Coronavirus Sars-CoV-2/Covid-19 Megathread

[Threviel]

The disease does not seem to affect the kids very much, nor do they seem to be much of a vector for it.

The parents working in health care that has to stay at home to take care of the kids on the other hand, that will have an effect.

[Sheilbh]

Also people often use grandparents for child-care. Even if they're under 70 they'll be older and higher risk than the parents.

And if you set up an alternative arrangement, such as childcare for key workers - that's still going to be kids mixing, just like in school. Plus there's doubt about how effectively you can stop children from mixing over a long period of time - it would be different if they were at risk.

I imagine they'll close at the end of the month, so for the Easter holidays and then not re-open this school year.

[The Larch]

Apparently Boris limiting his measures to "advising" people not to visit pubs or restaurants really screws over their owners, as they won't be able to claim insurance because there aren't any official bans in place.

[Threviel]

And all the kids will get it the minute school starts back up again anyway.

Most of us are probably going to get it, if not this year then some other year. What needs to be done is stretching out exposure for the 80+ age group as much as possible.

So, in Sweden we are recommended to work at home, not see grandparents, cannot go to retirement homes, should not gather in large groups, wash our hands all the time, stay at home if sick, keep a distance when in public. Closing of schools and such is decided locally. The government has instituted extra sick pay and also lots of money for companies, deferred tax payments and such.

I assume that there will be harsher rules as the effects of the disease spreads.

[Sheilbh]

Updated trends - as mentioned earlier I'm really concerned by the UK death numbers as this isn't the health service under significant pressure yet:


And the infections trend:

[viper37]

Explain why the British response is too soft...

you want numbers, or a graph?
I'll start with number.

A population of 100 individuals.
You do nothing, 70 individuals will get sick in a very short time.Out of these, 14 will likely require a bed and a respirator for at least 1 week.You have 1 bed with respirator.  By stretching resources and reassigning staff, you can free one other unit from an operating room.  That's 2 bed for 14 people.Out of the 14, 2 will assuredly live, 2 will assuredly die (3% lethality rate on the 70 infected).  Since you can't help them in anyway, the 10 others are most likely to die too since they have trouble breathing.  Assume 80% of these critical cases will die.  That's 10 out of 14 deaths.

And since all your ER staff is overloaded, some will get sick too and need to be isolated before they spread the disease.  If you do noting at all, you risk having more than 70% infected rate, and you will infect more people that are in the hospital right now and who are, obviously, more fragile.  Since they are already fragilized by their (non-infection related) condition, they will die.  You can then expect the lethality rate to double toward 6-7%, as we have seen in Italy.

Since all your intensive care unites are used and your staff is sick, you will not be able to place a new patient in a new unit.  Since hospitals staff are bright people, they will divide the place in half.  If they have 2 beds, they will keep one for infected people, 1 for non infected people with other, critical health problem.  For our 100 people, that's  11 deaths, most likely.  That makes it 11% direct death.

We've already established that out of your 2 beds available, one will be for non infected.  Instead of the 2 you could have used in regular conditions.  If someone has an heart attack, they will be treated.  The next one to have a heart attack, won't be so lucky, outside normal reanimation manoeuver, nothing can be done since you have no equipment to maintain him alive.  We are at 12 deaths for 100 people.  One person has a critical car accident.  You either use the respirator on that person, or you decide to return home the 60 year old man in intensive care.  Either way, it's 13 deaths out of 100 people.

Now, let's take the UK has an example.  You have 67 800 000 people living there as of 2020.  Assuming a 70% infected rate, since we do nothing, that makes 47 460 000 infected people.  20% of those will require a place in an intensive care units.  That's 9 492 000 people.
You have 169 500 units available (3.5/1000 people) in the whole of UK.  That leaves 9 322 500 uncovered, criticially ill patient whom most likely die.

Since Italy did implement containment measures, although a tad too late, that makes their numbers in the low range.  But let's still assume a constant 7% lethality rate for the infected, even if it's in the low range.  That makes 664 440 deaths that could have been avoidable.

No, you can not contain the disease.  But you can spread it.

In accounting terms, it's like tax season.  Every accountant and accounting technician does overtime and you can recruit more people, as a temporary measure to help.  Assume the number of hours in your pool was fixed all years long, being equal, just like an intensive care unit.  What would happen during tax season if you are understaffed, if the manhours pool you have is the same as it was during summer?  You can't filed every client's tax by the deadline.  Some of your clients will miss their deadline.  So you prioritize.  Clients whom you know with almost a certainty will need to pay a supplemental amount will be treated first.  Those whow are most likely to get a tax return are delayed.  Eventually, even with that, you run behind the schedule for the emergency cases.  And since you're overloaded by work, you will also forget a few clients.  That's the equivalent of indirect deaths in my previous model.

