the beginning but we didn't know they were positive.

In the beginning the elderly and those with underlying health conditions died, people with the same conditions could still die now but we have social distancing, face coverings, schools have been closed for a long time, nightclubs aren't open and care homes have restricted visiting.

Clinically vulnerable people may be taking more precautions to keep themselves safe so less chance of them getting infected.

We also know more about treating the virus now so giving people a better chance of survival.

Well yes at the start bj did say soon we will ask the CEV to shield. Took about a week to do that. Many of the shielded people probably caught it then.
My own parents still nipped to the supermarket, went to the dentist and the corner shop in that week.
We had to have a car mot as they hadnt done the exemption period.

Cases are also rising now, based on the same number of tests or slightly less each day and increasing numbers. But it takes Days to weeks For people to be poorly enough to be hospitalised. So let’s see how the hospital admissions look in 2 weeks and deaths would follow a few weeks after that, although the criteria seems to have changed to dying within 28 days of their positive corona test result. Not sure how often people are tested though. Seems odd to me as you don’t die immediately people were on ventilators sometimes for weeks before they passed.

They’ve stopped sending Covid positive patients back to the care homes.

As others have said true number of cases was unknown.

As you say, there seems to be more younger people being infected. It’s highly likely that those who were previously shielding or just consider themselves higher risk are still being super careful not to catch it and these are the people who would have likely ended up in ICU. I don’t know many people who are vulnerable who are carrying on life normally now, most are still in some form of shielding.

Our cases are very low compared to feb/March when they only tested those who had contacts from Wuhan and those hospitalised.

I think estimates were 100k per day but only 5/6k tested.

Whereas our 1500 per day now is more accurate. Estimates are it's likely 2.5k max.

So even now the true amount is only about half of what the numbers of sickest people were at the peak.

We seem to be managing quite well actually. It's ticking up a bit but that's expected because we've opened more in past 2 weeks.

But looking at how fast France and Spain have increased we've kept a fairly good lid on it.

A fair proportion will be false positives too.