Covid-19 and purity spirals

[DreadPirateLuna]

Covid-19 is a very serious illness which threatens our most vulnerable and risks overwhelming the NHS. We should all do what we can to flatten the curve and save lives. People whose behaviour risks lives (e.g. urban residents traveling out to holiday homes in rural communities) should face criticism and sanctions.

However, I can't help feeling that some of the outrage at some behaviours is less about reducing the spread and more about getting caught in a "purity spiral".

Take all the outrage about people in parks. Fresh air and sunshine is good for physical and mental health, it improves the immune system which is particularly important during an epidemic! Many urban residents have no other source of open space except the local park. The ability to get outside can be lifesaving for victims of DV. Risks of contracting disease are very low if you keep your distance from others outside your household.

Yet I've seen photos of walkers and family groups in parks, keeping far away from others, but accused of selfishness and killing the elderly and disrespecting the NHS. Parks in London have been closed, meaning more congestion of other areas and residents confined to homes, which is damaging for reasons outlined above.

And it's usually (though not exclusively) women and esp mothers who get blamed. Those selfish Karens and their broods.

A more sensible solution would be to allow restricted access to the parks. Maybe allow only locals in nearby flats without gardens. But it seems we're not doing sensible these days.

Sorry, I just realise I typed a whole load of geek there...

Love a bit of geek.

And yes, indyref

Those were the days! Compared to this it seems almost fun (I know it was horrid at the time btw, I do remember)

We don't know how many infected people there are...so trying to model how it evolves is very challenging.

I don’t think any of the factors that could be plugged into a model are known or reliably constant. rO will vary a lot between individual people based on community contact but also probably based on viral load. Intuitively you’d also say that symptomatic people are more likely to pass it on (more respiratory symptoms = more droplets) bit that may not be true either. I’m really interested in delving into the individual risk factors and separating out the confounders. Ie is it being male in itself that’s risky, or just the male cardiovascular risk factors or that overweight men are more likely to be centrally obese, which makes ventilation even harder. Apparently with COVID ventilation is much harder, and much higher pressures are used at baseline.

The geekery is both interesting and welcome! Also the fact that the stats provided by the Chinese government are likely to be not so much unreliable as deliberately falsified isn't helping.

Oh agreed, that was very much an example of the challenge in that for this model you don't even have a definitime time zero value.

The risk factor breakdown is very interesting and makes it hard to compare between countries (and therefore to extrapolate their info to our situation)

The number of asymptomatic people is a huge factor IMO. It potentially means that the initial r0 was way off as well as meaning current assumptions (which were in turn extrapolated based on the previous estimate and the reduction in contact) are off. Many more may have been infected by each infected person than was every caught by testing. But that then also means that the intervention rates and the survival rates are potentially much lower/higher than originally thought.

There seems to be increasing evidence (maybe evidence is too strong, discussion perhaps?) that full ventilation isn't all that successful for Covid-19

There seems to be increasing evidence (maybe evidence is too strong, discussion perhaps?) that full ventilation isn't all that successful for Covid-19

That’s funny because I thought it was the opposite. That if you were sick enough to be ventilated then doing it early was better. The issue being that if you’re being fully ventilated then you’re very sick as a starting point. I’m open to new information though!

I think giving oxygen at an earlier stage is better than ventilation. Many more people with more basic breathing support survive, according to the critical care audit report on covid-19. Vulnerable and older people included. The 111 line is apparently in many cases telling people with already severe symptoms to stay at home until they are becoming unable to speak/breathe etc.

But yes it's difficult to determine who would have progressed to needing full ventilation.

Many more people with more basic breathing support survive, according to the critical care audit report on covid-19.

But surely that’s just because they’re less sick?

I’m really interested in delving into the individual risk factors and separating out the confounders. Ie is it being male in itself that’s risky, or just the male cardiovascular risk factors or that overweight men are more likely to be centrally obese, which makes ventilation even harder.

Yes, me too. But it seems to me that there is a level of risk for males which outweighs the cardio risk factors. Which is probably likely to have some genetic basis.

