Coronavirus Sars-CoV-2/Covid-19 Megathread

[mongers]

Why does the UK have one of the very highest Covid19 death rates in the world, I think we're fourth behind Belgium, Slovenia and San Marino?

Noticeably higher than the US, of which our media often refers to as a disaster.

It depends what we mean. In terms of case fatality rate - now that everywhere is doing a lot of testing - the UK has a CFR of 2.6% which is about the same as the EU, the US is lower at 1.7%. In part I think that might just be demographics. Europe is older and with this disease that really matters because your risk of dying doubles every 7 years.

I also suspect there's a higher level of "soft triage" in the UK's health system than in Europe or the US - I could be wrong on that. But I think several decades of focusing on running the NHS "efficiently" with no waste, plus ten years of basically frozen funding is part of that - because "waste" in normal times is just capacity in a crisis. But I think part of it was also just decisions made around who is clinically viable (I think about that FT article a fair amount) which I think might be different to other countries. Add into that a very fragmented care home sector which is funded by local government (by far the most cut in the last decade) and often run by small businesses with underpaid staff in old B&Bs.

So I think those are factors in deaths - we are older (than the US) and we have less capacity and that impacts the CFR. The biggest reason is because we've had a bigger outbreak than most countries (not Belgium) but certainly the US and most of Europe. Track and trace collapsed and is a huge failure. Every time we see new case numbers those are baked in as deaths in 2-3 weeks time. Part of that will be a more transmissible variant - this is why the rest of Europe needs to stay locked down because that variant is growing there and they need to avoid the risk of it getting out and I think it is spreading throughout the US now and we'll see the impact in the next few months - this is why I think getting vaccines out is key.

But I think the biggest reasons are Johnson dithering/procrastinating/not wanting to make hard decisions - so we repeatedly see decisions that were logically inevitable only be taken when they are absolutely essential. The one day school re-opening is the best example. There's been zero attempts (with the exception of vaccine roll-out) of trying to get ahead of things. Some of it goes to competence which has been variable at best - Williamson strikes me as a huge liability especially over schools and universities, on the other hand I think Coffey at the DWP has done well because they've had to re-engineer a lot of benefits and deal with a lot of new people on benefits, but the system hasn't collapsed which has surprised me.

I also think there's big material reasons, people still need to work , people still need to earn money there's not enough support for people to self-isolate and not enough pressure (or support) on employers to shutdown. I think we've had far too many decisions this year led by the Treasury looking at things on a spreadsheet and it's been very pennywise and pound-foolish. For example the whole "we can't possibly pay people to self-isolate, that would create bad incentives and cost too much" when the alternative is that a virus behaves like a virus, spreads until we have a far more costly lockdown. We've seen this dynamic repeatedly this year - I've mentioned it before but this should have been like Harold MacMillan's advice to Thatcher on the Falklands war: have a small group to make decisions and don't include the Chancellor. The only involvement the Treasury should have had in the last year is paying for everything other departments needed to do and otherwise they should've been in their box - instead I think they've been the driving force behind decisions, especially on restrictions, until we have so many cases lockdown's inevitable and necessary again.

Edit: On the soft-triage point - something I've wondered about for a while is that based on stats available we have had significantly fewer people placed on ventilation than, say, France or Spain. Which I've always found surprising because we've had more people in hospital but it makes me think if the clinical decision of who can survive ventilation has been different here.

Shelf, a very good summary; have you considered applying to be a member of the official enquiry when it happens?

I think the big stand out as you mentioned, is the Johnson government's dithering and to some extend having policies heavily influenced by that day's or the next day's likely headlines.

[Sheilbh]

Shelf, a very good summary; have you considered applying to be a member of the official enquiry when it happens?

I think the big stand out as you mentioned, is the Johnson government's dithering and to some extend having policies heavily influenced by that day's or the next day's likely headlines.

Thanks, I think

I don't think it mattered in terms of the number of cases but linked to that I also think the media have not covered themselves in glory. I've been saying for ages taht we'd be better off if there were fewer Westminster correspondents and more health or science correspondents leading the coverage. For example I found the whole several days of coverage about scotch eggs or the distance you can go to exercise incredibly frustrating - they'd find an edge case from a relatively clear instruction and then build a story about how the whole thing was so unclear. I think that was easier for the political press to cover because it fits a political narrative. But frankly I would have far rather heard science correspondents (who I've seen commenting on this in Twitter) asking why government advice doesn't mention ventilation and still focuses on hand-washing - that's still going on and matters far more titting about the definition of a scotch egg

I also wonder if about a public inquiry's report because I just think it's going to be complex and probably won't line up with opinions people (especially online) hold. In terms of the politics - from everything I've read Cummings was always the most aggressively pro-lockdown; or the fact in October (!) cabinet ministers and Treasury civil servants were taking the piss out of Hancock for thinking there'd be a vaccine before Q3 2021. I don't think that fits into the narrative around those individuals.

Similarly I remember the WHO and also UK scientists coming out really hard against masks as bad science - I don't know if they were trying to protect supply chains or just got it wrong but that seems to have been memory holed. I also remember them being very dismissive about border closures (and as with masks - I agreed with what they were saying) in the spring - looking back, especially looking at Australia, Japan, South Korea, Vietnam, Taiwan etc, we can see that border closures and quarantines are important and effective parts of fighting this but it's something we're still only just considering in Europe.