We have the same with "herd imminuty" by letting a disease spread.  Lots of people will die because when we reach the peak, there will be no more staff, no more units available to help these people and many will die, as well as many others with other health problems that could have been cured, had there been resources available.  You cannot build a new hospital with all the equipment you need and you are already on a shortage of staff.  Let's say Shielb really wants to help in London.  He's not a trained ER doctor, he's never trained in any connex field.  All he could do was wash sheets, great people, distribute meals as required, help with the cleaning tasks, maybe.  You don't just pull a doctor out of thin air.

Sure, you can ask retired nurses and doctors to come back to help with supplemental work.  But you won't double or triple your capacity.  And do you really want a 75 year old doctor who hasn't work for 15 years to treat you on a novel disease?  Probably all he could do would be to monitor your vital signs, like a nurse would do.

So yeah, that's the thing, you want that peak to be as low as possible.  No you can not prevent infected people from spreading the disease.  But you can limit the contagion.  Maybe instead of 70% infected British person, you'll get 20-30%.  At 20% infected, that makes it 2.7 million people requiring critical treatment.  Did you avoid all possible deaths?  No, but you gave a fighting chance to a lot of people.  And the longer you have for people to live, the better are the probabilities that a cure can be found a vaccine successfully tested.


If you want it graphically, try this link:
https://www.washingtonpost.com/graphics/2020/world/corona-simulator/

[Valmy]

The disease does not seem to affect the kids very much, nor do they seem to be much of a vector for it.

The parents working in health care that has to stay at home to take care of the kids on the other hand, that will have an effect.

So you are saying kids can easily survive the disease but also do not transmit it?

So, in Sweden we are recommended to work at home, not see grandparents, cannot go to retirement homes, should not gather in large groups, wash our hands all the time, stay at home if sick, keep a distance when in public. Closing of schools and such is decided locally. The government has instituted extra sick pay and also lots of money for companies, deferred tax payments and such.

Well dude that is pretty much the same that everybody else is already doing.

[Sheilbh]

Apparently Boris limiting his measures to "advising" people not to visit pubs or restaurants really screws over their owners, as they won't be able to claim insurance because there aren't any official bans in place.

If that's the case I imagine they'll change policy. But I think most business interruption insurance is already activated because covid-19 is a "notifiable disease" which the government's already declared, that allows business to claim for interrupted business because of that disease.

Flipside is I think because the government hasn't ordered businesses to close down, it will be more difficult to fire staff.

As I say I suspect the whole sectors - arts, hospitality, certain retail and possibly insurance will need a huge bailout.

Johnson said today that no-one should be worse off for doing the right thing. I think that also needs to apply to business.

[Agelastus]

Updated trends - as mentioned earlier I'm really concerned by the UK death numbers as this isn't the health service under significant pressure yet:

People who get infected at the same time don't die at the same time - we had a number of days at the start without deaths; plus we don't know the age spectrum of our infections (I haven't seen a chart similar to the one that was posted comparing Italy and South Korea - by you?)

If you look at the current figures -

https://www.worldometers.info/coronavirus/country/uk/

While we have had 55 deaths to 52 recovered, our active cases split 1416 mild to 20 critical which is much closer to the ratio in other countries.

Our death rate does look a little high, but if our government's advisors are right and we are only detecting about 10% or so of infections? If so, we are currently looking at a mortality rate of about 0.5%, well below the rate of 3.4% WHO currently estimates - but quite close to the 0.7% of China outside Wuhan.

Of course, we don't know that the advisors are right about those undetected infections - and we are still in the early stages of the epidemic in Britain.

[Sheilbh]

So you are saying kids can easily survive the disease but also do not transmit it?

Yeah. My friend who's in infectious disease research says the main current theory is this virus basically hangs onto a specific lung receptor. Kids have far less of certain lung receptors so that's the theory (at this stage) for why there's less pathology and less replication with kids.

Well dude that is pretty much the same that everybody else is already doing.

Yeah - so's the UK - it's more my frustration at the narrative about UK measures that we're doing nothing - like in viper's post. There is a difference of approach on schools and borders (which makes sense to me) and an emphasis on non-coercive measures for this to work (in part, I wonder if this is because the government think they'll need people to do it for at least 12 weeks so need them to buy-in). But the measures are very similar, we're just a bit later - but we've had a lot of, I think, irresponsible reporting and sort of fear-mongering online and by people like Piers Morgan, Nigel Farage and people on the left.

