Infection fatality rates - can we live with this?

[PuzzledObserver]

Apparently there's going to be an update to MP's shortly about the latest data and how things look for unlocking.

I confess I have been concerned by how quickly cases have risen, already we are nearly a quarter of the daily cases we peaked at in January. However, very reassured by this report which says that the infection fatality rate now is only 1/20th of what it was in the winter wave (which itself I think was lower than the first wave, as we have got better at treating it.)

0.08% of cases now result in death - for every 10,000 people infected, 8 are likely to die. That's 8 too many, but hugely better than it was.

Yesterday there were 14,876 cases reported, which would mean 11-12 deaths eventually. IF maintained at that rate year round, that would be around 4,400 deaths per year - less than seasonal flu.

Is that the sort of level the public will tolerate in return for removing restrictions, do you think?

I appreciate it's not as simple as that - hospitalisation rates, long Covid and the risk of new variants arising are also relevant. But purely on the death rate, do you think we can live with it?

The 0.08% IFR from covid will fall. The future old (very vulnerable) people will have been exposed (if not vaxxed) to wild covid when young enough that it didn't make them sick, but did trigger a good immune response.

So between jabs, wild infection, and passage of time, the IFR will decline.

I think we need to learn to live with the virus. And I don't mean just letting rip and doing nothing. But I do mean ending all restrictions.

In their place, I'd like to see:

• Massive funding increases to the NHS. We spend considerably less than other similar nations on health care and our ICU beds are a lot lower per capita then many EU nations. We need an NHS that can cope with the surge in demand from yearly outbreaks of Covid and Flu, as well as an aging population with increasingly complex care needs.

• Increases in statutory sick pay to end the culture of presenteeism. Plus a one off payment to anyone who tests positive for Covid to enable them to stay at home.

• The legal right to work from home for office based workers, with businesses requiring to demonstrate why workers are not able to work from home when required.

• A dedicated funding stream for research and support into Long Covid. I'm skeptical of the 2 million number because there have been no clinical studies that take confirmed PCR positive patients and follow them through to the end. As far as I'm aware, so far, all our estimates for Long Covid are based on self reported studies and surveys, with many of the reported symptoms overlapping with depression and anxiety. I'm not denying it exists (I know two people that have it) but I think it needs a proper assessment, hence the funding, rather than just relying on media hysteria.

1500 people die every day, and sadly some of those will continue to be from Covid, probably forever more. At some point, we do need to accept that this is the case.

I think this what the whole world will have to eventually decide really.

I don’t believe that the majority of world leaders are even considering zero Covid. I think most of the world has decided it’s impossible so that ends that really.

So, we have to decide on both an individual and global scale what living with Covid will look like, including what is an ‘acceptable’ death rate.

I think a lot of people (at least in the UK) have accepted looking at Covid in a similar way to flu. So, we would need to look at measures and strategies which will make that possible.

I think this is why so much time, money, and effort has been put into the vaccination program.

@Hopefullynamechanged935

It's tricky though isn't it because it still hospitalises 5% of the population who catch it. I don't know what the answer is, but I don't want to have to be on hospital on oxygen

Full vaccination provides up to 98% protection against illness serious enough to require hospital treatment.

Just a single dose of Pfizer offers 94%.

Is there any evidence that long covid is more prevalent than other post viral syndromes? We’re seeing lots of people infected all at the same time therefore lots of long covid sufferers come to light at the same time.

As we move forward through time and the IFR decreases is it not likely that long covid will occur at a similar rate to other post viral illnesses such as ME/CFS?

I’m not making any claims as to what is acceptable and not minimising anyone’s experience, just genuinely curious.

It’s fine governments preparing their populations to accept a level of death but who are we offering up to die? It’s not like deaths from car crashes where everyone has an equal level of risk and we all have the same safety precautions in place. Life with Covid essentially impedes a large number of people and burdens them with fear either for their own health or their loved ones.

@justwanttodanceagain where did that 70% figure come from? Are you sure it's not just the uptake among eligible people?