I also remember German commentators in the first wave saying how part of the reason Germany did so well was because their healthcare system has lots of parties (including the private sector) involved and is very decentralised, while in England we rapidly centralised testing and it was overwhelmed. It now feels like the same things that slightly undermined the health system in the UK in the first wave might actually be helping it delivering the vaccine, and vice versa for countries like Germany with decentralised delivery. I don't know what the lesson is there

I'm not sure that there'll be a simple narrative or simple fixes coming out of this - although I suspect Public Health England isn't fit for purpose

[Crazy_Ivan80]

According to my mom (who is a retiree from the pharmaceutical sector), Pfizer has a pretty terrible reputation in their sector because of their business practices. 

that's what we heard from friends working at the plant in Puurs (where Pfizer is located) and was one of the reasons why the wife decided against working there despite a successfull interview. And that was nearly a decade ago.

[Josquius]

I'm having flash backs to last summer as I keep checking exponential graphs.
This time they're a bit more positive though. The UK does seem to be picking up speed.

https://ourworldindata.org/covid-vaccinations

[Sheilbh]

On the soft triage point it's the last three charts here that I think of:


I'm not saying I'd expect ICU admissions to automatically track hospital admissions - but given how the deaths looks - I'd expect more of the over 75s and I suspect that's partly based on clinical decisions about who can handle ICU and ventilation etc. Again one for the public inquiry and there'll be some clinical judgement and there'll be some of the pressure on the NHS but I think there is an element of soft triage going on as well.

Unrelated but the last bar shows what a big difference there'll be in terms of the mortality of this disease within just two or three weeks if we can get the over 80s vaccinated (and then, obviously, the 70-somethings).

[Tamas]

On the soft triage point it's the last three charts here that I think of:


I'm not saying I'd expect ICU admissions to automatically track hospital admissions - but given how the deaths looks - I'd expect more of the over 75s and I suspect that's partly based on clinical decisions about who can handle ICU and ventilation etc. Again one for the public inquiry and there'll be some clinical judgement and there'll be some of the pressure on the NHS but I think there is an element of soft triage going on as well.

Unrelated but the last bar shows what a big difference there'll be in terms of the mortality of this disease within just two or three weeks if we can get the over 80s vaccinated (and then, obviously, the 70-somethings).

I am hoping what is showing on that chart is over-75s dying before ever getting to a hospital, because if the situation is such that a good number of over-75s do make it to the hospital but then there is not enough ICU beds for them, the public should be told. 

[Legbiter]

Similarly I remember the WHO and also UK scientists coming out really hard against masks as bad science - I don't know if they were trying to protect supply chains or just got it wrong but that seems to have been memory holed. I also remember them being very dismissive about border closures (and as with masks - I agreed with what they were saying) in the spring - looking back, especially looking at Australia, Japan, South Korea, Vietnam, Taiwan etc, we can see that border closures and quarantines are important and effective parts of fighting this but it's something we're still only just considering in Europe.

Yeah you're not alone I remember this well.

[Zoupa]

Yeah, if that was his argument and he would be correct. But he claimed that Tegnell's response was based on herd immunity. Herd immunity has been discussed and debated and talked about, but it was never the strategy of Tegnell. And that is something a professional ought to know.

You guys are so fucking thin-skinned 

[Tamas]

Similarly I remember the WHO and also UK scientists coming out really hard against masks as bad science - I don't know if they were trying to protect supply chains or just got it wrong but that seems to have been memory holed. I also remember them being very dismissive about border closures (and as with masks - I agreed with what they were saying) in the spring - looking back, especially looking at Australia, Japan, South Korea, Vietnam, Taiwan etc, we can see that border closures and quarantines are important and effective parts of fighting this but it's something we're still only just considering in Europe.

Yeah you're not alone I remember this well.

I am fairly certain they wanted to protect mask supplies for healthcare workers.

[Threviel]

Yeah, if that was his argument and he would be correct. But he claimed that Tegnell's response was based on herd immunity. Herd immunity has been discussed and debated and talked about, but it was never the strategy of Tegnell. And that is something a professional ought to know.

You guys are so fucking thin-skinned 

Yeah, I'm very tired of politicians and journalists driving Covid response. I'm also very tired of having whole nations policies run by people that shouldn't be allowed to run a kindergarten. I had hoped for change with Biden, but apparently the US cannot into covid response.

[mongers]

So what's the over/under on this virus having mutated to become More infectious?

[Sheilbh]

I am hoping what is showing on that chart is over-75s dying before ever getting to a hospital, because if the situation is such that a good number of over-75s do make it to the hospital but then there is not enough ICU beds for them, the public should be told.

Yes and that could be part of it - my suspicion is that it's less about the number of beds available than the approach being taken as to whether someone can deal with or survive going into the ICU. As I say I think there's a soft triage going on across the NHS where the people being put into ICU are those with the best chance of survival (which may be right and is influenced by resources).

I'm sure it's changed/been updated but I think a lot about the clinical decision support tool:


The NHS said at the time that it's a tool not a rule so it helps guide clinical decisions and doesn't need to be followed. I just wonder if this is a bit more rigid than elsewhere so over a certain age you're just far likely to get into ICU.

Edit: Also vaccination numbers still look good - can't see the weekend effect in today's numbers which is positive:

Just under 500k UK wide - something's going wrong in Scotland which is currently delivering fewer vaccines each day than Wales. Not sure what though.

Edit: Another example of the Treasury getting involved where they don't belong. On quarantine for people arriving in the county Hancock and Patel want this applied to everyone basically (not a huge surprise for Patel as she was keen on closing the border and quarantining foreigners before there was a pandemic). Sunak and Shapps want it applied selectively. Chances are the Treasury will win - because they normally do - and it won't work because you can't negotiate with a virus - it's a virus

[Maladict]

Riots in at least five cities, less than 24 hours since the 9pm curfew came into effect. 

[Tamas]

Sheilbh if they have free beds and don't even try saving over over-75s because "what's the point" that would be pretty damning. Also perhaps somebody then should try and get data on how many of the "what's the point" people are minorities.

[viper37]

My nephew tested negative