If you read the ICNARC (UK critical care) report they have a comparison with a cohort of patients who were in critical care before with non covid-19 viral pneumonia and the numbers are not completely but more equally distributed female 45.7% as opposed to covid 27.5%

www.icnarc.org/DataServices/Attachments/Download/c31dd38d-d77b-ea11-9124-00505601089b

Finally if you like looking at ALL the data can I recommend this thread (and the 3 previous):

www.mumsnet.com/Talk/coronavirus/3876462-Daily-numbers-graphs-analysis-thread-4?pg=2

But surely that’s just because they’re less sick?

Not necessarily. We don't know. Posters on other MN threads with suspected (almost definite) covid are reporting that they're being told to stay at home unless they can't speak, their lips turn blue or they are gasping for breath. My 64 yo dad has a nasty chest infection and 111 have told him no antibiotics as they don't have enough for him, although he's been given them in the past and is worried about it turning into pleurisy as has happened in the past, and just to keep an eye on it and let them know if it gets worse.

Namesgonenow has it in a nutshell, this cannot be solved by punishing individuals

Posters on other MN threads with suspected (almost definite) covid are reporting that they're being told to stay at home unless they can't speak, their lips turn blue or they are gasping for breath. My 64 yo dad has a nasty chest infection and 111 have told him no antibiotics as they don't have enough for him,

That’s pretty grim.

I don't think my dad has covid, my brother and I talked him out of going to A&E which is why he rang 111. He was determined so we thought he would go but then thought it through and told us he didn't in the end.

Very worried about him and there isn't much I can do! He's 100 miles away in the SW which luckily for him isn't as badly affected by covid as other places (at the moment). It was his birthday as well, poor bloke. I sent him a jigsaw puzzle

He's a smoker, on blood pressure medication, with cardio issues and has had pleurisy before and is prone to these chest infections.

And has skin cancer (not the most dangerous type) which is being treated and has been for several years. So not great!

It’s people like your dad I worry about. People who maybe should have been in hospital but aren’t due to lack of hospital resources (as in the U.K.) or perceptions about the riskiness of hospital.

Our relatively big teaching hospital has very few people with COVID-19, less than 10, yet people are coming in sicker and later with non COVID conditions due to their perception that the hospitals are full of it, and people will get sick.

I suppose it’s hard to balance a public health message of, “Keep everything shut, stay socially distanced!” with “There’s not much COVID around, go to hospital if you are sick!” Especially given that a whole heap of non-urgent hospital clinic appointments and surgeries have been cancelled.

The Op is correct, for those countries where all parties within governments are responding together, and earlier, to the outbreak , this is what works to minimise the disease spread.

Vilification of families and individuals out for their daily exercise in whatever nearby public space remains open is not the answer.

Thank-you for helping my pea-brain better understand with informative discussion of data Statisticallychallenged

I suppose it’s hard to balance a public health message of, “Keep everything shut, stay socially distanced!” with “There’s not much COVID around, go to hospital if you are sick!” Especially given that a whole heap of non-urgent hospital clinic appointments and surgeries have been cancelled.

Yes I completely agree with you.

And thanks for your concern about my dad

Hope your Dad feels better soon Ereshkigalangcleg ,

Thank you!

Sorry I can't recall where I saw the info re ventilation, it wasn't solid data, more of an opinion piece.

That’s funny because I thought it was the opposite. That if you were sick enough to be ventilated then doing it early was better. The issue being that if you’re being fully ventilated then you’re very sick as a starting point. I’m open to new information though

I posted a couple of links earlier on in the thread which suggested that early, and unnecessary, ventilation might not be a good thing at all. A German lung specialist commenting on the high and early hospitalisation rates in Italy. It was in The Spectator. Here: www.spectator.co.uk/article/is-germany-treating-its-coronavirus-patients-differently-

www.spectator.co.uk/article/Ventilators-aren-t-a-panacea-for-a-pandemic-like-coronavirus. Another piece about ventilators by a Canadian specialist.