Coronavirus outbreak

[Wobblers]

In what way is UK strategy looking inept?

Every western country is adopting a herd immunity strategy in which a lot of people get infected and the immunity stops the spread. All that is differing is the methodology to achieve herd immunity

The present R0 is about 2.3 and this requires about 60% to become infected to stop it. This % is highly susceptible to the R0. Normal flu is 1.3 and that requires about 25% to stop it in its tracks.

Every western country is trying to reduce the R0.

FWIW I think that the current strategy is a good one. We will quarantine the elderly so they, in the main, don't get it. Everyone else MUST adopt measures to reduce the R0. The infection will pass through the younger and healthier. If we could get the R0 down to 1.3 then once about 25% are infected it will die out and all our at risk population is spared.

Hmmm. I understand the strategy, but I'm not convinced that it will work. In particular, I'm sceptical that it'll take the UK four weeks to reach the stage that Italy is. The current data (40% growth in infections per day) pretty much mirrors what Italy was two weeks ago. That suggests that we should be moving to banning large meetings and closing bars/restaurants etc sooner rather than later.

The government strategy is based on two assumptions. The first is that most transmissions occur when people are ill - hence the advice to self isolate when you've got a persistent cough or a fever. But we know that transmissions occur before symptoms appear: it's estimated that around 25% of all infections occur that way. Furthermore, at least half of those infected do not become ill - the assumption is that they are not infectious. At the moment, we don't know whether or not that is true.

The other assumption is based on the "ascertainment rate": that's the number of people who get the illness but never present to the medical authorities for one reason or other. For Covid-19, this is estimated to be between 75% to over 90% don't appear in the official figures - it is quite reasonable to assume that this is because they either have very mild symptoms or none at all. I've been spending some time this evening looking at he medical literature, most is suggesting that this number to be 90%.

Let's calculate some numbers, so we can have a stab at what's at stake here. First, the worst case scenario. Almost all people get infected, and the ascertainment ratio is low. So, 60 million infections, of which 15 million become noticeably ill. Of those, 5% will become critically ill. In this situation, the NHS will be overwhelmed, suggesting a case fatality rate of 4%. That's 600,000 people! This is roughly the same number of casualties you'd get if a sizable nuclear bomb was detonated over Sheffield (some of you who've been following the Threads of this post will understand why Sheffield...)

The better case: herd immunity at 40 million infections. 90% do not go on to develop significant symptoms. That's still 4 million infections, but the NHS is able to cope and the case fatality rate is 1%. Which is still 40,000 people.

I'm not sure what to make of this strategy, to be honest. 40 thousand people is still an awful high number. On the other hand, China's extreme lockdown has left almost all the population vulnerable to Covid-19. It will get reintroduced to China, probably sooner rather than later - and there's no guarantee that they'll be this lucky the next time.

It's a huge gamble we're taking. The scientific advisors assisting the government have better, and more, data than we do. I just hope they're right.

 

[RecordAceFromNew]

Hmmm. I understand the strategy, but I'm not convinced that it will work. In particular, I'm sceptical that it'll take the UK four weeks to reach the stage that Italy is. The current data (40% growth in infections per day) pretty much mirrors what Italy was two weeks ago. That suggests that we should be moving to banning large meetings and closing bars/restaurants etc sooner rather than later.

The government strategy is based on two assumptions. The first is that most transmissions occur when people are ill - hence the advice to self isolate when you've got a persistent cough or a fever. But we know that transmissions occur before symptoms appear: it's estimated that around 25% of all infections occur that way. Furthermore, at least half of those infected do not become ill - the assumption is that they are not infectious. At the moment, we don't know whether or not that is true.

The other assumption is based on the "ascertainment rate": that's the number of people who get the illness but never present to the medical authorities for one reason or other. For Covid-19, this is estimated to be between 75% to over 90% don't appear in the official figures - it is quite reasonable to assume that this is because they either have very mild symptoms or none at all. I've been spending some time this evening looking at he medical literature, most is suggesting that this number to be 90%.

Let's calculate some numbers, so we can have a stab at what's at stake here. First, the worst case scenario. Almost all people get infected, and the ascertainment ratio is low. So, 60 million infections, of which 15 million become noticeably ill. Of those, 5% will become critically ill. In this situation, the NHS will be overwhelmed, suggesting a case fatality rate of 4%. That's 600,000 people! This is roughly the same number of casualties you'd get if a sizable nuclear bomb was detonated over Sheffield (some of you who've been following the Threads of this post will understand why Sheffield...)