For example this link suggests that the uptake in over 65s hovers around at just over 70%.
www.nuffieldtrust.org.uk/resource/adult-flu-vaccination-coverage

I know children and vulnerable younger people are offered it but I'd be surprised if healthy under 65s are paying for it at a rate that would put the coverage of the entire population at 70%. I could be wrong though!

Yes I think the flu vaccine uptake is 70% of eligible people (old and vulnerable). It’s about 15 million a year which is nowhere near 70% of the population.

Did a bit of reading last night.

Ive been confused about things, probably because I am not an expert or a scientist, so tried to locate a few unbiased, non click-batey sources.

I read that Astrazeneca is only 60% effective against delta even with both jabs, and Pfizer somewhere around 80% (don't quote me, but def thereabouts!). Not sure what to make of that but it would explain why things might be creeping upwards however slowly. I don't know.

I did some research into my sister's town in the north west (a current hotspot) and found that in the past week, over 1196 people tested positive - an increase of nearly 300 the week before.
Vaccine rate take up is similar to the English average.

I think this week there have been 2 deaths.
A small bit of data but still interesting.

I also noticed after looking at worldometer that whilst the UK is increasing again (as opposed to other Euro countries, the US and even India, our death rate appears lower.
For example, I noticed Germany had around 700 reported cases but triple our deaths yesterday.

If anyone can add to this I would be grateful:)

Lots of really good points made, thank you.

On cases: if all things remain equal with restrictions, i.e. no more easing and consistent levels of compliance, then I would assume that cases will continue to rise, but slow down and then start to decline. That would happen because fewer people are susceptible, mostly because they’ve been vaccinated but also because some unvaccinated have been infected.

I very much hope that the decline in cases starts well before more restrictions are lifted (now looking like 19th July), as when they are, there will almost certainly be an uplift. And if it’s delayed, I suspect compliance will drop.

On Long Covid - there was some data recently from the Zoe app I think about the prevalence of long Covid - something like 30% of even young people were reporting at least one symptom 12 weeks after testing positive. But the severity and impact of that will vary massively - I haven’t seen any data about how many people’s quality of life and ability to function are severely impacted, because that’s what really matters, I think.

Covid is not going away, and long Covid is not going away. But as time goes on, they will eventually affect fewer new people. I had glandular fever when I was 20 - I was acutely ill for about 3 weeks, and it took me a few months to fully recover. But that’s unremarkable - hundreds of thousands of people get it every year, a small proportion have long term effects. We will reach that point with Covid. Just don’t know when.

PS I don’t think there is a vaccine for glandular fever, is there?

I read that Astrazeneca is only 60% effective against delta even with both jabs, and Pfizer somewhere around 80% (don't quote me, but def thereabouts!). Not sure what to make of that but it would explain why things might be creeping upwards however slowly. I don't know.

I presume those figures refer to infections. The more important metrics are hospitalisations/deaths. I think I read that both vaccines are 90%+ on those measures.

@WeirdArchitecture one thing you need to bear in mind is that the vaccine effectiveness against severe illness and death is significantly higher than the effectiveness against simple infection. I think your lower numbers possibly refer to the latter.

The difference in apparent case fatality rates is a tricky one - one obvious reason would be a difference in vaccination rates. However because of the delay between infections and deaths and the different ways different countries capture their statistics (the UK has saturation testing at the moment) I don’t think any amateur can do those sorts of comparisons on the back of an envelope. I speak as someone who normally loves to do back of the envelope calculations, but you need to accept the limits of what the data can tell you.

That’s a good point about glandular fever - I know many young people who have had it. Some shake it off, others are ill for a few weeks (ds) and a few unfortunate souls are left with long-term health issues.

@Thewiseoneincognito

It’s fine governments preparing their populations to accept a level of death but who are we offering up to die? It’s not like deaths from car crashes where everyone has an equal level of risk and we all have the same safety precautions in place. Life with Covid essentially impedes a large number of people and burdens them with fear either for their own health or their loved ones.