This is a comms failure by the government because I wouldn't be explaining it if they'd done their job on communications - I hope that's correcting now - but it's really annoying.

Similarly I'm seeing loads of conspiracy theories that the UK isn't following WHO guidance and testing. The testing is increasing (and there's hopes for the backward-looking test too) but there's still a capacity issue and the focus is on people in hospital or care homes, not suspected cases in the community. If you look online - and I'm talking people with tens or hundreds of thousands of followers - the government is lying and has stopped running tests/isn't following what the WHO says.

[Threviel]

The disease does not seem to affect the kids very much, nor do they seem to be much of a vector for it.

The parents working in health care that has to stay at home to take care of the kids on the other hand, that will have an effect.

So you are saying kids can easily survive the disease but also do not transmit it?

So, in Sweden we are recommended to work at home, not see grandparents, cannot go to retirement homes, should not gather in large groups, wash our hands all the time, stay at home if sick, keep a distance when in public. Closing of schools and such is decided locally. The government has instituted extra sick pay and also lots of money for companies, deferred tax payments and such.

Well dude that is pretty much the same that everybody else is already doing.

I did not write in absolutes.

Apart from the silly border and school closings, yes. Most countries seem to do stuff that works. Some countries also du counter-productive stuff for political points.

[Sheilbh]

People who get infected at the same time don't die at the same time - we had a number of days at the start without deaths; plus we don't know the age spectrum of our infections (I haven't seen a chart similar to the one that was posted comparing Italy and South Korea - by you?)

Yeah and I feel like the age profile must be like Italy given that testing is now focusing on hospitals and care homes. I believe the youngest has been in their 50s but I think all have had pre-existing conditions. The information about the fatalities are still being issued by the local NHS Trusts, while the overall figure is collated.  So I think the age profile does look like

While we have had 55 deaths to 52 recovered, our active cases split 1416 mild to 20 critical which is much closer to the ratio in other countries.

Our death rate does look a little high, but if our government's advisors are right and we are only detecting about 10% or so of infections? If so, we are currently looking at a mortality rate of about 0.5%, well below the rate of 3.4% WHO currently estimates - but quite close to the 0.7% of China outside Wuhan.

Of course, we don't know that the advisors are right about those undetected infections - and we are still in the early stages of the epidemic in Britain.

Yeah. Fair points.

[viper37]

Borders are closed

As I said yesterday night.  It was coming.

Montreal was fed up by the "irresponsible inaction of the Federal government" and send its own sanitary staff to the airport, as well as the government of Quebec.  We were all doing the Liberal's work.  The popularity of secession has jumped sky high in the last week.  I've seen call to secede by people who whould have voted 'No' as of a few weeks ago.

[The Larch]

Apparently Boris limiting his measures to "advising" people not to visit pubs or restaurants really screws over their owners, as they won't be able to claim insurance because there aren't any official bans in place.

If that's the case I imagine they'll change policy. But I think most business interruption insurance is already activated because covid-19 is a "notifiable disease" which the government's already declared, that allows business to claim for interrupted business because of that disease.

Flipside is I think because the government hasn't ordered businesses to close down, it will be more difficult to fire staff.

As I say I suspect the whole sectors - arts, hospitality, certain retail and possibly insurance will need a huge bailout.

Johnson said today that no-one should be worse off for doing the right thing. I think that also needs to apply to business.

Apparently it's not enough to claim for interrupted business, according to some pub owners. From the Guardian article:

Gareth Bentham, a joint pub landlord in Altrincham, said he and thousands of other landlords won't be able to claim for the coronavirus outbreak on business interruption insurance.

"Because the prime minister is just advising the public not to go to pubs and restaurants, our insurance won't cover us. If he had said that we cannot open, then we would have been able to claim. But this has left us in limbo and struggling to cover our costs and overheads without any insurance cover. It is not good enough," said Bentham from the Old Roebuck pub.

[alfred russel]

Explain why the British response is too soft...

you want numbers, or a graph?
I'll start with number.

A population of 100 individuals.
You do nothing, 70 individuals will get sick in a very short time.Out of these, 14 will likely require a bed and a respirator for at least 1 week.You have 1 bed with respirator.  By stretching resources and reassigning staff, you can free one other unit from an operating room.  That's 2 bed for 14 people.Out of the 14, 2 will assuredly live, 2 will assuredly die (3% lethality rate on the 70 infected).  Since you can't help them in anyway, the 10 others are most likely to die too since they have trouble breathing.  Assume 80% of these critical cases will die.  That's 10 out of 14 deaths.