The better case: herd immunity at 40 million infections. 90% do not go on to develop significant symptoms. That's still 4 million infections, but the NHS is able to cope and the case fatality rate is 1%. Which is still 40,000 people.

I'm not sure what to make of this strategy, to be honest. 40 thousand people is still an awful high number. On the other hand, China's extreme lockdown has left almost all the population vulnerable to Covid-19. It will get reintroduced to China, probably sooner rather than later - and there's no guarantee that they'll be this lucky the next time.

It's a huge gamble we're taking. The scientific advisors assisting the government have better, and more, data than we do. I just hope they're right.

I like the way you paint and contrast the two scenarios. Good work!

I understand the 600,000 fatality case, but less so with the other.

Since we all happily have similar population for ease of comparison, knowing hospitals in Hubei were and now Italy are on their knees with X0,000 infected over a period of a couple of months, what do you think is the likelihood that our precious nhs might "cope", achieving 1% fatality, with 40,000,000 infected even if spread over twice/thrice/N times as long, when we are talking about some 1000 times more infected?

 

[DCLane]

@McWobble - your numbers consider the population as a whole, but we know that it's mostly age 70+ and immunosupressed that subsequently die.

The plan is to 'hide' them away, which means the general death rate is likely to be much lower; i.e. let everyone else get it, recover and then let the 'hidden' come out.

 

[nickyboy]

@McWobble I think the other consideration is whether other steps that will be taken will reduce the R0 sufficiently to make a dent in the numbers. Closing bars and restaurants for example, more social distancing.

What I don't understand is what is Spain and Italy's strategy? Are they hoping a lockdown stops transmission so most of the population never catch the virus or do they expect many millions to catch it and the lockdowns are a tool to flatten the curve and reduce the R0

Like you I would be concerned with a strategy to stop it in its tracks like China. We are at least 12 months from a vaccine. Can countries with high freedom of movement maintain a lockdown or semi lockdown for a year?

 

[oldfatfool]

Absolutely disgusted with this country, sons fiancee is 23 so only young but she has a heart condition and has had minor heart attacks in the past. She has developed a sore throat, tightness I the chest and a fever, rung 111 and her own gp and told to self isolate, they will test her in a week if she is no better. One way of keeping the case numbers down!! Son is also having to self isolating when he should have been starting a new job today (just his luck). Why the fiddly fark arent they testing her when she is in a high risk group! Oh that's right she is not over 60

 

[marinyork]

What I don't understand is what is Spain and Italy's strategy? Are they hoping a lockdown stops transmission so most of the population never catch the virus or do they expect many millions to catch it and the lockdowns are a tool to flatten the curve and reduce the R0

Like you I would be concerned with a strategy to stop it in its tracks like China. We are at least 12 months from a vaccine. Can countries with high freedom of movement maintain a lockdown or semi lockdown for a year?

Sigh. Right, ignore what your mate has told you in alicante for a second this time.

Italy has had three lockdowns. They also had a fourth major set of changes after the third lockdown wasn't working fully. The first two lockdowns didn't work. It was widely flouted. Additionally after the national lockdown further measures - basically nearly everything closed was implemented. Apart from that schools and universities were also closed before lockdown 2 and 3.

The only difference between countries is Italy did it first and deaths have continued to rise, so other populations may take it more seriously more quickly. Many won't hold out much hope on that.

 

[glasgowcyclist]

@McWobble - your numbers consider the population as a whole, but we know that it's mostly age 70+ and immunosupressed that subsequently die.

The plan is to 'hide' them away, which means the general death rate is likely to be much lower; i.e. let everyone else get it, recover and then let the 'hidden' come out.

I've read of the plan to ask those over 70 to self-isolate but I haven't seen what the government wants to do about those of us with conditions that make this virus a more serious threat to life. As my wife and I fall into the latter category I do try to keep up to date, do you have any link to the government's advice about this?

 

[deptfordmarmoset]

I don't seem to have seen this online here: French authorities have counselled against taking Ibuprofen if anyone's self-isolating because of COVID-19 symptoms. They believe it has led to respiratory complications.

There also appears to be a danger from ACE-inhibitors, such as Ramipril, but I think that has been mentioned upthread. Current advice is to continue taking them unless advised to the contrary.