Those of us with conditions/are on medication which make common ailments such as flu potentially fatal have always lived with this burden of fear. For many it's just part of life already - and those for whom it is are also most likely to be struck hardest by Covid.

Thankfully vaccinations offer us very, very good protection and I personally understand that I cannot expect (nor would I want) everyone to live with restrictions forever to protect me further.

There will never be zero Covid. My life will probably be shortened by my health conditions and I just want to live it while I'm healthy enough to do so. Living with Covid needs to be just that - living.

@WeirdArchitecture

Did a bit of reading last night.

Ive been confused about things, probably because I am not an expert or a scientist, so tried to locate a few unbiased, non click-batey sources.

I read that Astrazeneca is only 60% effective against delta even with both jabs, and Pfizer somewhere around 80% (don't quote me, but def thereabouts!). Not sure what to make of that but it would explain why things might be creeping upwards however slowly. I don't know.

I did some research into my sister's town in the north west (a current hotspot) and found that in the past week, over 1196 people tested positive - an increase of nearly 300 the week before.
Vaccine rate take up is similar to the English average.

I think this week there have been 2 deaths.
A small bit of data but still interesting.

I also noticed after looking at worldometer that whilst the UK is increasing again (as opposed to other Euro countries, the US and even India, our death rate appears lower.
For example, I noticed Germany had around 700 reported cases but triple our deaths yesterday.

If anyone can add to this I would be grateful:)

The figures you quote re efficacy - that's against all infection, including asymptomatic. Efficacy against serious illness is much higher (I've mentioned figures elsewhere on this thread).

@Quiero

Is there any evidence that long covid is more prevalent than other post viral syndromes? We’re seeing lots of people infected all at the same time therefore lots of long covid sufferers come to light at the same time.

As we move forward through time and the IFR decreases is it not likely that long covid will occur at a similar rate to other post viral illnesses such as ME/CFS?

I’m not making any claims as to what is acceptable and not minimising anyone’s experience, just genuinely curious.

With all due respect that's not the right question. As a society we need to ask: What will be the total cost of long COVID? That will depend on the total number of people affected (not the percentage), the effect on them (a lot to work? Medical costs?) and where they fall in the population (older, younger).

able to work

We just can’t have serious conversations about long Covid without clearer definitions and better data.

Not while cases continue to rise exponentially, no.

Especially when we're just going to let it rip in a couple of weeks time.

I'm skeptical about the numbers bandied around for long covid, or post viral fatigue.

Some will be genuine but also a malinganers joy to be given an opt out card. It needs a proper assessment and diagnosis. Some love nothing more than to whinge and this gives them a club to join.

Yes based on deaths alone that is fine. Unfortunate yes, but you cannot stop every life to preserve every life.

What we need to know is that of those deaths, how many are dying OF Covid and would not have had their life cut short anyway of other issues ie cancer, accidents, diabetes, obesity, smoking etc. These people should not count as Covid deaths. 1600 people in the uk die every single day - we can't stop everything just because some of those deaths have been rebranded as Covid deaths.

And focusing solely on the IFR disregards important factors such as Long Covid and new Variants.

What happens if a new Variant comes along with a significantly higher IFR?

We need to focus on getting case numbers down.

@IrmaFayLear

That’s a good point about glandular fever - I know many young people who have had it. Some shake it off, others are ill for a few weeks (ds) and a few unfortunate souls are left with long-term health issues.

Indeed many viruses take time to shift, be that a week, weeks or months. Some are positive in approach to beat it and others milk it for anything they can get, sympathy, a topic to talk about, benefits, attitude helps.

@BarbarianMum and then balance that against the cost of restrictions and continued isolations. This is not a zero sum game. Continuing to implement lockdown or isolation has a huge impact on people’s lives, finances and kids education.

There also needs to be a better/ stricter definition of long covid criteria. How many people actually have serious symptoms and how many people have standard post viral symptoms which resolve themselves in time? Losing your sense of smell or feeling a bit tired after covid for a few months is not a good enough reason to retain restrictions.