And since all your ER staff is overloaded, some will get sick too and need to be isolated before they spread the disease.  If you do noting at all, you risk having more than 70% infected rate, and you will infect more people that are in the hospital right now and who are, obviously, more fragile.  Since they are already fragilized by their (non-infection related) condition, they will die.  You can then expect the lethality rate to double toward 6-7%, as we have seen in Italy.

Since all your intensive care unites are used and your staff is sick, you will not be able to place a new patient in a new unit.  Since hospitals staff are bright people, they will divide the place in half.  If they have 2 beds, they will keep one for infected people, 1 for non infected people with other, critical health problem.  For our 100 people, that's  11 deaths, most likely.  That makes it 11% direct death.

We've already established that out of your 2 beds available, one will be for non infected.  Instead of the 2 you could have used in regular conditions.  If someone has an heart attack, they will be treated.  The next one to have a heart attack, won't be so lucky, outside normal reanimation manoeuver, nothing can be done since you have no equipment to maintain him alive.  We are at 12 deaths for 100 people.  One person has a critical car accident.  You either use the respirator on that person, or you decide to return home the 60 year old man in intensive care.  Either way, it's 13 deaths out of 100 people.

Now, let's take the UK has an example.  You have 67 800 000 people living there as of 2020.  Assuming a 70% infected rate, since we do nothing, that makes 47 460 000 infected people.  20% of those will require a place in an intensive care units.  That's 9 492 000 people.
You have 169 500 units available (3.5/1000 people) in the whole of UK.  That leaves 9 322 500 uncovered, criticially ill patient whom most likely die.

Since Italy did implement containment measures, although a tad too late, that makes their numbers in the low range.  But let's still assume a constant 7% lethality rate for the infected, even if it's in the low range.  That makes 664 440 deaths that could have been avoidable.

No, you can not contain the disease.  But you can spread it.

In accounting terms, it's like tax season.  Every accountant and accounting technician does overtime and you can recruit more people, as a temporary measure to help.  Assume the number of hours in your pool was fixed all years long, being equal, just like an intensive care unit.  What would happen during tax season if you are understaffed, if the manhours pool you have is the same as it was during summer?  You can't filed every client's tax by the deadline.  Some of your clients will miss their deadline.  So you prioritize.  Clients whom you know with almost a certainty will need to pay a supplemental amount will be treated first.  Those whow are most likely to get a tax return are delayed.  Eventually, even with that, you run behind the schedule for the emergency cases.  And since you're overloaded by work, you will also forget a few clients.  That's the equivalent of indirect deaths in my previous model.

We have the same with "herd imminuty" by letting a disease spread.  Lots of people will die because when we reach the peak, there will be no more staff, no more units available to help these people and many will die, as well as many others with other health problems that could have been cured, had there been resources available.  You cannot build a new hospital with all the equipment you need and you are already on a shortage of staff.  Let's say Shielb really wants to help in London.  He's not a trained ER doctor, he's never trained in any connex field.  All he could do was wash sheets, great people, distribute meals as required, help with the cleaning tasks, maybe.  You don't just pull a doctor out of thin air.

Sure, you can ask retired nurses and doctors to come back to help with supplemental work.  But you won't double or triple your capacity.  And do you really want a 75 year old doctor who hasn't work for 15 years to treat you on a novel disease?  Probably all he could do would be to monitor your vital signs, like a nurse would do.

So yeah, that's the thing, you want that peak to be as low as possible.  No you can not prevent infected people from spreading the disease.  But you can limit the contagion.  Maybe instead of 70% infected British person, you'll get 20-30%.  At 20% infected, that makes it 2.7 million people requiring critical treatment.  Did you avoid all possible deaths?  No, but you gave a fighting chance to a lot of people.  And the longer you have for people to live, the better are the probabilities that a cure can be found a vaccine successfully tested.


If you want it graphically, try this link:
https://www.washingtonpost.com/graphics/2020/world/corona-simulator/

The lethality rate you project is too high. Evidence is more like under 1%. But aside from that, I don't think you can say this has a sunny ending with a lower end total infection rate.

Suppose all the measures we have adopted do lower the infection rate to 20-30%. We then declare victory and go back to live our lives. The problem is the disease isn't going to disappear. If normal activity would result in a 70% infection rate, we will go back there in another outbreak. Either we live like this forever (extremely hard pass) or we hit whatever the total infection rate would normally be before the community immunity stops further spread.

The alternative is that we lock down until there is a more effective treatment or vaccine, but I don't think we can wait that long.

There aren't enough ICU beds or health care professionals for what most projections indicate. I know that politicians will have a tough time admitting that - they just want to make the statements that sound good, and initiate ineffective but popular measures like random travel bans that exclude allied countries or key trading partners. But we should be willing to see things for what they are.