 

[nickyboy]

Sigh. Right, ignore what your mate has told you in alicante for a second this time.

Italy has had three lockdowns. They also had a fourth major set of changes after the third lockdown wasn't working fully. The first two lockdowns didn't work. It was widely flouted. Additionally after the national lockdown further measures - basically nearly everything closed was implemented. Apart from that schools and universities were also closed before lockdown 2 and 3.

The only difference between countries is Italy did it first and deaths have continued to rise, so other populations may take it more seriously more quickly. Many won't hold out much hope on that.

I'm not sure what you're referring to regarding any friends I have in Spain, this is a general question unrelated to any cycling conversations I had with them

So do you think that Italy is expecting that its lockdown strategy will result in most of the population never contracting the virus? Or do you think they expect that most will contract it and these steps are to flatten the curve and reduce the R0?

Genuine question as I don't know the answer. If they are expecting most to become infected then it's like the UK strategy but a different route. If they expect most not to become infected then it's different from the UK strategy

 

[mjr]

I've read of the plan to ask those over 70 to self-isolate but I haven't seen what the government wants to do about those of us with conditions that make this virus a more serious threat to life. As my wife and I fall into the latter category I do try to keep up to date, do you have any link to the government's advice about this?

There's naff all on https://www.gov.uk/government/topical-events/coronavirus-covid-19-uk-government-response AFAICT. This seems unhelpful. Maybe you could email them a wake-up?

 

[cookiemonster]

All these EU nations now controlling their borders to contain the virus. Weren’t we told for several years that we needed to leave the EU to do this?

 

[PK99]

IThere also appears to be a danger from ACE-inhibitors, such as Ramipril, but I think that has been mentioned upthread. Current advice is to continue taking them unless advised to the contrary.

I take Ramipril so have an active interest in this.

Because of the social media-related amplification, patients taking these drugs for their high blood pressure and their doctors have become increasingly concerned, and, in some cases, have stopped taking their ACE-I or ARB medications.

This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it. Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans.

The Council on Hypertension of the European Society of Cardiology wish to highlight the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak.

The Council on Hypertension strongly recommends that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the Covid-19 infection.

https://www.escardio.org/Councils/C...cil-on-hypertension-on-ace-inhibitors-and-ang

 

[deptfordmarmoset]

I take Ramipril so have an active interest in this.

Because of the social media-related amplification, patients taking these drugs for their high blood pressure and their doctors have become increasingly concerned, and, in some cases, have stopped taking their ACE-I or ARB medications.

This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it. Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans.

The Council on Hypertension of the European Society of Cardiology wish to highlight the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak.

The Council on Hypertension strongly recommends that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the Covid-19 infection.

https://www.escardio.org/Councils/C...cil-on-hypertension-on-ace-inhibitors-and-ang

I also take Ramipril, in fact I'll be off to the pharmacy today to pick up my next 3 months' worth. I'm not planning to stop without medical advice.

 

[snorri]

I've read of the plan to ask those over 70 to self-isolate but I haven't seen what the government wants to do about those of us with conditions that make this virus a more serious threat to life. As my wife and I fall into the latter category I do try to keep up to date, do you have any link to the government's advice about this?

I have no faith in any of the sound bites from random people at Westminster whose honesty has been brought in to question on so many topics in past months. Instead I'm placing my faith in the words of Jason Leitch, National Clinical Director who speaks clearly and confidently and is medically qualified. There is new stuff coming up all the time from BBC Scotland on it's own website and via Twitter. Here's a link from yesterday. https://www.bbc.co.uk/news/uk-scotland-51898288

There is not a UK nationwide policy as this extract of a report in The Telegraph makes clear, so utterings from Westmister may not apply throughout the UK.........
"People aged over 70 face up to four months in self-isolation and the public risk being taken into custody or being given a £1,000 fine if they refuse to be tested or quarantined for suspected coronavirus.
The emergency powers, expected to be announced this week, allow police in England and Wales to use "reasonable force" to detain people who are at risk of infecting others."

 

[Pale Rider]

I have no faith in any of the sound bites from random people at Westminster

Looks like we are to get a daily dose of Boris - and others.

I can't see it becoming required viewing, but I will have a look see at the first one and occasionally thereafter.

https://www.bbc.co.uk/news/uk-51901818